“There is no pillow as soft as a clear conscience.”
“Don't leave your dreams on the pillow.”
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So, what about pillows?
Studies exploring the best properties of a pillow indicate that pillows must be supportive to decrease the stress on the cervical spine (neck) during sleep, must be of intermediate height and must be made of a material that does not result in excessive pressure. The ideal shape is still debatable. According to Hager et al. (2001), visco-elastic polyurethane (“memory”) foam is an ideal material for a pillow, as it has ‘conformable’ properties, and is able to shape to the individual’s neck shape. Memory foam also dampens sound and vibration, and absorbs shock and energy, all of which are important for quality sleep, and may assist in pain relief because sleep quality has been implicated in neck pain relief.
THIS study, intitled Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment, compared chiropractic treatment with the addition of a viso-elastic polyurethane (“memory”) foam pillow verses chiropractic care without the use of a memory foam pillow. In this relatively small (30 people) study, a clinical improvement in pain scores of 73% were seen in the group with the addition of the pillow compared an improvement of pain scale of 43% in the chiropractic treatment alone group. The pillow and chiropractic group also had a 71% improvement in their daily activity function scores compared to a 59% improvement in the chiropractic only group.
THIS small (22 people) study found similar results in improved pain and disability with chronic neck pain patients undergoing physical therapy treatments with and without the addition of a latex foam pillow.
THIS study of 106 participants compared several different pillow materials. They found that a latex memory foam type pillow scored the best and a feather pillow was the worst for having the highest frequency for waking neck pain.
THIS study, entitled Pillow preferences of people with neck pain and known spinal degeneration: a pilot randomized controlled trial, had 117 participants, and basically did not show any significant difference in pillow type for people with spinal degeneration. The author remarked that a good study would require 400 plus participants to truly detect pillow impact on waking symptoms and sleep quality
Much like the information on mattress types, there is some evidence that a memory foam / latex type pillow reduces pain and might be a superior choice of material. As the last paper above stated, most of the studies done are too small to get a very clear signal of benefit for one type of pillow verses another. That said, I think memory foam pillows are a good blend of support and comfort. As with a mattress, medium firm seems to be the best.
My first suggestion goes back to sleeping posture. If you are a stomach sleeper, I encourage you to work on transitioning to a side lying or supine (on your back) position. Next, if possible, recruit an assistant to take a look at your overall posture and alignment as your settle into your sleeping position. If you start out on your back, is your head flexed forward too much (pillow too thick), is your head tipping backwards (pillow too thin) or is your head relatively level? Same thing if you are a side sleeper. You want to be in the Goldilocks “just right” zone with your head aligned with your spine, not tipped too high or too low.
In our office we carry THESE Pillowise brand pillows. There are six different sizes of pillows available. The correct pillow size is determined by an algorithm which utilizes three specific measurements of the neck and shoulders, mattress firmness and sleeping posture. These pillows are comparable in price to other high-end pillows. Many of our patients who purchase this pillow are very happy with them. In full disclosure, they are not right for everyone. I think we have had three or four people return the pillow because they did not find them comfortable. Often, I will try to talk people out of buying one if they are sleeping well, have good positioning and alignment with their current pillow. I don’t think there would be significant benefit from adding the custom pillow. I also discourage someone who is in acute pain from purchasing. If you are in severe pain, I don’t find that it a good time to make a pillow switch.
HERE is what looks to be a good review of pillows by US News and World Report