How a simple change to your pillow height reduces morning neck stiffness, according to osteopaths

Sophie Bennett • December 10, 2025 16:45

The first time you wake up with that sharp, “can’t-look-over-my-shoulder” neck, you blame the way you slept. The second time, you blame your laptop, your mattress, your age. By the end of the week, you are rolling your shoulders over your morning coffee, feeling older than the date on your birthday card suggests, and telling yourself this is just what mornings are like now.

Then, almost by accident, you sleep at a friend’s house or in a hotel, on a completely different pillow. You wake up, turn your head, and realise there is no familiar tug of stiffness. The only real difference? The height under your head.

According to many osteopaths, that small change is not a coincidence. It is biomechanics.

The neck ache you keep writing off as “just sleeping funny”

We tend to treat morning neck stiffness as background noise. A bit of ache that fades after a hot shower. Something you put down to stress, too much driving, or scrolling in bed. It rarely feels serious enough to call a doctor, but it is annoying enough to colour your whole morning.

Osteopaths see a different pattern. A lot of the people who turn up on their treatment tables with recurring morning pain have one simple thing in common: their neck is being held at an awkward angle, for hours, every single night. Not by some dramatic injury. Just by a pillow that is the wrong height for their body and sleeping position.

When you add up those hours, the picture changes. Eight hours a night is around 2,900 hours a year. That is a lot of time to ask your neck to tolerate a position it quietly hates.

What osteopaths actually mean by “pillow height”

“Pillow height” is not the number printed on the packaging. Osteopaths talk about it as the distance between your head and the mattress once your weight has actually sunk into the pillow.

Two pillows stacked up can end up lower than one firm pillow, depending on how soft they are. A big, bouncy pillow can look tall, then collapse flat by 3 a.m. The relevant question is: where does your head end up, not what you started with.

From an osteopathic point of view, a good pillow height does one job: it keeps your neck in a neutral, fairly straight line with the rest of your spine.

On your back, that means your chin is neither tipped towards your chest nor lifted to the ceiling.
On your side, it means your nose, breastbone and belly button line up in one plane, instead of your head drooping towards the mattress or being propped up towards the ceiling.

Anything that pulls you away from that “neutral” is asking your muscles and joints to work all night.

How the wrong height winds your neck up overnight

When your pillow is too high, your neck bends forward (on your back) or side-bends (on your side). Osteopaths often see:

Tightness in the muscles at the back and side of the neck as they work to hold your head up.
Pinching around the facet joints (the small joints between the vertebrae).
A subtle closing-down of the spaces where nerves exit the spine, which can contribute to tingling or ache into the shoulders.

When your pillow is too low, the opposite happens:

Your head tips backwards on your back, compressing the joints at the back of the neck.
On your side, your head drops towards the mattress, stretching the muscles and ligaments on one side and scrunching the other.

Neither version usually causes instant, dramatic pain. Instead, your neck muscles sit in a low-level, static contraction for hours. Blood flow is a bit reduced; joints are slightly compressed or stretched for longer than they like. By morning, you feel it as stiffness, not because anything “snapped” but because nothing got to fully relax.

That is why so many people say: “I’m fine by mid-morning once I’ve loosened up.” As you move, blood flow improves, muscles warm, and the annoyed joints start to glide again.

Quick clues your pillow height is wrong

You do not need an X-ray to suspect your pillow is part of the story. Osteopaths often listen for the same small clues in people’s habits:

You punch, fold or bunch your pillow into a lump under your neck every night.
You regularly wake with:
- Stiffness turning your head to check your blind spot.
- A heavy feeling at the base of the skull.
- Ache across the tops of your shoulders.
You feel better after a night away with a different pillow, or worse after a hotel pillow that is huge and puffy.
You wake with your arm under your head because you are subconsciously trying to “add height”.
Your pillow looks fine, but if you press the centre and let go, it stays squashed instead of springing back.

If two or three of these sound familiar, it is worth experimenting before you resign yourself to “bad neck days”.

Finding your neutral: simple tests you can do in bed

Osteopaths use hands-on assessment, but there are a few at-home checks that get surprisingly close.

For back sleepers

Lie on your back in your usual sleeping position with your normal pillow set-up.

Place one hand gently under your neck. You should feel a soft curve, not a big gap and not a hard, forced bend.
Imagine someone looking at you from the side:
- If your chin is noticeably nearer your chest than in standing, your pillow is probably too high.
- If your chin is pointed slightly up, and your throat feels stretched, your pillow is likely too low.

You are aiming for your face to feel as though it would if you were staring straight ahead, standing tall, against a wall.

For side sleepers

This is where height matters most, because your pillow needs to fill the distance from your ear to the outer point of your shoulder.

Lie on your side in your usual position.
Ask someone to take a photo from behind you at mattress level, or use the selfie camera propped on a chair.
Draw an imaginary straight line from the middle of the back of your head down your spine.

If that line slopes towards the mattress, your pillow is too low. If it slopes towards the ceiling, your pillow is too high.

A quick position guide

Sleep position	Pillow goal	Simple cue
Back	Support the natural neck curve without pushing head forward	Chin neither tucked nor lifted
Side	Fill the gap between ear and shoulder	Nose in line with sternum and belly button
Front (stomach)	Ideally: phase out	If you must, use the thinnest pillow possible

Front sleeping is the hardest on your neck, as it forces a twist to one side. Osteopaths consistently report less morning stiffness when people gradually move towards side or back sleeping, often starting by using a body pillow to stop rolling fully onto the stomach.

The tiny changes that make a big difference

You do not have to buy an expensive “orthopaedic” pillow to test this theory. Many osteopaths start with very simple height tweaks and see what happens over 7–10 nights.

If your pillow is likely too high

Ditch the double stack. Try one medium pillow instead of two squashed ones.
Use a towel, not another pillow. Place a folded hand towel inside the pillowcase to fine-tune height by small steps, rather than whole-pillow jumps.
Check where your shoulders are. Make sure your shoulders stay on the mattress, not on the pillow. If your shoulders are on the pillow, it effectively raises the height under your neck.

If your pillow is likely too low

Add slim support, not a second big pillow. Slide a neatly folded towel underneath your existing pillow, near the edge where your neck lies. Adjust fold thickness until your head feels level.
Choose depth that matches your build. Broader shoulders generally need a higher pillow on your side than narrower ones.
Consider an adjustable pillow. Some pillows let you remove or add filling. Osteopaths like these because you can change height in small increments rather than gambling on a fixed model.

For both

Replace very old pillows. Most lose support long before we admit it. If it folds in half and stays there, it is giving your neck almost nothing.
Give each change a fair trial. It can take several nights for your neck to stop bracing in its old habits. Note how you feel across a week, not just one night.

What improvement should actually feel like

When you land on the right height, the change is often modest, not miraculous. Osteopaths describe people reporting:

Less “locking” feeling turning the head first thing.
Morning ache that fades in minutes rather than hanging around till lunchtime.
Fewer nights of waking to stretch or flip the pillow.
Less need to “crack” the neck or shoulders to get comfortable.

Neck issues are rarely only about pillows. Desk set-up, stress, past injuries and general strength all play a part. But for a lot of people, tweaking pillow height takes the nightly aggravation out of the system, so everything else has a chance to settle.

When it is more than just your pillow

There are times when neck stiffness is a signal to get proper medical advice, not just a new pillow.

Osteopaths and GPs would usually want to see you promptly if you notice:

Severe pain that does not ease with simple movement or over-the-counter pain relief.
Weakness, clumsiness or heaviness in your arms or hands.
Pain, tingling or numbness that shoots down into your shoulder blade, arm or fingers.
Unexplained weight loss, fever, or feeling very unwell alongside neck pain.
Recent significant trauma, such as a fall, collision or whiplash.

In those cases, treat pillow adjustment as supportive, not as your main plan. An assessment can rule out more serious problems and give you tailored exercises or treatment.

Building a neck-friendly sleep set-up

Think of your pillow as one piece of a simple three-part system:

Mattress: Too soft and your shoulder sinks deep while your head stays high; too firm and your shoulder cannot sink enough, pushing the neck sideways.
Pillow height: Fine-tunes where your head and neck land relative to your spine.
Day posture and movement: Strength in your upper back and shoulders helps your neck tolerate more without complaint.

You do not need perfection in all three to feel better. Often, a small win in one area – like correcting pillow height – tips the balance from “irritated every night” to “mostly comfortable, most of the time”.

FAQ:

Is it better to sleep with one pillow or two? The number does not matter; the resulting height does. Many people find that one medium-support pillow plus, if needed, a thin folded towel gives a better neck position than two soft pillows that squash flat or push the head too high.

Do I need a special orthopaedic or contour pillow? Not necessarily. Some people love them, especially side sleepers with a pronounced neck curve, but plenty do well with a straightforward, good-quality pillow adjusted to the right height. The key test is whether your neck looks and feels neutral in your main sleep position.

How often should I replace my pillow? As a rough guide, every 1–2 years for synthetic pillows and a little longer for good-quality feather or latex. If it is lumpy, stained, or stays folded when you bend it, it is time. Loss of support matters more than age on the label.

What if my partner needs a different pillow height? That is normal. Shoulder width, neck length and sleep position all differ. Treat pillows as individual kit, like shoes, not something that has to match across the bed.

Can changing my pillow cure headaches as well as neck stiffness? For some people whose headaches are linked to neck tension, better night-time alignment does ease symptoms. But headaches can have many causes, so if they are new, severe, or changing, speak to a healthcare professional rather than relying only on bedding fixes.