You might have heard that propping your head up at night can help you sleep, whether you’re dealing with acid reflux or snoring. However, you may have also noticed that the next day, your neck hurts. What’s that about?
As sleepless nights and achy mornings will tell you, propping your head up at night can be both helpful and unhelpful. Sometimes, it’s the answer to your sleeping woes – and other times, it’s the cause of them.
How propping your head up at night can help
One of the “clearest situations” in which elevating the upper body can help is when someone has gastroesophageal reflux disease (GERD), said Dr. Likhita Shaik, a sleep medicine specialist and neurologist at University of Iowa Health Care.
Gravity keeps your stomach contents from flowing 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,” noted 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.”
The latter can be mistaken for an apnoea-related gasp, he continued, in which some patients are misdirected toward a sleep apnea workup.
Acid reflux isn’t the only cause; congestion-related reasons are also on the list. More specifically, Shaik listed nasal congestion, allergic rhinitis and post-nasal drip.
Propping your head up provides other benefits, too. According to Dr. Phyllis Zee, the Chief of Sleep Medicine at Northwestern Medicine, it “can help with snoring and breathing,” which is “particularly relevant for people with breathing disorders, such as sleep apnoea, 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 it helps people with obstructive sleep apnea (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.”
Just be aware that the elevation can cause a false sense of improvement. You might snore less, Kashani said, but the apnoea is still there, causing drops in oxygen levels.
Additionally, note that this doesn’t mean you should start stacking pillows underneath your head. It’s also not a substitute for OSA treatments, such as a CPAP. (We’ll explain that more later.)
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When doctors warn against propping your head up for sleep
Elevating your head can also cause problems, in which there’s one main trap people fall into.
“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 can cause may make you think elevation is inherently bad when it can actually relieve health symptoms.
Shaik also warned against using too many pillows, saying it forces your neck into a flexed position and elevates your head too steeply. That can cause neck pain, shoulder pain, muscle strain, morning headaches, stiffness, numbness, tingling, disturbed sleep and worsened breathing problems.
If that’s not enough, Breen added that the neck strain can narrow the airway, and Zee added that the wrong position can cause spine and low back strain.
“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 prop your head up at night
So, you need to prop your head up but aren’t sure how to do it the “right” way.
“The safest approach is generally to elevate the upper body rather than simply stacking pillows under the head,” Shaik said.
For people with GERD, she recommended raising the head about 6 to 8 inches or using a wedge pillow, 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 encouraged thinking in terms of the angle. “An incline of 10 to 30 degrees is typical, but 20 to 25 is a good start,” she said.
Kashani said risers or blocks under the bedposts, as well as adjustable beds with a pre-set snore setting that elevate the head of the bed, are other safe options.
The takeaway here is that you need to prop up your upper body (not just your head!) at night if you have one of the medical conditions listed above.
“I would not routinely recommend sleeping propped up simply to improve sleep in someone who does not have a medical reason for it,” Shaik clarified. “I would also avoid or reassess elevation if it causes neck or back pain, headaches, numbness, difficulty breathing or significant discomfort.”
She emphasised that new or worsened shortness of breath requires more attention than a wedge. It can signal an underlying cardiopulmonary condition that necessitates medical evaluation.
Even if you have one of those conditions mentioned earlier, adjusting your head isn’t the only step to take.
“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.
Remember, you can often benefit from a chat with your healthcare provider, even before making “simple” at-home changes. Every person’s body is different, and you want to make sure you’re doing what’s best for yours.
