Expert advice on how to find the pillow that suits your sleep style.
By Colette Bouchez
Reviewed by Louise Chang, MD
Nothing starts your day off better than getting a good night's sleep. And sleeping with the right pillow can help.
"Pillows can not only impact the quality of our sleep, but also how healthfully we rest and recharge," says sleep expert Michael Breus, PhD, a clinical psychologist and author of Beauty Sleep: Look Younger, Lose Weight, and Feel Great Through Better Sleep.
But the wrong pillow may worsen headaches, neck pain, shoulder and arm numbness, discomfort, sneezing, and wheezing, notes orthopaedic surgeon Andrew Hecht, MD.
"A bad pillow won't be the cause of any of these problems, but using the incorrect pillow can certainly exacerbate many of the underlying problems linked to these symptoms, and it certainly can keep you from getting a good night's rest," says Hecht, the co-chief of spine surgery at Mt. Sinai Medical Center in New York.
And if your pillow is past its prime, it may contain skin cells, mold, mildew, fungus, and dust mites, which make up more than half of an older pillow's weight, Breus notes.
Is it time to buy a new pillow? Experts say the general rule is to buy a pillow every 12 to 18 months. After two years, it's definitely got to go.
Pillow Shopping: Consider Your Sleeping Style
Before you buy a new pillow, think about your sleep position.
"The goal of using a pillow is to help keep your head in what is called a 'neutral alignment,' meaning your head is sitting squarely on your shoulders without bending back too far or reaching too far forward," says Kammi Bernard, PT, a physical therapist at the Baylor Health Care System in Dallas.
Some expert advice:
If you sleep on your back: "Back sleepers need thinner pillows, so their head is not thrown too far forward," Bernard says. Also look for a pillow with extra loft in the bottom third of the pillow to cradle your neck.
If you sleep on your side: Side sleepers need a firmer pillow to fill in the distance between the ear and outside shoulder.
If you're a stomach sleeper: Look for a very thin, almost flat pillow. You may not even need a pillow for your head, but consider tucking one under your stomach to avoid lower back pain, Breus suggests.
Pillow Stuffing Options
There is no shortage of fillings you can find stuffed in a pillow these days. The most common ones are down-feather combinations, foam, or polyester fiberfill. Memory foam and latex pillows have become quite popular in recent years, particularly among people looking for additional neck support.
What's right for you? That may depend on how you're feeling on a given day, says Breus, who recommends that most people have more than one type of pillow to choose from. A pillow wardrobe, in other words.
Pillows serve multiple purposes," Breus says. For instance, you may want a pillow to support your neck if your neck is bothering you one day. But once your neck feels fine again, that same supportive pillow may not be the most comfortable for you, Breus notes.
Here's what to look for in each type of pillow filling:
Foam: "Go by the density," Breus says. "The higher the density, the less breakdown, and the more support you will have without getting too soft."
Memory foam: These are popular because they reduce pressure points by continuously molding and adjusting to the shape of your body as you move throughout the night. Memory foam pillows come in various shapes, including a popular contoured S-shape, which is meant to support the neck. Breus notes that memory foam material is known to make sleepers hot, and can sometimes emit an unpleasant chemical odor.
Latex: This is the firmest type of pillow, and it resists mold and dust mites, Breus says. Latex pillows may also help with back and neck alignment, as they're often contoured for neck support.
Wool/cotton: Wool and cotton pillows are hypoallergenic and resist mold and dust mites. Both also tend to be quite firm. So if you love a squishy pillow, these fillers aren't for you.
Down/feather: Many sleep experts recommend these as one of the best pillows for a good night's rest. "One of the great things about down pillows is that you can move the stuffing around so that you have the most support where you need it," Bernard says. "Plus, it's soft, yet firm enough to give you the support you need."
A combination of 50% feather and 50% down works well because the feathers act like springs and are "quite supportive," Breus says.
Do you avoid down or feathers because of asthma or allergies? Several studies have shown they pose no greater risk than a synthetic pillow -- and may, in fact, be better for you. But if you're allergic and prefer not to take a chance, synthetic down pillows are an option.
If a good-quality down pillow is out of your price range, other options include polyester fibers, such as Primloft, that mimic down. But Breus warns that although alternatives to down pillows are cheaper than some pure down pillows, they also won't last as long.
Shopping for your Perfect Pillow
When shopping for a new pillow, keep these tips in mind:
Consider more than cost. "Just because a pillow costs more does not automatically make it a better pillow or the right pillow for you," Bernard says. "What matters is how the pillow feels to you. Most of the time, you can find something that works without breaking the bank."
Try it out in the store. "If you're in a store and there's the option to lie down, do that," Breus says. If that's not an option, Breus suggests that you stand next to a wall in the position in which you like to sleep, put the pillow against the wall as though the wall were a vertical mattress, lean your head against it, and ask someone to tell you if your neck is tilting one way or another. Your neck should be in line with your spine.
Specialty Pillows: What You Should Know
Many pillows are designed to address specific needs, including hot flashes, headaches, and neck pain. But they can be pricey, and there is little clinical research available about how well they work.
Here's a quick look at some of the options:
Cervical pillows: Available in various materials and shapes, these pillows add extra cushioning in the lower portion of the pillow to support the neck. Doctors say that occasionally they can be of some help, but a research review, conducted by the Canadian Institute for the Relief of Pain and Disability in 2007, showed insufficient evidence to recommend for or against the use of these pillows.
Water pillows: Favored by some physical therapists and many chiropractors, these pillows use water to create your own customized level of density and support.
Cool pillows: Touted as an antidote to hot flashes and night sweats, these pillows include a filling of tiny "beads" that absorb and whisk away head heat, leaving the part of the pillow that touches your face cool. "You lay your head on it and it's like you always have the cool side of the pillow," Breus says.
Oxygen-promoting pillows: This pillow technology is based on studies of sock fabric that helped promote circulation in diabetes patients. These pillows use the same technology to increase oxygen content in tiny blood vessels by up to 29%. What can that do? Doctors aren't sure, but "some people have even reported a reduction in pain after using these pillows," Breus says.
Anti-snore pillows: There is limited research showing that any particular pillow design affects snoring. But individual patient reports, and a study published in 2005, show that relief is possible in some people.
Positional pillows: These pillows are designed for back, stomach, or side sleepers. Experts say some can be very helpful. If you choose one, look for support, comfort, and the right size for your body.
Freelance writer Lisa Zamosky contributed to this report.
Michael Breus, PhD, WebMD sleep expert and clinical psychologist; author, Beauty Sleep: Look Younger, Lose Weight, and Feel Great Through Better Sleep.
Andrew Hecht, MD, co-director of spine surgery at Mt. Sinai Medical Center, New York City.
Kammi Bernard, PT, physical therapist, Baylor Health System, Dallas-Fort Worth, Texas.
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Conference of Chiropractic Research and Education, San Diego, June 1996.
Zuberi, N. Sleep and Breathing, October 2004; vol 8: pp 201-207.
Reviewed on January 20, 2010
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