Pillow Talk

A good pillow is a vital ingredient of a sound night’s sleep. This section should help you track your way through all the issues, providing you with the information you need to choose the right one and use it in the right way.

What problems can the wrong pillow cause or worsen?

  • Neck aches and pains
  • Aches, pains, numbness or pins and needles in the arms or hands
  • Headaches

But a sub-optimal pillow won’t in itself usually cause mid or low back problems – that would be more likely to be the mattress.

How can you tell if the pillow you are using at the moment is causing a problem? After all, you might just have a poorly neck! Ask yourself the following questions;

  • Do you wake up in the morning with more aches and pains than when you went to bed?
  • Does your sleep get disturbed by neck aches and pains?
  • Do you find yourself ‘propping up’ the pillow with one or both hands?
  • Do aches and pains tend to go away during the mid-morning?

If the answer to just two of these questions is yes, then it is definitely worth checking your pillow.

Why do we need a pillow anyway?

Sleeping without one is not recommended at all. At night you want the joints, ligaments and muscles of your neck and upper back to be in a comfortable position, with little if any strain going through them. That can’t happen without a pillow. During the day, the best posture for your neck as you are walking around or sitting requires balanced muscle effort and the least strain on joints or ligaments. As we all know, this isn’t easy to achieve! We need to try and arrive at this ‘neutral’ position while sleeping.

If you don’t use a pillow, one reason might be because you like lying on your stomach, with your head turned to one side. This is quite hard work for a good neck, never mind one that’s dealing with the effects of a problem, or a stiff mid back, or advancing years. It’s really only young kids that can sleep how they like. For this reason, osteopaths don’t generally recommend sleeping on your stomach (the ‘prone’ position).

How many pillows do you need?

You need one good pillow, and you need to use it in the right way. Why not two? The main reason is that they can get separated during the night. Once they move off each other, you won’t get the support you need. After all, the main reason for using two is because one pillow does not seem to give enough support.

How should I use a pillow?

Whether you lie on your back (‘supine’) or on your sides (‘side-lying’), the rules are the same. The correct use of the pillow enables the neck (not just the head) to be supported in a neutral position.

Don’t let your shoulders and upper spine rest on the pillow in any way. The picture below shows a lady lying on her side, with her shoulder on the pillow. This makes the neck ‘arch’ back over the pillow.

Pillow resting under shoulder.

Don’t let the head alone rest on the pillow. The pillow should be pulled in and tucked underneath the neck itself, to avoid a ‘space’ under the neck. Try not to use two pillows. Apart from moving all over the place during the night, two pillows raise the head excessively, as seen in the picture below. Even if you do use a single pillow, make sure it’s deep (and soft) enough.

Pillow too high.

The picture below shows the effects of too shallow a pillow.

Pillow too low.

The right pillow, used in the right way, should look a little like this (note the straight alignment of the lady’s spine).

Just about right.

A final tip: if you like lying on your side but have a problem with the bottom shoulder, it is a good idea to bring the underneath shoulder a little in front of you to avoid too much compression.

So what’s the right type of pillow to use?

I recommend using a standard pillow with a foam filling. Whatever type you use, the right pillow for you allows your neck to relax in a neutral position (providing you use it correctly). One that works well for you may not work for your partner.

I am often asked whether the pillow should be hard, soft or medium (the ‘give’ of the pillow). Now, we have already seen that we need the pillow to mould to the shape of our neck, to give the neck support while the head is comfortably resting on the pillow. It’s easy to see that a hard pillow won’t let that happen (imagine lying on a piece of wood!). And a hard pillow just won’t feel comfortable. So you really need at least a medium or even a soft one.

Another common question is whether the pillow depth should be shallow, deep or medium. The answer to this question depends on two factors.

  • The first relates to how broad your shoulders are relative to the width of your neck. The larger the difference, the deeper the pillow needs to be.
  • The second factor relating to pillow depth relates to the trade-off between pillow depth and pillow give. Clearly, the more give in the pillow, the deeper the pillow can afford to be as the head and neck can still ‘sink’ down to the right depth. Now you can see why too shallow a pillow (a common fault) or too skimpy a filling makes most people put another pillow on top (the wrong solution!).

I advise patients to go for a regular polyurethane deepish pillow with a lot of give. This provides excellent support for the neck while still having a nice comfortable feel.

But if you can’t get on with this type of pillow, read the following section.

Other types of pillows

Specially shaped pillows (often called ‘orthopaedic’). These mainly have a raised ridge designed to give even more support to the neck area. But for most necks that don’t have a severe problem, they don’t provide any advantage over a standard pillow. Some disadvantages of these are;

  • Increased cost (up to 3 to 4 times that of an ordinary pillow)
  • They come in a standard size and give which won’t suit everyone
  • The raised ridge paradoxically can feel too intrusive for the neck
  • They are often not wide enough compared to a conventional pillow

However, they can be better than ordinary pillows in cases of very high neck muscle tension or of advanced wear and tear in the neck. Your osteopath or manual therapist will be able to advise you if you are in this category, or you can try one yourself if an ordinary pillow just doesn’t seem to work.

Feather and down pillows. In general, I’m not in favour of them. Feathers especially tend to bunch and clump together, thereby gradually losing support during the night.

Special memory foam pillows. Here the foam has been altered to react to the heat of the body and ‘mould’ to the shape of the head and neck. Although I think this quite a neat idea, I don’t think it’s necessary to use them to get a good night’s sleep. But they can be quite comfortable.

Latex (Dunlopillo). Some people like the way latex seems to mould to the various shapes and contours of the head and neck, and it is a ‘natural’ product.

Pillows with springs. This idea has been borrowed from the mattress world. I don’t think it’s at all necessary, and the ones I’ve tried don’t add much comfort or support.

Water pillows. Excellent, in my opinion. A water jacket underneath a shallow, regular pillow creates a heavier pillow (good, because it does not move around), becomes infinitely adjustable (you vary the water to get the right depth) and supportive (because the water is a conforming substance). Don’t worry, they don’t get cold, and they don’t gurgle.

Key points at a glance 

  • Use one pillow
  • Try not to lie on your front
  • Don’t let any part of your shoulders or upper spine rest on the pillow
  • Don’t lie on the pillow only with your head – make sure the pillow is pulled in to buff up into the neck itself
  • Choose a pillow that, when you lie on it properly, allows your neck to relax in a neutral position
  • A standard pillow – deep but relatively soft – may well be the best option
  • Specially shaped pillows are not necessary for the majority of cases
  • Pillows with gimmicks often don’t add much and might work worse than a good standard pillow
  • Try the pillow before you buy it!