Flat Pillow for Neck Pain: When It Suits You and When It Doesn't

A flat pillow can suit you if you have neck pain, but it is not a universal solution. What matters is not whether a pillow is flat or high, but whether it fits your body. Shoulder width, neck circumference and neck length all play a part, as do your sleeping position and your mattress. You should also have neck pain checked by a doctor. A pillow is no substitute for that.

Why do people so often say a flat pillow is good for the neck?

The reasoning behind it is understandable. A very high pillow pushes the head forward, the chin moves towards the chest, and the neck muscles work all night. If you wake up with a stiff neck, it is easy to think: less pillow, less problem.

Sometimes that is true, but not always. A pillow that is too low has the same problem in the opposite direction: the head sinks down, and the cervical spine does not line up straight with the rest of the spine.

Our inventor, Thijs van der Hilst, was a physiotherapist who specialised in neck and shoulder complaints. He could not recommend a suitable pillow to his patients with neck complaints, because there was no method for working out the right height. So he developed one himself: three measurements that point to the right pillow. That is how Pillowise came about.

When can a flat pillow suit you?

A low pillow can suit you if there is only a small gap to bridge between your head and the mattress. That depends on three things:

• Sleeping position: Back sleepers usually need less height than side sleepers. Stomach sleepers have their head turned to one side, and a high pillow then overextends the neck. You can find more under Pillows for back sleepers and Pillows for stomach sleepers.
• Mattress: On a soft mattress, your shoulders and hips sink in. This means you need less pillow height than on a firm one.
• Body measurements: If you have narrow shoulders and a short neck, you generally need less height than someone with broad shoulders and a long neck.

So flat is right when your body genuinely calls for little height, not because flat is healthier as a rule.

When is a flat pillow too low?

Mainly when you sleep on your side. In that position, your shoulder creates a large gap between your head and the mattress. If the pillow is too flat, your head hangs down and your cervical spine bends sideways. Broad shoulders and a firm mattress make this effect stronger. You can read what this looks like for side sleepers under The right pillow for side sleepers.

For side sleepers, a flat pillow is therefore more often too low than too high.

How can I tell whether my pillow is too high or too low?

There are clues, but no sure proof. Look out for the following:

• You wake up in the morning with a stiff neck that eases during the day.
• You tuck your arm under the pillow at night or fold the pillow over.
• Your head visibly sinks into the pillow or is pushed upwards.

Signs like these can point to a height that doesn't suit you. But they can also have other causes. For a more detailed overview, see our article Pillow too high or too low? How to tell.

Which body measurements determine the right height?

With Pillowise, three measuring points count. Everyone has different values here, which is exactly why the height is hard to guess.

Then there are your sleeping position (back, side, stomach) and your mattress (soft, medium, firm). Only all five details together tell you anything about the right height. We also describe how to approach the right height in general under Calculating your pillow height.

How does Pillowise determine the right size?

1. Take three measurements. You can have them measured at a Pillowise stockist with the Pillowise tape measure. Or you can find your size yourself with PillowScan at scan.pillowise.com, on your phone or via a QR code.
2. Enter your sleeping position and mattress. Back, side or stomach, plus soft, medium or firm.
3. Get your size. An algorithm uses your details to choose the best-fitting pillow from the six sizes. Each size has its own colour: pink, orange, green, blue, red or purple.

The pillow measures 55 x 35 cm and has a core made of 100% memory foam, manufactured in the Netherlands. The cover has a moisture-regulating Tencel top and is washable at 40 °C. The materials are certified to STANDARD 100 by OEKO-TEX. Every Pillowise pillow comes with a 5-year guarantee; you can find the terms on our guarantee page. We have described what makes memory foam what it is under Memory foam pillows. For an overview of the pillow itself, see Your perfect pillow size.

The measurement may confirm that you need a low pillow. But it may also show that you have been lacking height. Either is a useful result, because afterwards you know where you stand.

What can a suitable pillow do, and what can't it do?

A pillow at the right height helps keep your head and cervical spine in line and gives your shoulder room. That is a good basis for a restful night.

It is not a cure. Neck pain can have many causes, and a pillow does not treat any of them. Have your symptoms checked by a doctor if they last a long time, spread into your arms or hands, come with numbness, dizziness or headaches, or appear after a fall or accident. The same applies if you regularly wake up at night because of the pain. You can find general information on the subject under Which pillow for neck pain?.

Should I just try a flatter pillow?

You can, but it remains guesswork. If you sleep worse after the change, you won't know whether the height, the material or simply getting used to it is the reason. Your body also sometimes needs a few nights to get used to new support, which makes it even harder to judge. A measurement takes away some of that uncertainty, because it starts from your measurements and not from gut feeling.

So: do I need a flat pillow?

That depends on your body, not on the label. A low pillow often suits back and stomach sleepers, narrow shoulders and soft mattresses. For side sleepers with broad shoulders, it is often too low. If you wake up without complaints in the morning and sleep well, you don't need to change anything. If you have already tried several pillows and are unsure, a measurement is worthwhile. If you have ongoing neck pain, a medical check-up comes first.

Find your size

Have yourself measured at a Pillowise stockist near you, or find your size yourself with PillowScan.

Find your size yourself | Find a stockist

Do you work as a professional and would like to offer Pillowise? You can find information for partners under Become a Pillowise partner.

Thijs van der Hilst, physiotherapist (non-practising)
Inventor of Pillowise