Finding the right pillow is not simply a question of choosing between soft and firm. How you sleep, your body shape and even your mattress can determine the level of support your neck needs.
Physiotherapist Dr Chris McCarthy, associate professor at the Manchester School of Physiotherapy, says there is no single pillow design that works for everyone. Instead, the aim should be to keep the head, neck and spine comfortably aligned during sleep.
Start with your sleeping position
Most people sleep predominantly on their side, back or front, and each position creates different requirements.
McCarthy discourages sleeping on the front because the neck remains turned to one side for an extended period. This can stretch and irritate muscles or ligaments.
For back sleepers, the natural curve at the top of the spine is important. This curve can become more pronounced with age, meaning people with a greater curvature may need a slightly thicker pillow than someone with a relatively flat upper back.
For side sleepers, shoulder width becomes particularly important. Broadly speaking, wider shoulders require a thicker pillow to fill the space between the head and mattress and keep the spine aligned.
Your mattress changes the equation
Pillow height should not be considered separately from the mattress.
On a firm mattress, a side sleeper's shoulder remains relatively high, creating a larger space between the head and sleeping surface. A thicker pillow may therefore be necessary.
A softer mattress allows the shoulder to sink further, reducing that space and potentially making a thinner pillow more appropriate.
This tends to matter less for back sleepers, who generally do not sink into their mattress in the same way.
If a pillow feels too low, McCarthy suggests a simple test: place a folded towel underneath it and experiment with the number of folds until the height feels comfortable. That can provide a rough guide when choosing a replacement.
Do specialist pillow shapes help?
Pillows marketed as ergonomic, orthopaedic or contoured are widely available, but McCarthy says evidence supporting particular designs remains limited.
There is some evidence that side sleepers may benefit from slightly greater support at the front of the pillow around the neck.
Before buying a specialist pillow, sleepers can experiment by rolling a towel and positioning it beneath the front of their existing pillow.
For back sleepers, some pillows feature a depression in the centre with raised sides. While these can encourage an appropriate sleeping position, McCarthy says some patients find the shape restrictive.
Head size and weight also matter. Someone with a particularly large or heavy head may require a firmer and thicker pillow for adequate support.
Feather, fibre or foam?
The material inside a pillow can affect both temperature and how well it maintains its shape.
Feather and down can help keep the head cooler because they allow heat to dissipate. However, these fillings can move during the night, particularly for restless sleepers.
A pillow that begins as a relatively flat and supportive surface can therefore become bunched up, potentially leaving the neck at an uncomfortable angle.
Hollow-fibre and microfibre pillows can maintain their shape more effectively, although they may not disperse heat as well as feather and down.
Some designs incorporate firmer material in the lower half to help the pillow maintain its structure overnight.
McCarthy himself uses a foam pillow with ventilation channels and adjusts its height with a folded towel because he sleeps on his side.
There is no universally ‘perfect’ pillow
Ultimately, pillow choice is highly individual.
A pillow that works well for one person may provide insufficient or excessive support for somebody else because of differences in sleeping position, shoulder width, spinal curvature, head size and mattress firmness.
Where available, McCarthy recommends making use of manufacturers’ trial periods rather than assuming that a particular design will automatically provide the best support.
There is no single pillow suitable for every sleeper. The best option is one adjusted to your own body, mattress and usual sleeping position.
Source: BBC
