What Doctors Say About Sleeping With Your Head Elevated

If you use extra pillows to get comfortable at night, experts say there are a few important points to consider.

You may have heard that sleeping with your head raised can ease problems such as acid reflux or snoring. But you may also have woken up with a sore neck. So what gives?

As restless nights and stiff mornings show, elevating your head while you sleep can be helpful in some cases and troublesome in others. At times it can ease sleep problems, and at other times it can contribute to them.

How raising your head at night can help

One of the clearest situations where upper-body elevation can help is gastroesophageal reflux disease, or GERD, said Dr. Likhita Shaik, a sleep medicine specialist and neurologist at University of Iowa Health Care.

Gravity helps keep stomach contents from moving back into the oesophagus.

“Acid reflux is one of the more common things that intrudes on sleep, and it doesn’t always show up as classic heartburn,” said Dr. Sam A. Kashani, a board-certified sleep medicine physician and member of Project Sleep’s advisory board.

“Reflux can present with sore throat, cough, morning nausea and in some cases, it can trigger sleep-related laryngospasm, a sudden closure of vocal cords that causes a person to wake up choking.”

That reaction can be mistaken for an apnea-related gasp, he added, which can lead some patients down the wrong path toward a sleep apnea evaluation.

Reflux is not the only reason people may benefit from elevation. Shaik also pointed to nasal congestion, allergic rhinitis and post-nasal drip.

There can be other advantages as well. Dr. Phyllis Zee, chief of sleep medicine at Northwestern Medicine, said it can help with snoring and breathing, which is especially relevant for people with breathing disorders such as sleep apnea or asthma, as well as people with heart conditions such as heart failure.

Dr. Gregory Breen, a pulmonologist and sleep medicine specialist at Inspira Health, explained how this can help people with obstructive sleep apnea, or OSA, in particular.

“For some people, gradually elevating the upper body from the mid-back through the head can help keep the airway more open,” he said. “Elevation uses gravity to reduce the tendency of the tissues surrounding the airway to fall backward and narrow it during sleep.”

Still, there is a risk of mistaking reduced snoring for a real improvement. Kashani said people may snore less, but apnea can still be present and continue to cause drops in oxygen levels.

And that does not mean you should pile several pillows under your head. It is also not a replacement for OSA treatments such as CPAP.

When doctors caution against elevating your head during sleep

Raising your head can also create problems, and there is one major mistake people often make.

“The biggest issue is doing it with pillows instead of a true incline,” Kashani said. “It’s not elevation itself that causes harm – it’s elevating the wrong way.”

The pain that results can make it seem as though elevation is always a bad idea, even though it may actually ease certain symptoms.

Shaik also warned against using too many pillows, saying it can force the neck into a flexed position and raise the head too steeply. That may lead to neck pain, shoulder pain, muscle strain, morning headaches, stiffness, numbness, tingling, disrupted sleep and worse breathing problems.

Breen added that neck strain can narrow the airway, while Zee noted that an improper position can also strain the spine and lower back.

“Finding a comfortable balance between breathing and GERD support and low back strain is important and highly depends on the individual, as well as the type of head support and mattress,” Zee said.

The safest way to sleep with your head raised

If you need to elevate your head but are unsure how to do it correctly, doctors say the safest approach is to raise the upper body rather than simply stacking pillows beneath the head.

For people with GERD, Shaik recommended lifting the head by about 6 to 8 inches or using a wedge pillow while keeping the neck in a neutral position.

“It should not be bent forward with the chin toward the chest or tilted backward,” Breen explained. “There also should not be a gap between the upper back, shoulders and head that leaves the neck unsupported.”

Zee suggested thinking about the angle. “An incline of 10 to 30 degrees is typical, but 20 to 25 is a good start,” she said.

Kashani added that risers or blocks under bedposts, along with adjustable beds that have a preset snore setting to lift the head of the bed, are other safe options.

The main point is that if you have one of the medical conditions mentioned above, you should be elevating your upper body rather than just your head.

“I would not routinely recommend sleeping propped up simply to improve sleep in someone who does not have a medical reason for it,” Shaik said. “I would also avoid or reassess elevation if it causes neck or back pain, headaches, numbness, difficulty breathing or significant discomfort.”

She stressed that new or worsening shortness of breath should not be brushed off as a pillow problem. It may signal an underlying heart or lung condition that needs medical evaluation.

Even when someone has one of the conditions discussed earlier, changing head position is only one part of care.

“Propping the head up is just one way to decrease the symptoms, adjunctive therapy, but not the solution to these conditions, which need to be treated under the care of a health care professional,” Zee said.

It can still be helpful to speak with a healthcare provider before making even simple changes at home. Every body is different, and it is important to make sure the approach is right for you.