Can’t give up that pillow? – think again!



by Carl Parnham RMT

I am not a pillow expert, but I deal with people’s proverbial “pain-the-neck” every day.  So, I did some research into pillows and here is what I found.  I came across this scientific study published in a physiotherapy journal (Physiotherapy Canada, Volume 63, Number 2, Pages 183-190).  Here they let people use their own pillow as well as other types.  The participants (106 of them!) were given 5 different pillows (New Latex, Polyester, Foam Contour, New Foam Regular and Feather) as well allowed to use their own pillow. They got to use each pillow in turn for a week in length and observed if they had any negative symptoms upon waking up in the morning…you know, neck (cervical) pain, stiffness, headache, and shoulder (scapula) pain. The data was collected and put in to charts. Here’s what they found….

And here is the most amazing conclusion that sort of tells us what we already know! “Conclusion: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common” with their own pillow. More than half (61 out of 106) of research participants who used their own pillow had negative neck symptoms upon waking.  That’s a problem right?! The article also noted that the biggest problem group was feather pillow who consistently reported poor comfort and sleep quality. That makes a guy think twice about a feather pillow, right?

The best pillow that was the most comfortable and had the least amount of “side effects” during and after sleep were the new latex, polyester, and foam contour pillows.  They “produced consistently lower frequencies of waking cervical pain than new foam regular or feather pillows”  I have many clients that have a sore neck and associated headaches when they wake up – so I realized it’s time for me to wake up a bit and start having my clients play around with their pillows.

Now here’s my problem with this study and where my common sense kicks in when you’re choosing a pillow. To be honest I really don’t think it’s the “type” of pillow per se is what is important here.  We have to look at the underlying principle or nature of both the pillow and your body and head.  Two factors come to mind for the pillow: 1) how thick and 2) how soft or pliable it is.  Now for the body/head part, the way to a goodnight sleep is to be in a  “neutral” neck position. We know about neutral position in massage therapy, since we want to put you into that for your best comfort.  So depending on how you sleep and how your neck is attached to your head (shoulder size, chest dimensions, neck length and contour), a neutral neck position may need a different pillow nature of thickness and softness.  To achieve a good night’s rest without pain or discomfort in your neck, you have to use a pillow that allows your neck to be relaxed, without stretch or strain – AND this will change depending on if you lie on your back, side, or front!

Here are some obvious examples: If you sleep on your back you are going to need a thinner pillow because you cervical (neck) spine doesn’t need to be very far forward. You may need something a little thicker if you neck naturally is forward more (this happens over time to those who work at a desk too long!).  Also, you need enough softness that it will hold your head stable without rocking around everywhere! For you side sleepers, you need a thicker pillow to match the width of your shoulders, and you need enough squish to conform to the asymmetry of the side of your face without suffocating your mouth and nose!  Some people put their arm under their pillow when they sleep on the side because the pillow isn’t thick enough, but we massage therapists see a lot of nerve impingement syndromes (numbness/tingling down the arm) because of that. If that is you, why not try a thicker pillow and get your arm out from under the pillow? And if you sleep on your tummy you will need something thinner, since any thickness will push the neck back (in fact, in this position, for many, no pillow is required at all. But like the side layers, if you use a pillow when you’re on your tummy, you will need enough squishiness to support the asymmetry of the side of your head/face.

A big problem is finding out what kind of sleeper you are.  For instance, you may think you’re a back sleeper because that’s where you start the night off, but you find yourself on your front with too big a pillow when you wake up! Quite the conundrum, indeed. I say go with how you wake up, since that is where your body wants to go anyhow, and you can’t control what you do when you sleep, so you may as well accept it as “your” position.  Buy a pillow according to keeping your neck/head in neutral position based on how you wake up. Radical thought eh?

Another thought.  Even if you had the “right” pillow for you, how do you know when it needs to be replaced ? (yes, they do lose their fluffy factor over time). A rule of thumb I have heard is that if you fold your pillow in half and put a shoe on it, and if it doesn’t unfold then it’s toast! Note some pillows, like the thinner less soft ones, can’t unfold on their own, so use commonsense.

In the end the only way to figure out what’s really best is through trial and error. So go and do your own experiment!  Buy a bunch of pillows based on what you feel you may need.  Try a couple you think would not be good for you too (you may be surprised, or at the least, more confident in your final choice!). Don’t think “pillow types” or “pillow cost”, but rather get pillows with different thickness and pliability based on the common sense applications of the principles discussed in this blog.  Try them out for a week each and record in the morning a rating for neck pain, stiffness, headaches, etc.  Now, after you discover the best one, what to do with the one’s you don’t like?  Give them to a friend and let them do their own experiment (they only have to buy one extra pillow now instead of several…maybe they can buy you supper or beer?). 

Happy hunting for that perfect sleep!