NINKLES guide · Skin and sleep

Sleep lines: what they are, why they form and what you can do

Sleep lines, also called sleep wrinkles or sleep creases, are lines that form when your face is pressed against a pillow or mattress while you sleep. The pressure, and the pull on your skin as you move, fold it in places that don't match your usual expressions.^{1, 2} They're usually most noticeable when you wake up and soften as the day goes on, but skin springs back more slowly with age, so they can linger for longer.³

Last reviewed 30 September 2026 · Written by the NINKLES team · 24 published sources

The short answer

Sleep lines are creases pressed into the face by the pillow when you sleep on your side or front. Doctors recognise them as a distinct type of wrinkle, separate from expression lines.^{1, 4}
They form because the face is compressed, dragged and folded against bedding for hours at a time.^{1, 5}
Repeated folding leaves its mark. In an eight-year study, the lines women showed when smiling predicted where their lasting wrinkles later formed,⁶ and in the laboratory, repeatedly folding a model of the skin's dermis changed its structure.⁷
Older skin folds more readily and recovers more slowly, which helps explain why sleep lines linger longer with age.^{3, 8}
Sleeping on your back is the only way to keep your face off the pillow. Specially shaped pillows aim to reduce the pressure, and overnight patches aim to reduce the folding it causes.

What are sleep lines?

Sleep lines are creases pressed into the skin by the surface you sleep on. They're a recognised type of wrinkle: a 2023 classification of cheek wrinkles by cause lists "sleep cheek wrinkles" as one of five types, alongside wrinkles from thinning skin, facial expressions and sagging.⁴ Doctors have described them for decades; a 1999 paper in Dermatologic Surgery credits Dr Samuel Stegman with describing "sleep creases" in 1987.²

They differ from the lines your expressions make. They tend to form in places your expressions don't usually crease, and they often run across expression lines rather than alongside them.¹ Clinicians use a "pillow or hand test", pressing the face the way it rests on a pillow, to bring them out.² A simple version at home: if a morning line matches where your face met the pillow, it's probably a sleep line.

They're common in older adults. A 2026 study of 201 people aged 60 and over in Brazil, which looked only at the forehead, found sleep lines there in 46%.⁹

What causes sleep lines?

Sleep lines are caused by the face being compressed, dragged and folded against the pillow while you sleep on your side or front. A 2016 review by plastic surgeons describes three forces at work: compression, shear and stretching.¹

Compression. The weight of your head presses your face into the pillow and folds the skin. When researchers watched 15 adults lying on a transparent, air-filled pillow, they recorded folding around the eyes and mouth, flattening of the forehead and folds beside the nose.⁵ How much pressure the face takes, and where, depends on how it's supported: in tests with 36 people lying face down on three surgical face pillows, one design put more than three times as much of the face above a set pressure threshold as either of the other two.¹⁰
Shear. As you move, the pillow drags the skin sideways over the tissue beneath it.¹ Skin doesn't simply slide over fabric; it deforms, and friction tests on forearm skin suggest that older, less elastic skin is displaced more and takes greater shear forces.¹¹
Stretching. Skin next to a fold is pulled taut while the fold is held in place.¹

Time matters too. According to the same review, people change position about 20 times a night on average, falling from around 27 to around 16 as they get older, so each position tends to be held for longer with age.¹²

Some people are also more prone than others. Early clinical work linked sleep lines to the way deeper facial tissue is anchored to the skin,² and a 2022 commentary argued that factors beyond pressure may also play a part.¹³

Sleep lines vs expression lines

Both are creases in the skin, but they form in different ways, which is why they respond to different things.¹

How sleep lines and expression lines differ
Feature	Sleep lines	Expression lines
What causes them	Pressure and drag from the surface you sleep on¹	Repeated muscle movement, such as frowning, smiling or squinting¹
When you notice them	Usually worst when you wake up, often softening through the day	When you make the expression, and over time at rest as well
Direction	Often run across expression lines^{1, 12}	Follow the pull of the muscles underneath
Common places	Forehead, cheeks, lips, around the outer eyes and temples^{12, 14}	Between the brows, across the forehead, around the eyes and mouth
Addressing the cause	Less pressure or folding on the face overnight	Less repeated muscle movement, for example with treatments from a qualified practitioner

Where do sleep lines appear?

Sleep lines appear where your face meets the pillow. Most are seen on the forehead, lips and cheeks,¹² and surgeons describing people who sleep face down found them around the outer eyes, at the temples, on the forehead and on the cheeks.¹⁴ On the cheek, they're classified as a type of wrinkle of their own.⁴

Where yours appear depends on how you sleep:

Side sleepers press one side of the face into the pillow, typically the cheek and the skin around the eye and mouth.
Front sleepers press the forehead and cheeks into the pillow.¹⁴
Back sleepers keep the face off the pillow, so the main force on the face is gravity.⁹

Does side sleeping contribute to sleep lines?

Yes. Sleeping on your side or front presses part of your face into the pillow for hours at a time, compressing, dragging and folding the skin in the same places night after night.^{1, 5} These mechanical forces are understood to contribute to the formation of sleep lines, which is why they appear where the face meets the pillow.^{1, 14} Back sleeping avoids direct pillow compression and shear on the face.⁹

Several independent kinds of evidence support this:

Recognised patterns. Sleep wrinkles differ from expression lines in cause, location and direction,¹ and on the cheek they're classified as a distinct type: "sleep cheek wrinkles".⁴
Measured pressure. Pillow design measurably changes how much pressure the face takes and where, including on the cheeks and under the eyes.¹⁰
Drag and shear. Skin rubbing against fabric deforms rather than simply sliding, and less elastic skin is displaced more.¹¹
Changes on the sleeping side. In a study of 262 adults aged 55 and over, 70% had a looser upper eyelid on the side they usually sleep on,¹⁶ and a second study of 71 people found the upper eyelid sat lower on the preferred side.¹⁷

The evidence is strongest for the mechanical process and the patterns it leaves. It's less clear how much older your preferred side will look than the other, because age, sun exposure and genetics affect both sides too.^{1, 18}

Do sleep lines go away?

Usually, at first. In younger skin, sleep creases tend to disappear soon after waking.^{1, 9} As skin ages, the same crease takes longer to fade and can last well into the day.³

Why they last longer as skin ages

Ageing changes how skin responds to being folded:

It recovers more slowly. In 300 people aged 20 to 74, the skin's ability to spring back after being stretched declined with age, more than its firmness did.³
It folds more readily. When researchers created a standard fold in the skin of women of different ages, older skin formed more pronounced wrinkles, alongside lower elasticity and extensibility.⁸
It deforms more under friction. Less elastic skin is displaced more when it rubs against fabric.¹¹

Can sleep lines become permanent?

Over time, they can contribute to lines that stay. Plastic surgeons describe sleep wrinkles as worsening with repetition, as skin also becomes thinner and less elastic with age.¹² Research on how skin responds to being folded again and again shows why:

Expression lines become persistent wrinkles. In an eight-year study of 122 women, the lines each woman showed when smiling at the start predicted where her lasting wrinkles were eight years later. The authors concluded that repeated folding of the skin during facial expression causes persistent wrinkles.⁶
Concentrated strain leaves residual creases. When volunteers smiled in very dry air, the strain around their eyes concentrated into crease-shaped lines, and more wrinkling remained afterwards than in humid air. The researchers propose that residual creases like these build up into permanent wrinkles.¹⁹
Repeated folding changes the tissue. In a laboratory model of the skin's dermis, repeated folding made the tissue contract and changed the orientation of its collagen fibres. The change was driven by the cells contracting, not by collagen breaking down.⁷
Deformation reshapes skin structure. Imaging of living skin showed that stretching flattens the wavy junction between the skin's outer and inner layers, and the researchers suggest that a lifetime of daily deformation may contribute to the flattening seen with age.²⁰
Wrinkles sit under compression. Computer modelling of an expression wrinkle found the skin beneath it is mainly under compressive stress, which the authors propose drives the tissue changes behind lasting wrinkles.²¹

Most of this research is on expression lines or on skin in general, and we're not aware of any study that has followed sleep creases over many years in the same way. But sleep lines involve the same repeated compression and folding, which is why plastic surgeons regard side and front sleeping as a contributor to lasting wrinkles.^{1, 12}

What can you do about sleep lines?

These approaches work on different parts of the process: keeping your face off the pillow, reducing pressure or friction, or limiting how much the skin folds.

Sleep on your back

How it works: Keeps your face off the pillow entirely.⁹
Trade-offs: Hard to keep up, because most people change position many times a night.¹²
Evidence: The most direct way to remove the cause: plastic surgeons describe back sleeping as ideal for limiting sleep wrinkles.¹²

Pillows designed to reduce facial contact

How it works: Changes how your face is supported, to spread or remove pressure on it.⁵
Trade-offs: Comfort varies, and your face may still touch the pillow as you move.
Evidence: Pillow design can change facial pressure a great deal: in tests of face-down surgical pillows, a curved design left the cheeks and the area under the eyes with little pressure.¹⁰ Effects on sleep lines over time haven't been measured.

Silk, satin and specialist pillowcases

How it works: Smoother fabric reduces friction, so skin may drag less as you move.
Trade-offs: Doesn't reduce the pressure of your face on the pillow.
Evidence: Friction against fabric deforms skin, more so when it's less elastic,¹¹ but we found no clinical trials of silk for sleep lines. In a randomised trial of pillowcases containing copper oxide, crow's-feet wrinkling fell over eight weeks, with no change in people using ordinary pillowcases; the researchers credited the copper rather than the fabric.²²

Overnight face patches

How it works: Designed to hold the skin they cover flatter, so it folds less while you sleep.
Trade-offs: Only covers the areas you patch, and adhesive won't suit everyone's skin.
Evidence: Studies so far are small and have looked at expression lines: in one, skin stayed measurably smoother for up to an hour after the pads came off;²³ in another, people rated their frown lines better after four weeks of nightly use, but surgeons judging photos blind found no significant change.²⁴

Everyday skincare and sun protection

How it works: Supports your skin generally. Daily sunscreen slows visible skin ageing: in a four-and-a-half-year trial of 903 adults, daily users showed no detectable increase in skin ageing.¹⁸ Keeping skin hydrated also softens its surface, which in computer models reduces the compressive stress beneath a wrinkle.²¹
Trade-offs: Can't stop your skin being folded while you sleep.
Evidence: Strong for sunscreen and skin ageing in general, not for sleep lines specifically.

For lines that have become established, a GP, dermatologist or qualified practitioner can talk you through treatments. Muscle-relaxing injections are designed for expression lines, and aren't aimed at creases caused by pressure.¹²

Where do face patches fit?

Overnight face patches are a mechanical approach, aimed at the physical process behind sleep lines. Sleep lines form when skin is compressed, dragged and folded against bedding,¹ and repeated folding is linked with lasting wrinkles and with structural changes in skin.^{6, 7} A thin patch stuck over an area of skin is designed to hold that skin flatter, so it's less free to fold into the same crease while your face is pressed into the pillow. Patches don't reduce the pressure itself; the idea is to change what that pressure does to the skin they cover.

They suit people who don't want to, or can't, change how they sleep, and who want to focus on particular areas such as the forehead or the skin around the eyes.

Research on adhesive facial pads so far has looked at expression lines rather than sleep lines. In a placebo-controlled study of 39 people, pads on the crow's feet area left the skin measurably smoother for up to about an hour after removal, and were well tolerated.²³ In another, 26 people wore pads on the forehead and between the brows every night for four weeks: they rated their frown lines better, but surgeons judging photographs without knowing which were taken before or after found no significant change.²⁴

How strong is the evidence?

The research comes from three directions: studies of sleep lines themselves, research on how skin behaves when it's pressed and folded, and a few questions that are still open.

Direct evidence about sleep lines

Sleep wrinkles are a recognised type of wrinkle, different from expression lines in cause, location and direction.^{1, 2, 4}
They form when the face is compressed and folded against bedding in side and front sleeping positions.^{1, 5, 14}
They're common in older adults: one study found them on the forehead of 46% of people aged 60 and over.⁹
The side people usually sleep on is linked with measurable eyelid changes on that side.^{16, 17}

Supporting evidence from skin mechanics

The way the face is supported measurably changes the pressure on it.¹⁰
Friction against fabric deforms and shears skin, more so when skin is less elastic.¹¹
Repeated folding changes the structure of skin tissue in the laboratory,⁷ and stretching alters the microstructure of living skin.²⁰
Repeated creasing from facial expressions is linked with lasting wrinkles,⁶ concentrated strain leaves residual creases behind,¹⁹ and in computer models the skin beneath a wrinkle is under compressive stress.²¹
Older skin wrinkles more readily and recovers more slowly.^{3, 8}

Still being studied

Long-term studies that follow sleep creases themselves, as researchers have done for expression lines.⁶
How much difference pillows, pillowcases and patches make over years: trials so far have been small and short.^{22, 23, 24}

Frequently asked questions

Why do I wake up with lines on my face?

Lines you wake up with are often sleep lines: creases made by your face being pressed and dragged against the pillow for hours.¹ If a line matches where your face met the pillow and softens as the day goes on, that's the likely cause.

Why do I wake up with a line on my cheek?

If you sleep on your side, your cheek takes much of the pressure, and the same crease can form night after night. A 2023 dermatology classification calls these "sleep cheek wrinkles".⁴ They usually fade after you get up, though more slowly as skin gets older.³

Are sleep lines permanent?

Not at first: they usually soften after you wake. Over time, repeated creasing can contribute to lines that stay. Long-term research shows this for expression lines,⁶ and sleep creases involve the same kind of repeated folding.¹

Does sleeping on your side cause wrinkles?

It can contribute to them. Side sleeping compresses, drags and folds the skin that rests on the pillow, which is how sleep lines form,¹ and in long-term research on expression lines, skin that creases repeatedly is where lasting wrinkles develop.⁶ Age, sun exposure and genetics play a part too.^{1, 18}

Can sleeping on your back prevent sleep lines?

Back sleeping is the only position that keeps your face off the pillow, so it avoids the pressure that causes sleep lines.^{9, 12} The catch is that people change position about 20 times a night on average.¹²

Do silk pillowcases help with sleep lines?

Silk reduces friction, so your skin may drag less as you move, but your face still presses into the pillow. Friction against fabric does deform skin,¹¹ but we couldn't find any published clinical trials of silk pillowcases for sleep lines.

Do anti-wrinkle injections work on sleep lines?

Muscle-relaxing injections target lines caused by facial movement. Sleep lines are caused by pressure, so relaxing muscles isn't designed to address them.¹² A qualified practitioner can advise on established lines.

Do overnight face patches work for sleep lines?

They're designed to reduce folding in the areas they cover while you sleep, which targets the mechanical process behind sleep lines.¹ Studies of adhesive pads so far have been small and have looked at expression lines rather than sleep lines.^{23, 24}

Are sleep lines the same as wrinkles?

They're one kind of wrinkle. Wrinkles in general are linked to age, sun exposure and repeated expressions; sleep lines are the kind formed by pressure while you sleep.¹

About this guide

Written by the NINKLES team using the published research listed below, and last reviewed on 30 September 2026. We've kept the research and our product clearly separate. This guide is general information, not medical advice.

Sources

Anson G, Kane MA, Lambros V. Sleep wrinkles: facial aging and facial distortion during sleep. Aesthetic Surgery Journal. 2016;36(8):931–940. PubMed · doi:10.1093/asj/sjw074 A review by plastic surgeons explaining how sleep wrinkles differ from expression wrinkles, and the compression, shear and stretching involved.
Fulton JE Jr, Gaminchi F. Sleep lines. Dermatologic Surgery. 1999;25(1):59–62. PubMed · doi:10.1046/j.1524-4725.1999.08073.x An early clinical description of sleep lines, the "pillow or hand test", and their link to how deeper facial tissue attaches to the skin.
Luebberding S, Krueger N, Kerscher M. Mechanical properties of human skin in vivo: a comparative evaluation in 300 men and women. Skin Research and Technology. 2014;20(2):127–135. PubMed · doi:10.1111/srt.12094 Measured skin elasticity in 300 people aged 20 to 74: the skin's ability to recover after stretching declines with age.
Peng JH, Peng HP. Cheek wrinkles revisited: etiological classifications and nonsurgical treatment options. Journal of Cosmetic Dermatology. 2023;22(6):1733–1738. PubMed · doi:10.1111/jocd.15689 Two dermatologists classify cheek wrinkles by cause into five types; Type 5 is "sleep cheek wrinkles", alongside atrophic, expression-related and laxity wrinkles. Open access.
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Lévêque JL, Fanian F, Humbert P. Influence of skin extension upon the epidermal morphometry, an in vivo study. Skin Research and Technology. 2014;20(1):58–61. PubMed · doi:10.1111/srt.12083 Imaging of living skin, relaxed and stretched: stretching flattened the junction between the skin's outer and inner layers. The authors suggest a lifetime of daily deformation may contribute to changes seen with age. The first author consults for L'Oréal.
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Baek JH, Yoo MA, Koh JS, Borkow G. Reduction of facial wrinkles depth by sleeping on copper oxide-containing pillowcases: a double blind, placebo controlled, parallel, randomized clinical study. Journal of Cosmetic Dermatology. 2012;11(3):193–200. PubMed · doi:10.1111/j.1473-2165.2012.00624.x 61 adults aged 30 to 60, randomised to copper-oxide or ordinary pillowcases for eight weeks: crow's-feet wrinkling fell in the copper group only. The authors credit the copper, not the fabric; a co-author worked for Cupron, a maker of copper-oxide fibres.
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Ryan WR, Most SP. A prospective evaluation of the efficacy of topical adhesive pads for the reduction of facial rhytids. Archives of Facial Plastic Surgery. 2009;11(4):252–256. PubMed · doi:10.1001/archfacial.2009.18 26 people wearing pads nightly for four weeks: no significant improvement when surgeons assessed photographs blind.