"Dr. Amy, what pillow should I use?"
This is probably one of the most frequent questions I get and I can’t believe I am just writing a blog post about this now! Unfortunately, there is no one size fits all approach here. Shopping for pillows is similar to shopping for shoes, it is all going to depend on your body!
To start, let’s define what a “neutral neck” means. You will need to know what this is for us to
describe the other positions. Imagine you are sitting up and you are trying to have “good”
posture. Your head is centered on your shoulders, and not leaning to one side or another. You tuck your chin slightly, trying to give me a slight double chin, avoiding the chin jutting out position we all assume after a day at work on a computer.
Next, let’s review how everyone would sleep in unicorn land! You would all sleep on your back, with a pillow that allows you to have a neutral neck. Your arms would stay down and below your waist. You would also have a pillow under your knees, allowing your low back to fully relax and lay flat against your mattress.
This is the point of the conversation where all my patients say, “But Dr. Amy- I CAN NOT sleep like that!!!” It’s ok. There is hope for all of you.
Stomach Sleepers - The Worst Kind
Let’s start with the worst of the worst sleeping positions- stomach sleeping. All stomach
sleepers always brace for impact when they tell me that is how they sleep, because they know they aren’t supposed to sleep that way! Your secrets always stay safe with me, however, you should really try and change the way you sleep. Imagine you spent 6-8 hours during your day with your head turned one direction. Awful, right?!
BUT, if you sleep like this, consider that you may not need a pillow at all. You need your neck to be as in line with your spine as you can get it if you are going to have your neck cranked to one side. If you use a pillow, it should be very soft and flat. My advice, at least sleep with your feet off the bed so you don’t trash your ankles as well and consider sleeping on a pillow under your stomach/pelvis to alleviate some low back pain.
Side Sleepers - Getting Better
If you are a side sleeper, you will need a thicker, firmer pillow to help support your neck in
order to keep your neck neutral through the night. The pillow should be as thick as the space between your outer shoulder and neck. The people that absolutely should not sleep in a side position are those of you with shoulder and low back, piriformis, ITB, and hip complaints.
Pressure on one shoulder all night long is very rough on your shoulder laying down, and you
impinge on all of your shoulder tendons. The side that is up also tractions down and pulls on your neck and glute musculature all night long. You also usually torque out your low back in rotation. If you are going to sleep like this, you should sleep with a pillow between your legs and a pillow under your arm that is up. Should you have a painful side, this side should be up.
However, I will reiterate, if you have a painful “side”, aim to sleep on your back at least until
you are not symptomatic.
Back Sleepers - Star Pupils
If you are a star pupil and sleep on your back, look for a medium thickness pillow. You don’t want it to be so thick it is pushing your head forward, or so thin your neck is laying in excessive extension. Be sure to sleep with your arms down so you don’t create unnecessary shoulder impingement. Memory foam is a good choice for pillow fill.
Fast Pillow Facts:
1 in 4 people know that pillows should be replaced every two years, but wait longer to replace them.
1 in 5 people have never washed their pillow
70% of people are not absolutely comfortable showing their naked pillow to others
While almost 90% of people wash their sheets one to three times per month, 20% have never washed their pillows, and nearly 45% only wash their pillows once a year.
I cannot stress this next part enough- replace your pillows frequently! Also, WASH THEM!
Pillows collect dead skin cells, mold, mildew, and dust mites (as well as their poop!). Many
pillows state on their wrapper how long they should last, be sure you make a note and set a
phone alarm. No seriously, I am not kidding. Most of you probably don’t remember the date on your pillow so a few things to check for include: permanent stains (yes, those gross yellow ones that look like pee but aren’t), permanent smell (think musty/mildew), and lack of “bounce back” if you were to fold your pillow in half. Your pillow should be washed every 3-6 months in hot water. The exception is memory foam, which does not need to be washed.
It is imperative you buy a high-quality pillow if you are an allergy sufferer and consider
replacing pillows at least yearly. You should look to see that your pillows are anti-microbial. Many allergy sufferers have been told to avoid down, however, this myth has somewhat been put to rest. Down alternatives tend to collect more dust mites (which is likely what they are allergic to) due to their loosely woven casings allowing dust mites, dander, and mold spores to collect inside. Instead of washing every 3-6 months, consider monthly.
I hope this pillow guide helps! Overall, many of us spend a third of our day utilizing our pillow (and breathing in whatever is growing in them), prioritize the quality accordingly!