Waking up with serious neck pain is definitely not the way anyone wants to start their day. When it happens frequently, we often troubleshoot the issue on our own, alternating between firm, soft and in-between pillows for relief. The problem is that neck pain can be very complex, both in cause and treatment, so what works for you one night might totally backfire the next.
"If this is the case, you should probably start exploring new pillows and possibly mattress options," Dr. Robert Koser, a chiropractic physician at Laser Spine Institute, says in an email interview. "If you find the issues are more with the neck, then it very well may only be the pillow you need to switch out. However, if you're finding yourself waking up with neck and back issues, it might be time to change out both."
In fact, all the nightly pillow-swapping might actually be exacerbating the problem. "Rather than change pillows periodically, I recommend using a pillow that supports you properly and change your body position for comfort," says Griffin, Georgia-based chiropractor Dr. Robert A. Hayden, spokesman for the American Chiropractic Association in an email.
There's some bad news for devoted stomach-sleepers, though. The ideal body position that he and other experts suggest is on the back or side. In fact, stomach-sleeping is one of the worst things a person with neck pain can do. "If you sleep on the belly you have to turn the neck all the way to one or other side, which in a patient with neck pain will aggravate it," physiatrist Dr. C. R. Sridhara from Moss Rehab in Philadelphia explains in an email.
Switching sleep positions sooner rather than later is advised. "Stomach sleeping is a recipe for degenerative joint disease," Hayden says, adding, "If you sleep on your stomach, you must turn your head. That means the weight of the head, somewhere between 12 and 15 pounds, is pulling on the joints in your neck and twisting them while you sleep. Eventually, disc disease and bone spurs are in your future."
So, now you know to sleep on your back or side. Just doing that will probably not relieve your chronic neck pain, though, if your pillow is ill-suited for you. The pillow that works for one person might not for the next, however, thanks to our individual body types. "When finding the right kind of pillow, it is very important to find one that supports your head and neck in a neutral position when lying on both your back and side," Koser explains. "If you find your head is flexed up too high or extended back too far into your pillow when lying on your back, it's time to ditch these pillows and find a new one." Same goes for side-sleepers. You should also change your pillow if your head sinks in or raises up too high. Koser says he typically recommends memory foam or down/gel pillows that are slightly firm.
If you love your pillow or can't afford a pricier model, Sridhara suggests a helpful hack where the patient uses a towel roll placed in the front end of the pillow case to support the curvature of the spine between the head and trunk. "One reason I ask the patients to use the towel roll is that each person's curvature is different and may need different height. One will have different thickness towels at home and they can experiment to get the best height for comfort," he explains, noting that a pillow manufactured with curvature is a fixed height, so the support cannot be varied if necessary.
Hayden specifically counsels patients to become side-lying sleepers, a position that is best served with two pillows. "The one under the head should be just the right height to keep the head level with the center of the body while lying on either side. It should be firm so that the head does not sag during the night, which would cause stress points in the neck, resulting in neck pain or headache the next day," he says. "The other pillow is a body pillow, one of those long ones that you can snuggle against while lying on your side. The upper arm and upper knee should be supported by the body pillow to keep the rest of your spine aligned while you are sleeping. This prevents a torquing effect on spinal joints while you rest."
It's important to note that occasionally, more serious causes of pain are at play. "Neck pain could be due to arthritis, disc pathology, spinal stenosis or plain muscle spasm," Sridhara notes. "A pillow may or may not help in situations where there are nerve issues such as with numbness or weakness in the hand or arm." So, if you've tried some of the simple fixes with little to no change, it's probably time to consult a professional.