New research links how you sleep with the risk of worsening eye health, showing that pillow height and neck position can influence eye pressure and blood flow in people with glaucoma; experts weigh in on what this could mean for sleep setup and spinal alignment.
A study in the British Journal of Ophthalmology measured intra-ocular pressure in people with glaucoma and found it rose when participants slept with two pillows compared with lying flat. The elevated position also cut blood flow to the eye, suggesting posture during sleep may matter more than we realized. Researchers think neck flexion from stacked pillows could compress veins and change pressure dynamics around the eye.
Dr. William Lu, medical director at Dreem Health, described the findings as “interesting and important.” He added, “It highlights how something as simple as sleep posture can influence intra-ocular pressure in people with glaucoma,” pointing out that small mechanical shifts while you sleep can have measurable effects. Lu cautioned that this is not a final verdict on pillows but a nudge toward awareness.
“That said, this is still early research, and it doesn’t mean pillows are inherently harmful – it’s more about how they’re used and the degree of elevation.” The takeaways experts stress are “balance and personalization,” and avoiding “extreme positions” such as sharply elevated heads or severe neck flexion. Most people will not need to toss their pillows, but they should consider how their usual sleeping posture aligns the head, neck, and spine.
For back sleepers, sleeping without a pillow can promote a neutral neck alignment, which may lessen cervical strain and reduce morning stiffness. “That can reduce strain on the cervical spine and may improve comfort or reduce morning stiffness,” one expert noted, adding that in some cases skipping a pillow “may also reduce pressure points that come from overly thick or unsupportive pillows.” That benefit tends to depend on individual anatomy and mattress firmness.
Not everyone benefits from ditching a pillow, however. Side sleepers typically need support to keep the head level with the spine, and “Without one, the neck can tilt downward and create strain over time.” Sleeping without proper support can also worsen snoring or airway positioning for some people and aggravate preexisting neck or shoulder problems. Choosing the right pillow height and firmness remains key for those who sleep on their side.
Experts recommend that people with glaucoma or those at higher risk discuss sleep posture with their healthcare provider and consider practical adjustments rather than drastic changes. Small shifts in how pillows are arranged or how the head is supported can keep the neck aligned without unnecessary elevation. Simple changes to sleep setup are often low risk and easy to test over a few nights.
Another sleep specialist pointed out that elevating the head of the bed itself can lower eye pressure in some studies, but stacking pillows is not the same and can sometimes backfire. She emphasized there is “very limited high-quality evidence” proving broad benefits from sleeping without a pillow, and the priority should be maintaining proper cervical alignment. “Without adequate support, especially for side sleepers, the neck can fall out of alignment,” which can show up as neck pain, morning headaches, or shoulder and arm discomfort.
The practical advice for at-risk sleepers is straightforward: avoid face-down positions that press on the eyes and be cautious with very high or stacked pillows. “For those with glaucoma or at risk should avoid sleeping face-down with pressure on the eyes and should be cautious with very high or stacked pillows … Be mindful of side sleeping, as the lower eye can experience higher pressure.” Testing slight adjustments and consulting a clinician can help find a comfortable setup that supports both spinal health and eye safety.
