As Shakespeare once said “Sleep, per chance to dream” is the aspiration of everyone. Having a good pillow is the often the key. If you have neck pain, finding a comfortable pillow is a challenge. There are multiple options in size, stiffness and materials that must be considered. The wrong pillow just makes everything worse from neck pain and headaches, to shoulder and upper back pain. Furthermore, a pillow that is over two years old will often be full of dead skin cells, and possibly mildew, mites, or fungus.
Finding The Perfect Pillow
The first thing in getting a pillow is to determine the position you sleep in such that the support will keep your head in a “neutral alignment” position. If you sleep on your back, a thinner pillow with a possible extra bit of cushioning in the bottom third cab help maintain the curve of the neck. A side sleeper will need a fuller and firmer pillow to keep the head from tilting. Sleeping on the stomach often requires only a very thin pillow for the head position. A second pillow that helps maintain body position may also be helpful to improve comfort and to prevent pain. If you change your position during the night, you may have to decide how to combine features to maintain the most neutral alignment.
Pillows are also filled with a variety of different materials. The most common are a variety of feathers, foam, polyester fiberfill, and some are filled with weird materials like water, rice or beads. Classically, pillows used to be either feathers and down, or cotton with wool. A 50-50 mix of down and feathers has been traditionally considered one of the best to provide comfort, support, and allow for adjustments of the cushioning to provide a quality sleep. However, for those with allergies and asthma, down or feathers may cause difficulties. A mix of cotton/wool is another traditional material, but tends to be quite firm and not very adjustable. Polyester fiberfill is an artificial hypoallergenic material that can be designed to mimic down pillows in comfort, and memory foam has become popular over the last several years. Memory foam can continuously mold and adjust to the neck and body position. Today, there are a bunch of different types of foam including cool foams, mold resistance foam and hypoallergenic foam.
Specialty pillows are often expensive and have many designs, shapes, claims and materials. Cervical pillows are made in shapes to cradle the neck supposedly in a neutral position, but studies have usually shown these to be no better than regular designs. Water pillows recommended by some professionals supposedly can be adjusted to customized density and support, but may have odd motion. Bead, wheat or rice pillows claim to provide customized position into a neutral position, but tend to be quite firm and heavy.
The bottom line in choosing a pillow is that everyone has different preferences that may be the best for you. The fancy claims and expensive costs do not make a perfect pillow. First, determine your sleep position, as this will give you an idea of the thickness you might like, then find your preferred firmness. Stay away from down/feathers if you have asthma or allergies. The best option often is trying out various types of pillows at the store if at all possible while lying down. Have someone with you to make sure your neck is in a good neutral position, and if it is the right comfort level, you may have found the winner. Remember, it is comfort and not necessarily cost that is key.
Thomas Cohn, MD
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