Pillow Talk

Picture showing lady sleeping on a pillow

Table of Contents


Having the right pillow is a vital ingredient of a sound night’s sleep. This article will provide you with the information you need to choose the right one, and show you how to use it properly.

What problems can the wrong pillow cause?

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

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

Is my current pillow any good?

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?
  • Is your sleep 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’s 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 strain going through them. That can’t happen without a pillow.

During the day, the best posture for your neck 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 achieve 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. That’s quite hard work for a good neck, never mind one that’s dealing with the effects of a problem or with advancing years. It’s really only young children that can sleep how they like. For this reason, osteopaths don’t recommend sleeping on your stomach (the prone position).

How many pillows do you need?

You need one pillow, and you need to use it in the right way. Why not two? The main reason is that they will separate 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 to be supported in a neutral position.

I recommend using a standard pillow with a foam filling. Whatever type you buy, a good pillow 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.

Should the pillow give be hard, soft or medium?

Pillow give is the amount that any pillow will compress as you lie on it.

We have seen that the pillow should mould to the shape of our neck. This supports the neck 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!

So you really need at least a medium or even a soft one.

Should the pillow depth 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. People do vary. The larger the difference, the deeper the pillow needs to be.
  • The second relates to pillow depth and the trade-off between pillow depth and pillow give. Clearly, the more give in the pillow, the deeper it 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 or too skimpy a filling makes most people put another pillow on top.

I advise most patients to go for a regular polyurethane fairly deep pillow with lots 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 on.

Other types of pillows

Specially shaped pillows

These are often called orthopaedic. These have a raised ridge designed to give 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 three times that of a regular pillow)
  • They come in a standard size and give which won’t suit everyone
  • The raised ridge paradoxically can feel intrusive for the neck
  • They are often not wide enough compared to a conventional pillow

But they can be better than ordinary pillows in cases of very high neck muscle tension or advanced wear and tear. Your osteopath or manual therapist will advise you if you are in this category. 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 tend to bunch and clump together, gradually losing support during the night.

Memory foam pillows

The foam reacts to the heat of the body and moulds 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 that 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 comfort or support.

Water pillows

These are excellent, in my opinion.

A water-jacket underneath a shallow, regular pillow raises the pillow the right height. The pillow becomes adjustable because you can vary the amount of water to get the right depth.

It also makes for a heavier pillow. This is good because the pillow doesn’t move around as much.

And it’s nicely supportive because water is a conforming medium.

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 shoulder 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 support the neck
  • 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 in the majority of cases
  • Pillows with gimmicks often don’t add much
  • Try the pillow before you buy it