Fewer than 10% of adults primarily sleep on their back. This position (unlike side sleeping) aligns the spine and neck, and is associated with less neck and shoulder pain than stomach sleeping. However, people tend to snore more when sleeping on their back and this can lead to sleep disruption for the sleeper and their partner.
Choosing the right pillow is crucial for getting a good night’s rest as a back sleeper. This guide will explore how the body responds to back sleeping, look at different pillow types, and reveal our picks for the best pillows for back sleepers.
The three general positions associated with back sleeping are illustrated below. They differ in terms of arm and leg extension. In the Soldier position, the arms are fully extended while one or both knees are bent slightly. In the Starfish position, both arms are bent at the elbows with the hands resting at the head level. And in the Savasana position, both arms and both legs are fully extended.
Some advantages of sleeping on one’s back include the following:
- Optimal spinal alignment: Back sleeping provides more spinal alignment than other positions. However, sleeping without a pillow is considered the best position for alignment — and most people find this uncomfortable. A thicker, firmer pillow that cradles the head and neck without letting it tilt too far back is the best option for most back sleepers.
- No extra pillows needed: People who sleep on their sides or stomachs often utilize secondary pillows between or beneath their legs for extra support. Most back sleepers do not need to use secondary pillows (but many do anyway).
- Fewer wrinkles: Side and stomach sleepers often sleep with one side of their face on the pillow, which can cause early wrinkles to form. Because their faces don’t touch the pillow, back sleepers do not need to worry about this issue.
- Can minimize acid reflux symptoms: Acid reflux is a medical condition characterized by stomach acid rising into the esophagus. Heartburn is the most common symptom of acid reflux. Sleeping on one’s back can alleviate heartburn and other symptoms of acid reflux as long as the pillow is supportive and elevated — otherwise, back sleeping may exacerbate these symptoms.
Now, let’s look at some disadvantages of sleeping on one’s back.
- Higher snoring potential: Sleeping on one’s back causes breathing muscles in the airway to relax, which can lead to heavy snoring. People with obstructive sleep apnea, or OSA, are especially susceptible to snoring when lying on their back. For this reason, doctors recommend side sleeping for people with sleep apnea, as well as people who snore heavily for other reasons.
- Greater risk of neck pain: Back sleepers can reduce aches and pains by using a supportive pillow and keeping their bodies aligned throughout the night. However, sleeping with one’s neck bent to one side can disrupt alignment and cause pain and pressure points to develop, even if the pillow is sufficiently supportive.
- May cause issues for pregnant women: Pregnant women who sleep on their backs are at risk for compressed veins. These include the inferior vena cava, which runs beneath the uterus; a compressed inferior vena cava can cause blood pressure levels to plummet. Most physicians urge pregnant women to sleep on their sides; this position is generally more comfortable, particularly during the latter stages of their pregnancy, and minimizes the risk of vein compression.
Back sleepers should consider several variables when selecting a new pillow. These include the following:
Size: Pillows come in six standard sizes, as well as a smaller specialty size that is normally reserved for certain types of pillows.
- Small (20W” x 12L”): This specialty size is normally associated with cervical memory foam pillows, as well as pillows made from materials like buckwheat (see below).
- Standard (20W” x 26L”): Standard is the most common pillow size, as well as the most compact and — usually — the lowest priced. This size is not ideal for people who toss and turn, as their heads can easily slip off one of the sides.
- Super Standard (20W” x 28L”): The Super Standard is two inches longer than a Standard, making it a possible alternative for people who toss and turn and find the smaller size to be too short.
- Queen (20W” x 30L”): A Queen-size pillow will accommodate most sleepers who toss and turn, since it is four inches longer than a Standard.
- King (20W” x 36L”): The King is ideal for people who prefer longer pillows, and this size also provides a comfortable backrest or headrest for people who read or watch television in bed.
- Euro (dimensions vary): Unlike the other standard pillow sizes, Euro-size pillows are square-shaped. They come in many different dimensions; the most popular dimensions include 26W” x 26L” and 20W” x 20L”. Most people in the U.S. do not sleep with Euro pillows as their primary head and neck support, but they are popular choices for backrests and headrests.
- Body (48-54W” x 20L”): Body pillows are exceptionally long. They are a good choice for sleepers who like to snuggle with a pillow.
Surface shape: Pillows may have even or contoured surfaces. Even-surface pillows are the more common option; they have full or flat shapes, depending on the material, but no contours. Curved-surface pillows include cervical memory foam pillows, which are elevated below the neck and recessed below the head. Curved-surface pillows are suitable for all sleepers, especially those with neck and/or shoulder pain.
Loft: Loft, or thickness, is crucial for back sleepers because too much or too little loft can compromise their spinal alignment. Generally speaking, there are three categories of pillow loft:
- Low-loft: Less than three inches (3″) thick.
- Medium-loft: Three to five inches (3″ to 5″) thick.
- High-loft: More than five inches (5″) thick.
Most back sleepers prefer medium- or high-loft pillows because they elevate the neck and head. This can help the sleeper maintain spinal alignment, and it also cuts down on snoring for some. Low-loft pillows may cause the head to drop back, which can cause more snoring and may also lead to pain and pressure points.
However, choosing the right pillow loft depends on other factors like the sleeper’s body weight, head size, and shoulder width, as well as the firmness of the mattress they use. The table below lists optimal conditions for each loft category.
|Loft Category||Thickness||Optimal Sleeper Weight||Optimal Head Size||Optimal Shoulder Width||Optimal Mattress Firmness|
|Low||Less than 3″||More than 230 lbs.||Small||Narrow||Soft to Medium Soft|
|Medium||3″ to 5″||130 to 230 lbs.||Average||Average||Medium|
|High||More than 5″||Less than 130 lbs.||Large||Broad||Medium Firm to Firm|
Many pillows offer adjustable loft; simply remove or add more filling to the interior pocket to decrease or increase how thick it feels. Adjustable-loft pillows are a suitable option for people whose thickness preferences vary from night to night.
Pillow material: Pillows may be made from a wide range of natural or synthetic materials. Each material option has benefits and drawbacks associated with them. Back sleepers generally need a pillow that is firm and thick enough to support their head and neck, which helps them maintain spinal alignment. In addition, shoppers should consider other factors like cost, temperature neutrality, and odor or allergy potential. The table below lists descriptions, pros, cons, and back sleeper ratings for the seven most common pillow materials.
|Pillow Material||Filling Description||Pros||Cons||Back Sleeper Rating|
|Buckwheat||Between five and 10 lbs. of removable buckwheat hulls (outer shells)||Adjustable loft|
Too firm for some
Buckwheat pillows are usually thick and firm enough to support back sleepers, and adjustable loft allows them to make the necessary customizations
|Down||Duck or goose down, which is the soft inner plumage found beneath the outer feathers||Adjustable loft|
Very soft and lightweightSleeps cool
Poor shape retention
Allergy and odor potential
Most down pillows are fairly soft, even at maximum loft, and will not provide sufficient support for back sleepers
|Down Alternative||Polyester puffballs that mimic the softness and weight or authentic down||Adjustable loft|
Very soft and lightweight
No allergy risk
Poor shape retention
Down alternative pillows have short lifespans and become flat easily, which can be problematic for back sleepers seeking thick, firm pillows that elevate their head
|Feather||Outer feathers of ducks or geese (may also include some down for extra softness)||Adjustable loft|
Very soft and lightweight
Quills can poke
May sleep hot
Feathers are not as soft as down, making them more suitable for back sleepers who can adjust the loft accordingly
|Latex||Solid latex, which is a natural substance extracted from the sap of rubber trees||Close conforming|
Too dense and heavy for some
Latex pillows maintain a full shape and are firm enough to support most back sleepers
|Memory Foam||Shredded or solid memory foam, or viscoelastic polyfoam, which softens when warm and retains shape when cool||Adjustable loft (shredded)|
Memory foam pillows are suitable for back sleepers, particularly firm models or cervical pillows that are shaped for elevated support
|Polyester||Shredded or interlocking polyester fibers; polyester is a synthetic fabric||Low cost|
Good shape retention (interlocking)
No allergy risk
No odor potential
Poor shape retention (shredded)
Interlocking polyester pillows maintain a full shape, making them suitable for back sleepers; shredded polyester pillows lose shape and become flat easily, so these are not recommended for back sleepers
Cost: Finally, cost is an important consideration because price-points vary by material. Low-cost options include down alternative, feather, and polyester, while buckwheat, down, and memory foam are considered the most expensive options. The table below lists average price ranges for the seven most common pillow materials.
|Material||Buckwheat||Down||Down Alt. ||Feather||Latex||Memory Foam||Polyester|
|Average Price-point||$50 to $75||$70 to $100||$20 to $30||$25 to $50||$40 to $60||$50 to $60||$10 to $15|