Which pillow is right for me?

pillow-guide osteopath Auckland

There are many different varieties of pillow and making the right choice can influence not only comfort but also quality of sleep. 

The big questions are.... 

  • Do you sleep mainly on your side, back or front? 

  • What shape is best for you?

  • What is your pillow made from?

"One's sleep position will dictate how a traditional pillow can be used to provide the appropriate support".

Using a Pillow While Sleeping on the Back

When lying on the back, a pillow should support the natural curvature of the cervical spine (neck), with adequate support under the head, neck, and shoulders.

When sleeping on the back, the height of the pillow should be lower than in the sideways position. Placing a pillow or two beneath the knees further alleviates any back strain, and is the gentlest position on the back.

Using a Pillow While Sleeping on the Side

When lying on one's side, a pillow should support the head and neck such that the spine maintains a straight and natural horizontal line. Weight should be evenly distributed so as not to create unnatural bending or pressure.

Some people may prefer placing a small pillow or rolled up towel under their waist while lying on the side for additional support.

Using a Pillow While Sleeping on the Stomach

If sleeping or resting on the stomach is preferred, the pillow should be relatively flat, or the head should rest directly on the mattress, so that the head and neck aren't turned unnaturally to either side. In this position, it is often best to place another relatively flat pillow under the stomach to help the spine keep its natural alignment.

Over time, most pillows will begin to lose their firmness and no longer support the neck adequately. When the pillow has reached this stage, it should be replaced.

Rest and sleep are the body's chance to heal itself from the postural, physical and nervous insults of the previous day.

The use of some of the following pillows can improve the quality of rest and repair, allowing one to wake up more rested and ready to face another day.

Types of pillow 

Neck Pillows

A pillow that is contoured to fill the spaces under the head and neck can be helpful for people with cervical spine (neck) problems including headaches and migraines. Also called cervical pillows or orthopedic pillows, this type of pillow has a deeper depression where the head lies, and extra support under the neck.

People with neck pain may favor these pillows, as they fill the hollow space created by the neck and help keep the neck in alignment with the spine. Some orthopedic pillows tend to wear out after one or two years and may need replacing.

Knee Pillows

Using a traditional pillow either between the knees (when sleeping on the side) or below the knees (when sleeping on the back) is important to alleviate strain on the lower back.

For sleeping on the side

When sleeping on the side, bending the knees and placing a pillow between the knees prevents the knees from coming together and keeps the spine in the neutral position. When there is no support between the legs, the upper leg rotates downward, pulling the pelvis, and distorting the natural line of the spine (this is a useful tip for those that get pelvis pain and can really help during pregnancy).

Adding support between the knees can prevent back pain induced by these types of forces and allow the back to heal and properly rest while sleeping.

Usually, a firm pillow between the knees works better than a softer pillow because it serves somewhat as a kickstand to keep the upper leg from rotating over the lower leg.

For sleeping on the back

When sleeping on the back, placing a pillow underneath the back of the knees helps reduce the load on the lower back.

Some people even prefer to have two pillows to elevate their knees higher. With two or more pillows underneath the knees, the lumbar spine is flattened, putting less force on the pain sensitive facet joints of the spine.

This position is the best overall to help the back rest comfortably, and many people find that this is the only way they can sleep during a severe bout of back pain or while recovering from spine surgery.

Body Pillows

A pillow that is as long as the body can serve several functions for people who prefer to sleep on their side, as the top portion can be used to support the head and neck, while the bottom portion supports the knees and legs.

Some people find this more comfortable than using separate pillows for the head and knees.

In particular, women who are pregnant may find that a body pillow that provides added support for the abdominal area helps them rest comfortably.

Throwing the top leg over the body pillow while side sleeping should be avoided, as this places torque (twisting force) on the lower thoracic and lumbar spine.

Lower Back Support Pillows

A lower back support pillow helps provide support for the inward curve in the lumbar spine.
Sitting for extended periods of time without any lower back support can create muscle tension and pain in the lower back and legs (e.g. sciatica).

Used when in a seated position, a lumbar support pillow fills the natural gap that is created between the lower spine and the chair.

Lumbar back support is also helpful when sitting in a car. When the lumbar curve is supported, the downward forces of gravity and driving are absorbed much like a coiled spring, as opposed to a non-supported straight or slouched lumbar spine.

Summary of Pillow Support and Comfort

Use of a variety of pillows for both comfort and support can make a big difference in alleviating or avoiding back pain and getting a good night’s sleep.

For people with spinal disorders, the right type of support can be especially important in helping the spine rest comfortably.

For example, most down or feather pillows offer very little structural support compared to pillows filled with firmer materials.

People who suffer from moderate or severe spinal disc degeneration, spinal stenosis, myofascial pain, or trauma often seem to experience a more restful night’s sleep with a firmer pillow.

Pillow shapes and sizes

Contour pillows offer support to your neck without raising your head. For people that find bunching a pillow under their neck adds extra comfort, this may well be what you are looking for. Contour pillows tend to be the most comfortable for a diverse range of sleeping positions and aren't limited to side sleeping. They often have a different height either side so you can turn the pillow as your sleep position changes, or if you change beds when on holiday etc. 

Just a note on gimicky pillows - pillows are designed to support and maintain a neutral position. Pillows that bunch and hold a position are going to do just that, if it holds you in a position that isn't a neutral one it may well make your neck pain worse. It is therefore relying on you knowing what you are doing when you are pre-forming the pillow for that night’s sleep. "Great for some, not for all!"

Loft Height

osteopath pillow guide

The loft height of a pillow is not only determined by the position in which you sleep but also your body size. If you have wide shoulders you will likely be more comfortable with a higher loft pillow. If you have petite shoulders you will likely enjoy a lower loft pillow. The aim in to keep the neck in line with the back whether you are lying on your back or side. You want to aim for a neutral position rather than bending your neck at an acute angle. 

On a softer mattress your shoulders sink in further (if you are a side sleeper) and therefore you don't need as much height to keep your neck in neutral. If you have a firmer mattress you wont sink in as far, and therefore will require more height from your pillow. 

Stomach sleepers find that they need even lower loft again, to avoid a large amount of rotation of the neck when they sleep. Sometimes, no pillow at all can be the answer. (A nice trick for the stomach sleeper is to tuck a pillow diagonally under the neck and arm - on the side you face when you sleep- allowing decreased rotation through the neck. You will look like you are almost cuddling the pillow longways if it is in the correct position). 

If you wake in the mornings with a sore neck or body, have restless sleeps or regularly get headaches, changing your pillow may well be the answer. 

Pillows are a very 'individual thing' for each person so it is hard to recommend one pillow that suits all. 
But, if you take these pointers and apply them to your new pillow purchase, you may be making a very positive change. 

What is your pillow made of?

Your pillow is the closest thing to your face for a good portion of your life. Not only that, it also supports your neck, and head. Choosing a natural organic pillow that lets you breathe fresh air and cradles your neck properly, will allow you to truly rest.

There can be a “toxic soup” of chemicals such as formaldehyde, PCBs, PBDEs, and boric acid. Health Hazards: Symptoms such as headache, nausea, fatigue, and sore throat, as well as conditions such as allergic reactions, respiratory distress, reproductive dysfunction, and cancer. If you want to know more we recommend you read the book  “Toxic Bedrooms” by Walter Barder.

We recommend ORGANIC NATURAL PILLOWS by Innature

  • INNATURE Organic cotton & wool pillows 

  • INNATURE Organic Buckwheat Husk pillows 

  • INNATURE Organic Latex pillows 

Please avoid memory foam as these are generally the worst. Additionally, most bamboo pillows, which we think are good for us, are usually memory foam pillow wrapped in a bamboo cover. Just cleaver marketing. I have not found a bamboo pillow that is actually bamboo. If you have one of these check it out and probably throw it out as it may be causing a lot of your problems.

Remember we spend 1/3 of our lives sleeping!

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