Should You Sleep Without a Pillow? (2025 UK Guide)

Pillows have been a staple of bedtime routines for centuries, providing support, comfort, and a sense of familiarity. Yet a growing number of sleep experts and health-conscious individuals are now asking: Should you sleep without a pillow? 

While it may seem unconventional, ditching the pillow could offer surprising benefits, depending on individual sleep posture, health needs, and personal comfort.

This guide explores the potential advantages, disadvantages, and health implications of sleeping without a pillow. It aims to help sleepers in the UK and beyond make an informed decision based on the latest research and expert advice.

The Traditional Role of Pillows in Sleep

Pillows have traditionally been used to:

• Support the head, neck, and shoulders

• Promote spinal alignment

• Enhance comfort and warmth during sleep

• Reduce snoring by positioning the airway

For many, a well-chosen pillow (such as an orthopaedic or memory foam pillow) can significantly improve sleep quality. However, not every sleeper benefits equally — and in some cases, pillows could cause more harm than good.

Potential Benefits of Sleeping Without a Pillow

1. Improved Spinal Alignment for Stomach Sleepers

For stomach sleepers, using a pillow can force the neck into an unnatural upward angle, creating strain on the cervical spine. Sleeping without a pillow may help maintain a more neutral position, reducing the risk of neck and back pain.

Research Insight: A study published in Healthcare (2021) indicated that excessive neck flexion during sleep was associated with increased cervical discomfort, especially among stomach sleepers.

2. Reduction in Neck and Shoulder Pain

Certain individuals find that pillow use exacerbates tension and misalignment in the neck and shoulders. Removing the pillow can promote a more natural, relaxed posture, especially when paired with a supportive mattress.

According to Rebecca Swain, mattress expert at WinstonsBeds.com:

"A lot of people may be surprised to hear this but sleeping with a pillow can mess with the alignment between the neck and the spine, causing tension on our muscles. If you regularly wake up with neck pain and tension headaches, it could be a sign to ditch the pillow."

3. Possible Reduction in Wrinkles

Some dermatologists suggest that sleeping with the face pressed into a pillow can contribute to the development of sleep wrinkles over time. Sleeping without a pillow — or using a very thin one — may help minimise skin folding, especially for those concerned with ageing.

4. May Support Natural Breathing

Without a pillow elevating the head, some people experience fewer airway restrictions, particularly if they sleep on their stomach or sides with proper posture. In theory, this could reduce minor snoring episodes, although it is not a substitute for clinical snoring treatments.

Potential Drawbacks of Sleeping Without a Pillow

1. Poor Alignment for Back and Side Sleepers

For back and side sleepers, a pillow is often necessary to maintain a straight spine. Without proper support:

• Back sleepers may experience head 'tilt' backward, straining the neck.

• Side sleepers may experience a dip in the neck and shoulder area, leading to spinal misalignment.

Clinical Perspective: According to NHS advice on back pain, maintaining a neutral spine during sleep is essential for long-term musculoskeletal health【source】.

2. Risk of Increased Pressure on Joints

Without a pillow, side sleepers in particular might place undue pressure on the shoulder joint. Over time, this can contribute to shoulder stiffness, tingling, or even conditions like bursitis.

3. Disrupted Sleep Transition

If accustomed to pillow use, the transition to pillowless sleeping can initially disrupt sleep quality. It may take several weeks for the body to adjust, during which time some sleepers experience restlessness or increased aches.

Who Might Benefit Most From Sleeping Without a Pillow?

Sleep Type	Pillow Needed?	Notes
Stomach sleepers	Often not	Can reduce neck strain by removing pillow elevation.
Back sleepers	Usually yes	Need slight elevation for spinal alignment.
Side sleepers	Strongly yes	Need substantial support between head and mattress.

Individuals with the following conditions might consider trialling pillowless sleep under supervision:

• Chronic neck stiffness caused by hyperflexion

• Habitual stomach sleeping habits

• Skin ageing concerns (sleep wrinkles)

However, it is recommended to consult a sleep specialist, physiotherapist, or GP if considering a major change in sleep setup.

How to Transition to Sleeping Without a Pillow (Safely)

If considering the switch, it is important to transition thoughtfully:

1. Start with a thinner pillow: Instead of going 'cold turkey', begin with a low-profile pillow or folded towel.

2. Strengthen neck muscles: Incorporate exercises to support natural head and neck positioning.

3. Focus on mattress quality: Ensure the mattress itself offers proper support to compensate for the lack of a pillow.

4. Listen to the body: Discomfort beyond mild adjustment aches may indicate a need to reintegrate a supportive pillow.

Alternative Pillow Options for Healthier Sleep

For those who prefer some head support but want to minimise health risks, several alternatives exist:

• Thin orthopaedic pillows designed for stomach sleepers

• Contoured cervical pillows for targeted neck support

• Memory foam pillows offering tailored spinal alignment

• Adjustable loft pillows allowing customisation of height and firmness

These can offer the "best of both worlds" — improving alignment without excessive elevation.

Final Thoughts: Should Pillows Stay — or Go?

There is no universal answer to the question: should you sleep without a pillow?The decision largely depends on sleep position, spinal health, comfort preference, and any pre-existing conditions. While some sleepers may benefit from ditching the pillow, others may worsen their posture and sleep quality without proper support.

For those curious about trying pillow-free sleep, gradual adjustment, mindful posture, and professional advice are key to ensuring long-term success.

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Frequently Asked Questions (FAQ)

Is it better to sleep without a pillow?

It depends on the sleep position. Stomach sleepers may benefit most, while back and side sleepers usually require a pillow for healthy spinal alignment.

Can sleeping without a pillow help posture?

For some stomach sleepers, yes. Removing the pillow can encourage a more neutral neck position, potentially improving posture over time.

Does sleeping without a pillow prevent wrinkles?

Some evidence suggests that less facial compression during sleep may reduce sleep wrinkles, although genetics, hydration, and sun protection play much larger roles in skin ageing.

Will sleeping without a pillow cause back pain?

For back and side sleepers, lack of pillow support could contribute to back or neck pain. It is important to align the spine properly, with or without a pillow.