Pillow Sizes: Which One Suits Your Sleeping Position?

Most people carefully measure when buying a mattress. When it comes to pillows, these same people grab the next best model on the shelf – even though the pillow determines whether the cervical spine lies in a neutral line at night or is bent for hours. The consequences show up in the morning: tense neck, headaches, a stiff shoulder girdle. In Switzerland, the large square pillow dominates, measuring 65 × 65 cm, while orthopedically oriented models usually measure 50 × 70 cm or smaller. Both formats have their justification – but not for the same sleeping position. This guide categorizes common pillow sizes and shows which one suits which body.

The short answer: What matters is not the surface area of the pillow, but its height in relation to your shoulder width and sleeping position. Side sleepers need a high pillow of 10 to 14 cm, back sleepers a flat one of 6 to 10 cm, stomach sleepers a very flat one of 4 to 6 cm or none at all. As for the format: The classic Swiss 65 × 65 cm pillow is good for sitting up and reading, but is often too generous for sleeping, because the shoulders also rest on it, and the neck is hyperextended. For the pure sleeping position, 50 × 70 cm or a neck support pillow is usually more suitable.

An Overview of Common Pillow Sizes

The 65 × 65 cm format stubbornly persists in Switzerland because it visually matches the wide duvet and is comfortable for reading in bed. From an ergonomic perspective, however, it is rarely the best choice – the next section explains why.

Why the Large Pillow Can Be a Problem

On a 65 × 65 cm pillow, not only the head but also a part of the shoulders rests. This is precisely the problem. When the shoulders are raised, the head tilts forward, and the cervical spine is bent – in the supine position, a permanent forward tilt occurs, as if looking at a mobile phone for eight hours. The neck muscles resist, do not relax, and make themselves known in the morning.

A smaller format, however, forces you to keep your shoulders on the mattress. The pillow then only fills the gap between the head, neck, and mattress. This is its actual purpose. The rule of thumb: The shoulder edge should start at the pillow edge, not lie on it.

If you want to keep your 65 × 65 cm pillow, you can slide half of it under your head and leave the other half free – this works as a makeshift solution but is not stable. It is better to have a second, smaller pillow for sleeping and the large one for reading. Further basics in the Pillow Guide.

The Right Height According to Sleeping Position

Side Sleepers

In the side position, the largest gap is created between the head and the mattress – it corresponds approximately to the shoulder width. For a slender person with a shoulder width of 38 cm, this is about 10 cm; for broad shoulders of 50 cm, it is more like 13 to 14 cm. The pillow must fill this space so that the cervical spine remains in a straight line with the thoracic spine. A pillow that is too flat will cause the head to drop, while one that is too high will bend it upwards. Both lead to tension over hours.

Back Sleepers

In the supine position, the hollow space is much smaller. The only concern is to support the natural cervical lordosis – that is, the slight curve in the neck. 6 to 10 cm is sufficient. A high side sleeper pillow would raise the head too far. If you use both positions, choose an adaptable pillow in the middle range or a model with removable filling.

Stomach Sleepers

The prone position is already the most demanding position for the cervical spine, as the head is constantly turned to the side. A high pillow exacerbates this. 4 to 6 cm or no pillow at all is recommended. Some stomach sleepers find a flat pillow under the pelvis more comfortable, as it relieves the lumbar spine. More information can be found under Mattress for Back and Stomach Sleepers.

How the Mattress Influences Pillow Height

One point that is almost always missing in consultations: the pillow height depends directly on how deeply the shoulder sinks into the mattress. On a very firm surface, the shoulder stays up, the cavity to the head is large – the pillow must be high. On a point-elastic mattress, into which the shoulder sinks 3 to 5 cm, the cavity becomes smaller accordingly. The same pillow would then be too high.

Practically, this means: If you change your mattress, you should check your pillow again. Many people buy a new mattress, sleep worse at first, and blame the mattress – but the old pillow is simply too high now. Give yourself at least two to three weeks to get used to it, as described in the article Getting Used to a Mattress, and then adjust the pillow.

Common Pillow Selection Mistakes

Mistake 1: Placing the shoulders on the pillow. The classic mistake with the 65 × 65 cm format. The result is a bent cervical spine throughout the night.

Mistake 2: Stacking two pillows. If you notice that one pillow is too flat, you often place a second one underneath. This creates an unstable, wedge-shaped surface that tilts the head forward. Better: a single pillow of the correct height.

Mistake 3: Never replacing the pillow. Fillings lose volume and support over the years. As a guideline, pillows with fiber and down fillings should be replaced every two to three years, and those with foam cores every three to five years. A simple test: Fold the pillow in half – if it doesn't spring back on its own, it's worn out.

Mistake 4: Only looking at the filling material. Down, latex flakes, cold foam, or memory foam all have their merits. But no material compensates for the wrong height. First determine the height, then the material.

Mistake 5: Using children's pillows too early. Babies under one year old sleep without a pillow – for safety reasons. From about two years old, a very flat children's pillow of 40 × 60 cm with a maximum height of 4 cm is appropriate.

How to Find Your Pillow Height in Four Steps

Step 1 – Measure shoulder width. Stand sideways in front of a mirror and measure the distance from the mattress surface to the outermost point of your shoulder in a side-lying position. Alternatively: Halve the shoulder width from joint to joint – this gives a useful approximation.

Step 2 – Consider sinking behavior. Subtract 2 to 5 cm, depending on how deeply your shoulder sinks into the mattress. For a very firm surface, do not subtract anything.

Step 3 – Test and have it checked. Lie in your main sleeping position and have someone assess from the front: Is the cervical spine in a straight line with the thoracic spine? Alternatively, take a photo from the head end.

Step 4 – Give it two weeks. The neck needs time to adjust. Slight irritation in the first few nights is normal; persistent pain is not. If symptoms persist after two to three weeks, consult a specialist. Further tips can be found under Neck Pain and Mattress.

Frequently Asked Questions About Pillow Sizes

What pillow size is common in Switzerland?

Traditionally, the square format 65 × 65 cm dominates. However, the smaller 50 × 70 cm is becoming increasingly popular because only the head and neck rest on it, and the shoulders remain on the mattress – which is ergonomically more favorable.

How high should a pillow be for side sleepers?

Side sleepers generally need a height of 10 to 14 cm so that the hollow space between the head and mattress is filled and the cervical spine remains straight. The exact value depends on shoulder width: narrow shoulders typically 10 cm, broad shoulders up to 14 cm.

Is a 65 × 65 cm pillow unsuitable for sleeping?

Unsuitable is too strong a word, but it is usually too generous for the pure sleeping position. Because the shoulders also rest on it, the head is raised and the cervical spine is bent. However, for reading and sitting up in bed, this format is very comfortable.

Do I even need a pillow as a stomach sleeper?

Many stomach sleepers sleep best without any pillow or with a very flat one of 4 to 6 cm. Some also find a flat pillow under the pelvis comfortable, as it relieves the lumbar spine.

Do I need to change my pillow when I buy a new mattress?

Often, yes. If the shoulder sinks deeper into the new mattress than before, the hollow space to the head becomes smaller, and the previous pillow will be too high. Re-check the pillow height after two to three weeks of adjustment.

How often should one replace a pillow?

As a guideline, two to three years for fiber and down fillings and three to five years for foam cores. A simple test: Fold the pillow and release it – if it doesn't spring back to its original shape on its own, it has lost its support.

This article is for general information purposes only and does not replace medical advice.