Pillow Size Does Matter: Which is Right for You?

So, you’ve finally decided to ditch that sad, flat excuse for a pillow that has had a home on your bed for the last three years. Well done! You’ve made a good choice.

It has been a while since you’ve last been pillow shopping. Chances are, you tested your luck with Google and quickly became overwhelmed by the different materials, sizes, and sheer magnitude of selection out there. We feel your pain.

Does the size of a pillow matter? Is a pillow even that important? What’s all of this fuss about memory foam?

Take a deep breath. We had many of the same questions you do and already did the heavy lifting ourselves to find out. Yes, we will share.

Make a Checklist

The first thing you should do is make a list. Sure, it sounds old-fashioned, but each individual sleeper has different requirements when it comes to catching some Z’s. You’ll need to make sure you’re covering all of your bases.

  • Do you suffer from insomnia?
  • Allergies
  • Back pain
  • Leg cramps
  • Snoring
  • Neck and shoulder pain
  • Trouble falling asleep
  • Trouble staying asleep
  • Side, back or stomach sleeper
  • Night sweating
  • Restlessness
  • Size of your bed
  • Cold natured, hot natured
  • Sharing with the dog or cat

All those considerations, and many others, contribute to finding the right pillow for you. Please underline the words “right” and “you” because a pillow is one of the most personal items you’ll ever purchase.


Now, with your checklist in hand, you head back to the Internet. There’s work yet to be done!

Loft and Sleep Position

The best size pillow will depend on how you sleep:

  • Side: This is often referred to as a “fetal” sleeper and applies to 41% of Americans. The pillow you select must provide optimal spine alignment. It doesn’t matter if you prefer right or left.

A pillow that is too high (or tall) will raise your head and cause your spine to begin curving at the upper portion of your neck. This is definitely not good. Not even several cups of strong coffee will improve your mental and physical well-being after a night in that position.

A pillow that is too low will cause just as many problems. This time, the misalignment begins at the same place in the neck, but the resulting curvature travels in the opposite direction. Again, forget the coffee.

In either one of these cases, you’re very likely to awaken yourself, and/or a sleep partner, several times during the night because of snoring. Even the dog or cat may jump down.

You’re looking for a pillow that has enough thickness to fill in that hollow spot between the mattress and your neck.

You’ve found the right pillow when you put your head down and your spine is in alignment, with no curves or dips or hills. You’ll know immediately.

The pillow should actually contour to, and cradle, the neck.

Sleep experts often recommend side-sleepers look for a pillow with a gusset, which is a side panel that goes around the entire pillow. The gusset adds both firmness and height which, in turn, maintains alignment through the head and neck.

A side-sleeper’s head will sag downward if the pillow is too soft. Then, the upper back and neck suffer the consequences.

There are definite benefits for a side-sleeper. Most side-sleepers bend their knees just slightly. This helps prevent painful acid reflux, puts the back in a neutral position and, overall, is conducive to a restful, rejuvenating sleep.

The most recommended pillow types are memory foam, natural filled and poly-cluster.

  • Back: For many people, the thought of spending the night flat on one’s back is akin to a medieval torture. They could be right.

Back-sleepers must be diligent in pillow selection. If the neck deviates from its normal curvature, the results usually include blocked breathing passages which leads to snoring. Neck pain is also in the future.

The reason back-sleeping encourages snoring is because the tongue falls back toward the throat. If you don’t tend toward snoring or sleep apnea, back-sleeping is actually a healthy position and helps prevent acid reflux even more effectively than side-sleeping. The spine also remains in a neutral configuration, which is good.

Oddly enough, most people actually drift off to sleep while on their backs.

The most common suggestion for back sleepers is a medium firm pillow. The goal is to place support under the head, neck and shoulders without pushing the neck forward.

Memory foam pillows are generally the best option for back sleepers, helping to preserve the natural curvature of the upper spine, and making it less likely for neck and upper back discomfort. Down, synthetic fill, buckwheat hull and latex are also good choices.

  • Stomach: Non-stomach sleepers often view this position as a guaranteed pathway to suffocation. As with the back-sleeping critics, they may be right.

Nevertheless, there is a percentage of the population in the stomach-sleeping category.

These people want to avoid the thicker, loftier and firmer varieties; steering, instead, toward a flat, soft pillow.

A sharp bend in the neck is unavoidable in this position, since your head is turned sharply to the side. Everything is brutally strained, including neck muscles, bones and ligaments.

And guess what, lady stomach-sleepers. Those creases and wrinkles you see on your cheeks when you look in the mirror in the morning are a direct response to your face being pressed hard into that pillowcase. If you must sleep on your stomach, at least invest in some satin pillowcases before those wrinkles become permanent.

Hopefully, a thinner and flatter pillow will hold the head and neck strain in check as much as possible. But, frankly speaking, the very best option is to go with no pillow. At least try. You just may get used to it.

Down and synthetic fills are recommended, if you decide you must have a pillow.

Physical Dimensions

Yes, the physical dimensions are definitely important.

A standard pillow measures 20” x 26”. It’s considered a basic pillow for sleeping and does offer foundational support for the head and neck. It pretty much accommodates any and all of the three sleep positions.

A queen pillow is 20” x 30,” less difference between it and a standard pillow than most people think.

Here’s a little queen pillow trick – use a standard pillowcase and the tight fit results in increased firmness. Use a queen pillowcase and the added firmness will disappear due to the slack fit.

King pillows are 20” x 36.” The extended length is perfect for people with muscle or joint pain because of the extra body support.

Consequences of the Wrong Size

What happens if you try to use the wrong size pillow? As you probably imagine, the answer isn’t good and, again, there is a direct correlation with your sleep position.

Generally, your head is shoved forward at an awkward angle if the pillow is too big. The spine follows along and is pushed forward with the head.

In the case of a side-sleeper with a too-big pillow, the head is cocked toward the ceiling.

The consequences are just as negative if your pillow is too small. It will go flat, taking away needed support from the neck and straightening the spine.

A side-sleeper on a pillow that is too small will actually feel his or her head pushed in a downward angle toward the mattress. You’ll be greeted with a stiff neck the next morning.

Physical Symptoms of the Wrong Size Pillow

You won’t need to do a lot of guessing to determine whether or not you’re using the wrong size pillow.

The clues are not subtle and include:

  • Wake up aching, in pain
  • Not feeling rested
  • Painful to turn your head the next morning
  • Snoring during the night
  • Painful ear upon awakening
  • Stiff neck
  • Restlessness during the night


Many people are surprised the first time they hear the size of their pillow has a huge influence on the quality as well as on the length of their sleep. Not only is it true but many of the symptoms listed above frequently don’t disappear within a few hours. Not only do they linger but they can become chronic if you continue returning to the same pillow night after night.

One specialized pillow not mentioned is a body pillow. It measures 20” x 54” and can be curved and manipulated to actually fit the individual shape of your body.

Body pillows are great for side-sleepers, expectant mothers or anyone who suffers from recurring joint pain.

The Right Pillow’s Health Contributions

Selecting the right pillow is not an easy task. Unfortunately, it sometimes becomes a trial-and-error process, which can become quite expensive.

A large part of the problem is that we’re not talking about a “one size fits all” situation. There’s not even a single pillow that’s best for most people, which is why the choice range is so broad.

Many people fight the sleep loss battle for years, before realizing it’s their pillow that is standing (or laying) between them and their need for a good, rejuvenating sleep.

Health Benefits of Sleep

Many people are shocked when they realize the important, life-benefits of good sleep

  • Contributes to heart health
  • May help prevent cancer due to increased production in levels of melatonin
  • Reduces stress
  • Reduces inflammation
  • Increases alertness
  • Improves memory
  • May help in weight loss (Poor sleep is strongly linked to weight gain.)
  • Reduces risk of depression
  • Helps body to repair itself, mentally and physically
  • Sleep is important for certain brain functions
  • Improves concentration, productivity, cognition and performance                                                                                                                                                                                                                                                                                 
  • Improves problem-solving skills
  • Maximizes athletic performance, including speed, accuracy, reaction times
  • Affects glucose metabolism/Type 2 diabetes risk
  • Reduces insulin sensitivity
  • Can cause symptoms of pre-diabetes
  • Good, sound sleep improves immune function
  • Poor sleep linked to long-term inflammation of digestive tract and inflammatory bowel diseases
  • Affects emotions and social interactions
  • Reduces ability to identify/recognize facial expressions of emotions such as anger and happiness

There is no way to achieve optimal health without the foundational support of sound and adequate sleep.


So many important things in life pass by unnoticed. They seem too humble to matter. Inconsequential. Yet, it’s some of those most humble, inconsequential elements that make some of the biggest differences in our health and in the overall quality of our lives.

A pillow.

A rectangle of fabric stuffed with any number of fillings – memory foam, feathers, down, polyester, latex, shredded memory foam, buckwheat hulls and more.

Seldom more than 20” wide, a pillow isn’t very big – at least, not when compared with the broad expanse of the mattress it rests on.

But “big” can’t always be measured and, in the case of a pillow, BIG can come in a very small package.

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