Dr. Frank Wen, DC
What Kind of Pillow Should I Sleep On?
Updated: Oct 9, 2019
It's another very common question that is asked by patients all the time that wake with neck pain and shoulder pain.
There doesn't seem to be a shortage of new pillow designs coming out year after year in attempt to alleviate the neck and shoulder pain that people might have when waking up. You might think that the problem would be solved by now. Yet... here you are reading this 😃.
In this article I'll present the most practical information that I've gathered from the research along with my professional opinion that you will hopefully be able to use to better manage your neck and shoulder pain.
Are People Good at Choosing Pillows?
I figure it's a good place to start to see how we're doing on the whole at choosing a pillow.
One Australian study (Gordon et al. 2011.) analyzed a set of data from a 10-week study (Gordon et. al. 2009) the authors previously did that compared polyester, regular foam, contoured foam, feather, and latex pillows to 106 participant's own pillows to examine the effect on neck pain, neck stiffness, headache, and shoulder blade pain.
The authors examined questionnaires that participants filled out regarding their sleep quality, pillow comfort, and symptoms when using their own existing pillows at the baseline week before testing other pillows. They found that just over 40% of people are waking up with no symptoms with their own pillow before any intervention. However, 50% wake with some sort of complaint.
That suggests that about half of us could be sleeping on a less than ideal pillow.
While the authors found some correlation between pillow comfort and sleep quality, high pillow comfort or high sleep quality do not guarantee waking up without symptoms. Subjects may go to bed without problems but wake with problems and vice versa. Neck stiffness was the most common symptom maintained or produced overnight in even those that rated their pillow comfort or sleep quality as high. On the other hand, bad sleep quality and low pillow comfort were more consistently able to produce neck and shoulder stiffness.
So the authors were curious what type of pillows the subjects were using before their study and asked the participants to send their own pillows in for the authors to examine.
What did they find?
Pillow Material Seems to Make a Difference
Of the 81 participants out of the 106 that sent their own pillows in, about 60% slept on polyester pillows, and 30% slept on contoured foam or latex. The least popular pillows used by participants were regular foam, feather, and wool pillows. While the authors did not find a statistically significant difference between the various pillows owned by the subjects in regards to comfort scores and sleep quality, they did see that feather pillow users were most likely to report poor sleep quality and poor pillow comfort. Latex pillow users tended to report high comfort and sleep quality.
How do those findings compare to the findings of their 10 week study (Gordon et. al. 2009) where they experimented with various pillows? The authors found that compared to the subject's usual pillow:
Feather pillows were the most problematic as they had a higher probability of creating pain or exacerbating existing pain
Polyester, contour foam, and latex pillows helped those who went to bed without pain wake up without pain
Latex pillows may help those with occasional pain wake with less
Polyester, contour foam, and regular foam pillows did not make much of a difference for those with occasional or frequent pain
Feather pillows were rated the least comfortable
There is some agreement between both the authors' studies. In the end, they concluded that the best pillow to recommend to people looking for a new pillow was a latex one. The brand they used for the experimental study was produced by Dunlupillo (they're on Amazon too).
Before you call it a done deal, there's still more to the story.
Do Neck Support or Contour Pillows Work?
When sleeping on your back, these pillows are generally designed to preserve a degree of curvature in your neck with some sort of contour. The presumption is that if the curvature of the neck is preserved, that should amount to less pain when waking. Does it work?
The best study at present (Shields et al. 2006) identified 127 research papers looking at the effect of cervical support pillows on chronic neck pain. The authors then whittled it down to 5 studies that were deemed just enough quality to attempt to answer if cervical pillows are able to reduce neck pain.
Within these 5 studies, there were only two studies that compared 3 types of cervical support pillows to the user's usual pillow as the control. Only one support pillow, which was the Mediflow water support pillow had a moderate effect on pain reduction. The remaining studies lacked controls to compare to despite showing some promising results. For this reason, the authors concluded that:
There is not enough good studies to recommend the use of cervical pillows.
The authors of the Australian study (Gordon et al. 2011) also questioned the utility of contour pillows also as they found they were less comfortable and provided poorer quality sleep in their study.
Pillow Height Can Affect Muscle Activity in the Neck and Upper Back
As most people in the world tend to be side sleepers, one novel study (Sacco et al. 2015) decided to look at the effect of 3 different foam pillow heights (5cm, 10cm, and 14cm) on muscle activity in the neck and upper back (Sternocleidomastoid, upper trapezius, middle trapezius) along with perceptions of comfort in side-lying subjects.
If you take a side-lying person and draw a line right down the spine to split the body in half, the study finds that electrical activity of the muscles in question are markedly higher on the downside compared to the upside in all pillow heights. However, the activity on the downside is even more when the subjects were sleeping on the 5 cm pillow. Activity was similar between the 10cm and 14cm, but participants preferred the 10cm pillow height for comfort.
Like most studies, this one wasn't perfect. It was a small amount of subjects and they were only tested for 5 minutes on each pillow and were not asleep. The muscles examined do not encompass all the muscles around the neck and upper back that can be responsible for pain. At a minimum though, this study shows that laying down may not be as passive of an activity to your muscles as you may have thought. This may partly explain why you wake with "knots" or "pinching" in the neck and upper back.
Putting It All Together and My .02 Cents
I believe most healthcare practitioners and people have been led to think that picking a pillow that supports “ideal” curvature of the neck is the most appropriate, but the solution isn’t that simple as it seems (see my article about why alignment doesn’t always tell the whole story). If good curve=no pain, then why do we need all these health practitioners treating neck pain? We can stick everyone in a brace or give them a contour pillow and call it a day. I can tell you that will create just as many problems as it may solve.
As someone who used to wake with daily neck pain I share your frustration. There likely isn't going to be one pillow that will work for everyone.
BUT - I think there is something to be gleaned from the research and it's that pillow height and deformation control is likely an important factor.
Too little height will cause excessive activity in your neck and upper back muscles and may contribute to the development of knots and stiffness as well as being less comfortable to sleep on.
When we consider the material types of the pillows examined in these studies, I'm not surprised that polyester, latex, and contour foam pillows perform better as they likely withstand the effects of weight and moisture well over time, causing them to maintain better shape and form. In fact, in a survey for the Australian study (Gordon et al. 2009) before the experiment, the authors also found that participants mostly discarded regular foam and feather pillows for another pillow type within 18 months while polyester, foam contour, and latex pillows showed greater longevity.
Instead of just throwing money at the problem to try every pillow there is, I believe in taking charge of your own health and applying some DIY when possible. I can’t promise you that this will work for you, but this solution has done wonders for me (along with some exercise and other environmental adjustments). It may even help lead you to the "right" pillow by learning your preferences.
Check my short video below on what it is I do to help me wake up pain-free:
*I forgot to mention at 3:30 that you can experiment with the folds in the towel. Everyone will have a different thickness that they feel better with. Some may need most of the fold where the neck falls on the pillow where some may need it across the whole pillow. Experiment to find what feels best for you!
If you've been dealing with neck and shoulder pain for a while now, fixing your pillow is one environmental aspect you can address. Check out my tips for neck and low back pain if you're a desk worker for more things that can help.
If you need an expert chiropractor in Kirkland, Bellevue, or Redmond- don't hesitate to reach out to me. Use code PILLOW when you book online only and you will receive 25% off your First Chiropractic Visit.
Thanks for hanging out!
Shields N, Capper J, Polak T, Taylor N. Are cervical pillows effective in reducing neck pain? New Zealand Journal of Physiotherapy. 2006;34(1):3-9.
Sacco IC, Pereira IL, Dinato RC, Silva VC, Friso B, Viterbo SF. The Effect of Pillow Height on Muscle Activity of the Neck and Mid-Upper Back and Patient Perception of Comfort. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. 2015;(6):375.
Gordon SJ, Grimmer-Somers K, Trott P. Original Article: Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy. 2009;14:671-678.
Gordon SJ, Grimmer-Somers K. Your Pillow May Not Guarantee a Good Night’s Sleep or Symptom-Free Waking. Physiotherapy Canada. 2011;63(2):183-190.