Weekly Newsletter:

December 10, 2025

Please note: This discussion does not address pulmonary and/or circulatory issues that may require lifting the head of the bed or other similar bed adjustments—an entirely different discussion!

 Starting with the neck:

Different sleeping positions—on your back, on your side, or on your stomach.

MOST BASIC PRINCIPLE HERE: SUPPORT THE HEAD AND NECK IN GOOD ALIGNMENT.

Choose a pillow that supports your sleeping position. When a pillow (under your head) fits properly, it fills in the space between your neck and the bed so your spine stays aligned. 

 Anatomically speaking… 

Neck or cervical alignment (or posture)

Here’s a graphic of the neck vertebrae looking from the front 

to back.



Good neck alignment: The neck vertebrae are aligned directly on top of each other. Obviously the neck can and does change positions while positioning your head for different situations. You may cock your head to the side to perhaps get a different viewpoint. And of course, you may rotate your head to see what’s coming up behind or next to you—without turning your whole body around. Or tilt your head forward or back to look up or down!

Also, here’s a graphic of neck vertebrae looking from the side. 

You can see there is a gentle curve here.

Sleeping on your back:  

Assuming your neck is comfortable in a normal alignment, there will be a space between the back of your neck and the bed. You want your pillow to fill that space with a soft, gentle support. Looking at the graphic below, note the dotted red line. In this graphic the dotted red line is nice and straight. The pillow shown here is supporting the normal neck curve as well as providing a nice and soft support under the head.

Now look at the graphic below here. The pillow is too thick, causing the neck to bend forward. Not a good position for your neck in most cases! Note the dotted red line here. For most people this will result in stiffness and discomfort by the time they wake up. (Or sooner or later…)

If your neck does not comfortably align straight up and down, the pillow or pillows need to support the range you have. For example—perhaps you have been sleeping on your back with several pillows under your head for a long time—while on your back. That will likely result, over time, in a loss of the full upright alignment. Also known as a forward head posture.

Without too much discussion, here, about how that might not work as well for comfortable and full neck movement… 

One can gradually restore a more functional neck alignment by little by little lowering the pillow pile under your head. Remove one pillow at a time if you have a pile of pillows under your head. And/or get thinner pillows or more squashable pillows—that flatten out as you lay your head down.

Example would be a down pillow or “alternative” down pillow. There are many different types out there, called “alternative down pillows.”

Down vs Down Alternative Pillow: Which Is Best?

When choosing between down and down alternative pillows, 

consider the following factors:

• Comfort: Down pillows offer a plush and fluffy feel, while down alternative-pillows provide a firmer support.
• Temperature Regulation: Down alternative pillows tend to disperse heat better making them suitable for hot sleepers.
• Maintenance: Down alternative pillows are generally easier to maintain & require less frequent replacement.
• Cost: Down alternative pillows are usually less expensive than down pillows.
• Durability: Down pillows are more durable and can last longer, but they require  more maintenance.
• Allergy Relief: Down alternative pillows are hypoallergenic and often machine-washable, making them a better choice for allergy sufferers.

Ultimately, the best choice depends on personal comfort preferences, sleep position & environmental considerations. 

Sleeping on your side:

Good positioning 

The same principles apply here. While sleeping or resting in a side-lying position, the pillow needs to fill the space between the head and the bed, keeping the alignment of the neck and back to make a nice straight line. (Note the red dotted line in the graphic above.) An important reminder—pillows can really help get a good night's sleep. However, this is not meant to replace or substitute in any way for professional assessment of joint pain or significant sleep problems. Especially if it comes on suddenly or is worsening quickly.

Not so good positioning  

Now in the this graphic the dotted red line is not straight. The “dysfunctional” curve here is partly in the neck and partly in the upper back. The vertebrae of the spine should be straight for the best back support while sleeping. The pillow under the head should basically just support the head in straight alignment. The pillow shown here is clearly too high.

Sleeping on your stomach:

When you sleep on your stomach, your spine, head, and neck are already aligned, so a very flat pillow or no pillow at all will feel most comfortable.  

Clearly, sleeping on your stomach forces you to turn your head to the side, which could cause it to feel pretty uncomfortable by morning. Obviously the head position is the first challenge to consider. (Most folks cannot rest on their stomach without their head turned to the side. In other words—face down on pillow or bed doesn’t work well!)

Putting a pillow under your stomach and hips will help keep your lower back aligned and more comfortable. This allows the neck to be rotated to one side to a lesser degree.

Please note this discussion is not meant to address neck pain.

It’s meant to help prevent neck pain and maintain good neck function!

Body pillows: Can be helpful supporting shoulders, hips, back, and neck in aligned and comfortable positions. A quick note on body pillows, which I personally love…

Sleeping with body pillow:

Body pillows are a great way for side sleepers to get a good night’s sleep and feel comfortable while they do so! They are excellent items for anyone who has trouble sleeping on their side and back, has lower back issues, or has hip or shoulder pain or for women who are pregnant.

Nowadays there are a plethora of body pillows as well as neck pillows. Some of the same principles apply here as discussed in the discussion of good neck support above. Keeping good body alignment.

Example: to keep the hips comfortable in side-lying for many people, having a pillow between the legs while lying on your side allows for the most comfortable hip positioning. However, for discomfort in the hip related to bursitis, it’s best to have the painful leg on the top.  

Body pillows can be used to support the shoulders, hips, back, and neck in gently aligned positions that are relatively easy to change throughout the night.  

If you click the link below here, you can see there are many different types and shapes of body pillows these days.  

• https://www.wikihow.com/Sleep-with-a-Body-Pillow

Here’s another way to understand comfortable body positioning for the hip or shoulder joint. It’s called the “open pack versus closed pack” position. Open-pack and closed pack positions refer to the stability and mobility of joints, with open pack allowing for greater movement and closed pack, providing maximum stability. In simpler terms, while resting, the open-pack position allows the most space in the joint. So the hip joint is most “open” and comfortable when the leg is somewhat flexed and rotated outward. A pillow between the knees in side lying helps relax the top leg in this open-pack position.

An important reminder—pillows can really help get a good night's sleep. However, this is not meant to replace or substitute in any way for professional assessment of joint pain or significant sleep problems. Especially if it comes on suddenly or is worsening quickly.

— Susan Musicant, DPT

Injury Prevention Specialist at DayBreak

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