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

A flat pillow can suit you if you have neck pain, but it isn't a one-size-fits-all solution. What matters isn't whether a pillow is flat or high, but whether it suits 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 assessed 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 thinking 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 long. If you wake up with a stiff neck, it's easy to conclude: less pillow, less problem.

That's sometimes 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 doesn't line up with the rest of the spine.

Our inventor, Thijs van der Hilst, was a physiotherapist who specialised in neck and shoulder complaints. He couldn't 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's how Pillowise came about.

When can a flat pillow suit you?

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

• Sleeping position: Back sleepers usually need less height than side sleepers. With stomach sleepers, the head is turned to the side, and a high pillow then overextends the neck. You'll 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. To see what this looks like for side sleepers, read 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 if 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.
• During the night you stuff your arm under the pillow 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 Is your pillow too high or too low? How to tell.

Which body measurements determine the right height?

Pillowise uses three measuring points. Everyone's values are different 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 pillow height.

How does Pillowise work out the right size?

1. Take three measurements. You can have them measured at a Pillowise stockist using the Pillowise tape measure. Or you can work out 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 warranty, and you'll find the terms on our page about it. We've described what makes memory foam special under memory foam pillows. For an overview of the pillow itself, see Your perfect pillow size.

The measurement can confirm that you need a low pillow. But it can also show that you've been missing height until now. Either is a useful result, because afterwards you know where you stand.

What can the right 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's a good starting point for a restful night.

It is not a cure. Neck pain can have many causes, and a pillow doesn't treat any of them. Have your symptoms assessed by a doctor if they last a long time, radiate 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 during the night because of the pain. You'll find general information on the topic under Which pillow for neck pain?.

Should I just try a flatter pillow?

You can, but it remains guesswork. If you sleep worse after switching, you won't know whether the height, the material or getting used to it is the reason. Your body also sometimes needs a few nights to get used to new support. That makes it even harder to judge. A measurement takes away some of this uncertainty, because it starts from your measurements and not from a 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's often too low. If you wake up in the morning without discomfort and sleep well, you don't need to change anything. If you've already tried several pillows and aren't sure, a measurement is worthwhile. If you have ongoing neck pain, a medical assessment should come first.

Find your size

Get measured at a Pillowise stockist near you, or work out your size yourself with PillowScan.

Work out your size yourself | Find a stockist

Do you work as a professional and want to offer Pillowise? You'll find information for partners under Become a Pillowise partner.

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