Sleeping on two pillows? Physiotherapists explain when it eases neck pain – and when it’s the reason you wake up aching

Daniel Cooper • December 11, 2025 16:12

You wake up with a stiff neck again and do the mental maths. Was it the late‑night scrolling, the awkward nap on the sofa, or that second pillow you shoved under your head at 2am because “it felt more comfortable”?

The bed still looks like it helped: two plump pillows, propped just like in the washing powder adverts. Your neck, however, is voting differently. You rub the sore spot, take a cautious first turn to the left, and wonder: do physiotherapists secretly sleep like this, or are you actually doing this all wrong?

The awkward truth is that both things can be true at once.
For some people, two pillows are exactly what their neck and shoulders have been begging for. For others, that extra cushion is the reason they wake up feeling like they’ve slept on a long‑haul flight.

Physiotherapists don’t care about how your bed looks. They care about one brutally simple question: what position does your neck stay in for the six or seven hours when you’re too unconscious to notice it’s complaining?

What your neck is trying to do while you sleep

During the day, your neck muscles are constantly making micro‑adjustments: when you look down at your phone, when you stare at a laptop, when you turn to check the traffic. At night, those muscles finally get a chance to switch down a gear.

The spine has natural curves. In your neck (the cervical spine), that curve is gently forwards, like a very soft “C”. Physiotherapists spend a lot of time trying to help people move around that neutral curve instead of fighting it.

Sleep is when you either:

let your neck settle into that neutral, easy curve, or
park it in a twisted or bent position for hours, then wonder why it’s cross in the morning.

Pillows are not “good” or “bad” in themselves. One pillow, two pillows, memory foam, feathers – the real question is: how do they line up your head, neck and upper back in your favourite sleep position?

When two pillows actually help your neck

Physiotherapists tend to see the biggest benefit from two pillows in one group of people: committed side‑sleepers with relatively broad shoulders or a soft mattress.

Lie on your side and imagine a straight line running from the middle of your forehead, through your nose, to your breastbone. In a perfect world, that line would stay straight and level, not tilted towards the mattress or up towards the ceiling.

That alignment is easier to get if:

your shoulder sinks into the mattress a bit, and
your pillow stack fills the gap between the side of your head and the mattress.

For many adults, one thin pillow on a fairly soft mattress simply isn’t tall enough. Your head droops down, your top shoulder rolls forwards and your neck spends the night side‑bent. In that case, adding a second thin pillow can:

lift your head so your neck is more level with your spine
stop your top shoulder collapsing forwards
reduce that morning “crunch” feeling when you first look over your shoulder

Physiotherapists often suggest a two‑pillow setup in these situations:

Side‑sleepers with broad shoulders – the distance from mattress to ear is bigger, so you need more height.
People with very soft mattresses or toppers – your torso sinks, your head doesn’t, so you need extra height under the head to match.
Those with shoulder pain – slightly more pillow height can keep the painful shoulder from being crushed.

One physio put it this way:

“If you’re on your side and your nose is level with your breastbone, I don’t care whether that took one pillow or three. I care that your neck isn’t hanging in mid‑air.”

The number is just a tool. The shape you end up in is what matters.

When that second pillow turns into the problem

Now flip to your back. This is where two pillows more often cause trouble.

When you lie on your back, that same gentle “C” curve in your neck wants to be supported, not forced into a deep bend. Stack your pillows too high and your chin tips down towards your chest. Stay like that for six hours, and you wake up with:

stiffness at the base of the skull
a sense that you need to “crack” your neck
tightness at the front of the neck and sometimes a dull headache

For back‑sleepers, two pillows often mean:

too much flexion – your neck is bent forwards more than it likes
shortened muscles at the front of the neck and chest
extra pressure on facet joints at the back of the cervical spine

Physiotherapists also see two‑pillow setups aggravating:

Existing disc issues in the neck – prolonged flexion can wind the area up.
Certain types of headache – especially those that start at the base of the skull and wrap forwards.
Jaw (TMJ) problems – if your head is propped up, your jaw may be held slightly back and compressed.

And then there are front‑sleepers.
If you sleep on your front and on two pillows, your neck is usually turned to one side and extended backwards at the same time. That’s the sort of position physios use in the clinic for short, specific tests – not something they’d choose for you to hold all night.

Soyons honnêtes : nobody falls asleep on their front thinking “I’d like eight hours of combined rotation and extension for my cervical joints, please.”

If you wake with any of these, your pillow stack is worth suspecting:

pain mostly on one side of the neck after a night on your front or side
a heavy, compressed feeling across the top of the shoulders
needing several minutes of slow movement before you can look over each shoulder

How physiotherapists actually “measure” your pillow

Physios don’t walk into your bedroom with a tape measure and decree “one pillow only, 10 centimetres high.” The process is more practical – and more human.

They usually ask three questions:

What position do you naturally fall asleep in?
Not the virtuous one you start in, the one you always return to at 3am.
Where exactly is the pain or stiffness when you wake?
One side? Both? Deep ache, sharp twinge, headache behind the eyes?
Does it ease or worsen with certain movements?
For instance, does looking up help, but looking down hurts?

Then they’ll get you to lie on a plinth or a firm bed and simulate your sleeping position with different pillow heights.

Things they look for:

From behind, is your head in line with your spine, not tilted?
From the side, is your chin poking forwards or tucked right in?
Do the muscles along the side of your neck look relaxed or like piano wires?

Often the “right” height ends up being:

One medium‑height pillow for back‑sleepers.
One firmer or higher pillow, or two thinner ones, for side‑sleepers.
As little height as you can tolerate if you insist on front‑sleeping – sometimes a folded towel instead of a full pillow.

The physio’s job is not to sell you a particular brand. It’s to help you test a rough height and feel the difference in your own neck the next morning.

A quick home check: is your pillow stack helping or hurting?

You can borrow a few of those physio tricks at home with no special kit.

If you sleep on your side

Lie on your side in your usual spot with your current pillows.
Ask someone to look from behind and check: is your nose roughly in line with your breastbone, or is your head dropped towards the mattress or tilted up?
Notice your shoulder: is it squashed up into your ear, or nicely “nestled” into the mattress?

If your head is clearly tilting:

Head tilting down → likely need more height (add a thin pillow or a folded towel).
Head tilting up → likely too much height (remove a pillow or change to a flatter one).

If you sleep on your back

Lie flat with your usual pillow setup.
Gently slip a hand under your neck: do you feel a small space or are you already jammed into a deep chin‑tuck?
Now try this: remove one pillow for 1–2 minutes, let your head settle, notice the difference.

Signs your pillows are too high:

your chin sits closer to your chest than feels natural
you feel a pull across the back of your neck
your upper back feels slightly rounded or “propped”

A simple rule of thumb

If changing your pillow height (even temporarily) makes your neck:

immediately more comfortable in your typical sleep position, and
you wake with less stiffness the next morning,

then you’re probably moving in the right direction.

Pillow experiments need a few nights each. Your neck may feel odd for night one or two just because it’s different. Physios usually suggest giving a new height 3–5 nights before judging it properly, unless it’s clearly making things worse.

Special cases: when two pillows make sense (and when they don’t)

There are some situations where physiotherapists, GPs or sleep specialists may deliberately recommend more height under the upper body – sometimes involving two pillows or a wedge.

Acid reflux or GORD – raising the head and upper torso can help reduce night‑time symptoms. Ideally this is done with a wedge or by raising the head of the bed, not just bending the neck forward on a stack of pillows.
Certain breathing issues or sleep apnoea – a more upright position can help, but again, the goal is to tilt the whole upper body, not simply jack‑knife the neck.
Acute shoulder or rib pain – extra pillows can prop you so you’re half‑reclined and less likely to roll onto the painful side.

In these cases, two pillows under the head alone are a blunt solution. Physiotherapists often suggest:

one pillow under the head,
plus another behind the upper back or lengthways under the trunk,
or a purpose‑made wedge pillow.

What they’re trying to avoid is a common DIY setup: three pillows under the head, none under the upper back, and a neck forced into a tight bend for hours.

If you’ve been told to “sleep propped up” and your neck is now protesting, it’s worth asking:

can we raise the entire upper body instead of just my head?
is there a different arrangement that helps my medical issue without wrecking my neck?

It’s not just the pillow: the habits around it matter

Physiotherapists will also quietly ask about the ten minutes before you lie down and the first ten minutes after you get up. Those windows often do as much damage as the pillow itself.

Typical pattern:

You fall asleep half‑sitting up on two pillows, phone propped on your chest.
You slide down slowly in the night, ending up with your neck hanging halfway off the stack.
You wake, instantly look down to check notifications, then roll out of bed and stare at a laptop.

That’s three solid hits of neck flexion and forward‑head posture wrapped around a questionable pillow height. No wonder things hurt.

Small changes that physios often see helping:

Bring screens up, not your head up. If you like reading in bed, prop the book or tablet higher instead of craning your neck forwards.
Give your neck a “neutral” minute after waking. Before you check your phone, lie on your back or side and gently look up and down a few times, then left and right.
Stretch your chest, not just your neck. Tight pectoral muscles and rounded shoulders often contribute to morning neck pain.

Sometimes people blame that second pillow because it’s visible, when the real culprits are the habits wrapped around it.

A simple cheat‑sheet

Here’s how physiotherapists often think about pillow height in broad strokes:

Sleep position	One pillow tends to suit…	Two (thin) pillows may suit…
Back	Most adults with neutral necks and medium mattress	People who like a very soft, compressible pillow and still feel “flat”
Side	Narrow shoulders, firm mattress, thick pillow	Broader shoulders, soft mattress, or slim pillow that needs a friend
Front	As flat as possible, sometimes no full pillow	Rarely ideal – if used, keep very low and aim to transition away

It’s not a prescription, it’s a starting point for your own experiments.

When to stop guessing and see a professional

Most “pillow problems” are annoying rather than serious, and respond within a couple of weeks to:

better pillow height for your main sleep position
small tweaks to pre‑bed and morning routines
some gentle neck and upper‑back mobility work

But it’s worth speaking to a physiotherapist or your GP if:

neck pain is getting worse over weeks despite your best efforts
you have pain, tingling or numbness running into one or both arms
you’re waking with severe headaches, dizziness or visual changes
you’ve had a recent fall, whiplash or trauma involving the neck

A physio can check whether your pillow is genuinely the main issue or just one piece of a bigger picture, and guide you on safe exercises – not just softer cushions.

FAQ:

Is two pillows “bad for your neck” in general?
Not automatically. For many side‑sleepers, two thin pillows give the right height. Problems usually come when two thick pillows bend the neck too far forwards, especially for back‑sleepers.

Do I need an expensive orthopaedic pillow?
Not usually. Physiotherapists care more about the right height and firmness than special shapes. You can often get close with standard pillows and a bit of trial and error.

How long should I test a new pillow setup?
Give each change 3–5 nights unless it clearly makes things worse. Your neck may feel odd for a night or two simply because it’s different.

Can my pillow really cause headaches?
Yes. Poor neck position overnight can irritate joints and muscles at the base of the skull, leading to so‑called cervicogenic headaches. Adjusting pillow height often helps, but persistent or severe headaches should be checked.

If I sleep on my front, do I have to stop?
It’s not mandatory, but front‑sleeping is the hardest position for your neck. Many physios aim for small steps: flatter pillows, one arm up by the head, or gradually rolling towards a side‑lying position.