A pillow that is too high forces the delicate structures of the neck into an unnatural position, disrupting the body’s natural resting posture. The purpose of a pillow is to support the head and neck in a neutral alignment, maintaining the gentle curve of the cervical spine as when a person is standing. When a pillow is excessively lofty, it pushes the head forward and upward, causing the cervical spine to go into excessive flexion. This sustained, unnatural angle during sleep can lead to physical issues that extend beyond simple discomfort.
Localized Pain and Muscle Strain
A pillow that is too high forces the head into a forward-flexed posture, introducing constant strain on the supporting muscles. This excessive flexion increases pressure on the cranio-cervical region and alters cervical spine alignment. This biomechanical stress results in muscle tension that manifests as stiffness upon waking.
The upper trapezius and levator scapulae muscles, which connect the neck to the shoulders, work overtime trying to stabilize the head against the pillow’s height. This sustained muscle contraction can lead to localized pain and stiffness, sometimes contributing to acute torticollis, or a wry neck. The tension can also trigger referred pain, known as a cervicogenic headache.
Cervicogenic headaches originate from the joints and soft tissues in the neck, with pain radiating up the back of the head, sometimes behind the eyes. For side sleepers, a pillow that is too high can also lead to shoulder impingement as the head is propped up, restricting the natural resting position of the shoulder joint.
Disruption of Breathing and Sleep Quality
An overly high pillow negatively impacts the efficiency of breathing during sleep. When the neck is forced into a flexed, chin-to-chest position, the mechanical action reduces the length of the upper airway. This narrowing of the airway increases the resistance to airflow.
For individuals prone to breathing difficulties, such as those who snore or have mild obstructive sleep apnea, this constricted airway can exacerbate symptoms. Reduced airflow and increased airway collapsibility lead to a higher likelihood of noisy or labored breathing. This struggle for air causes fragmented sleep architecture, as the brain shifts to lighter sleep stages or briefly wakes up to restore normal breathing. The resulting daytime fatigue and grogginess are consequences of the physiological disruption caused by the improper neck angle.
Finding the Correct Cervical Spine Alignment
The goal in pillow selection is to achieve a neutral spine position, meaning the head, neck, and chest are aligned as if a person were standing upright. The ideal pillow height, or loft, is highly individual and depends on one’s primary sleeping position and body dimensions.
Side sleepers typically require the highest loft (five to seven inches) to fill the gap between the head and the mattress created by the shoulder width. This height prevents the head from tilting down, keeping the spine straight. Back sleepers need a medium loft (three to five inches), which supports the natural inward curve of the neck without pushing the head forward. Stomach sleeping requires the lowest loft (less than three inches).
A simple way to assess alignment is to have a partner observe the head and neck while lying in a typical sleeping position. If the head is pushed upward toward the ceiling, the pillow is too high and needs adjustment.