Sleep quality and comfort are vital for overall health, and the choice of using a pillow during sleep is a fundamental aspect often debated.

The decision to sleep without a pillow can have varied effects depending on individual sleep positions, spinal health, and personal comfort needs.

Impact on Spinal Alignment

Pillows serve largely to maintain the natural curve of the cervical spine during rest. For side sleepers, pillows fill the gap between the head and mattress, preserving neutral alignment of the neck and spine. Without this support, the neck bends unnaturally toward the mattress, placing strain on muscles and ligaments, which can lead to pain and stiffness.

Back sleepers may experience their head tilting backward without a pillow, risking muscle strain. Only stomach sleepers or certain back sleepers with unique spinal curvature may benefit from skipping a pillow, as it keeps their neck in a more neutral position and prevents hyperextension.

Effects on Neck and Shoulder Comfort

Sleeping without a pillow can sometimes alleviate neck pain for those whose pillows are excessively thick or firm. Particularly for stomach sleepers, the absence of a pillow prevents the neck from bending upwards abruptly, which can reduce muscle tension accrued overnight.

However, many individuals wake up with neck or shoulder discomfort when sleeping pillowless, likely due to unsupported muscles working harder to maintain head position. These discomforts may degrade sleep quality and cause chronic neck issues over time if the sleeping posture is not optimized.

Influence on Breathing and Sleep Apnea

Some research suggests that sleeping without a pillow can open airways by allowing the head to rest in a neutral position, potentially reducing snoring and mild obstructive sleep apnea symptoms. Elevated pillows may sometimes restrict airflow by constricting the neck angle. For people with mild breathing issues during sleep, pillowless rest might improve airflow and oxygenation. Nevertheless, individuals with moderate to severe sleep apnea typically require specialized devices and positional therapy rather than changes in pillow use alone.

Skin Health and Pillow Hygiene

An often overlooked benefit of sleeping without a pillow involves skin health. Pillows can trap bacteria, oils, and dead skin cells, contributing to acne or skin irritation. Avoiding pillows may reduce face contact with these irritants and decrease the risk of acne breakouts and sleep wrinkles caused by pillow-induced skin compression. However, pillow hygiene management by regular washing mitigates many of these concerns while still providing necessary neck support.

Dr. Geet Paul, Director of Interventional Pain Medicine at George Washington University School of Medicine, notes that a pillow should keep the head and neck aligned with the spine—but many people choose pillows based on feel rather than support, which can disrupt posture and sleep quality.

Sleeping without a pillow offers potential benefits mainly for specific sleep positions such as stomach sleeping or certain back sleepers with unique spinal needs. However, for a majority of people, especially side sleepers, pillowless sleep can cause neck strain, discomfort, and spinal misalignment. Proper pillow selection tailored to individual needs generally supports the best sleep outcomes and physical well-being.