It is a very comforting feeling to have just the right pillow to rest an achy, tired body on. In addition to providing comfort, the right pillows can also provide the necessary support for the neck and spine - alleviating or preventing many common forms of back pain and neck pain.
Use of a pillow while sleeping has two main functions:
• Support: From a physical perspective, pillows prop up the head, neck and shoulders - keeping them in alignment, relieving pressure and counterbalancing the points in the body.
• Comfort: From a more subjective perspective, pillows create a feeling of comfort, which aids in getting a good night’s sleep and feeling well rested.
Different Types of Pillows
Mattress top pillow - the traditional pillow is the mattress top pillow - used to provide support for the head, neck, and upper spine while the body is lying in bed in a resting position. For optimum support, it is best to select a pillow that has the following characteristics:
• Designed to keep the spine in natural alignment - the human neck curves slightly forward (to sustain the weight of the head when upright), and it’s important to maintain this curve when in a resting position. If the height of the pillow is too high when sleeping sideways or on the back, the neck is bent abnormally forward or to the side, causing muscle strain on the back of the neck and shoulders. This type of position may also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep. Conversely, if the height of the pillow is too low, the neck muscles can also be strained. Based on the body’s measurements and personal preference, the pillow should maintain a height of 4 to 6 inches, properly supporting the head and neck (and shoulders when lying on back).
• Feels comfortable - a large part of what makes a good pillow is personal preference. If the pillow feels comfortable, it’s likely to help one relax, get a good night’s sleep, and feel well rested in the morning. The pillow's surface can also be a source of comfort - some people prefer a pillowcase with a cool, smooth feeling (such as cotton), some prefer warmth (such as flannel), etc.
• Adjustable - to help the pillow conform to various sleep positions, it is best if the pillow can be adjusted to fit the unique shape and curves and sleeping position of the user. A pillow should mold to one’s individual shape and alleviate any pressure points.
• Pillows for each sleep position - one’s sleep position will dictate how a traditional mattress top pillow can be used to provide the appropriate support.
o Back -when lying on the back, a pillow should support the natural curvature of the cervical spine, with adequate support under the head, neck, and shoulders. When sleeping on the back, the height of the pillow should be lower than in the sideways position. Placing a pillow or two beneath the knees further alleviates any back strain, and is the gentlest position on the back.
o Side - when lying on one’s side, a pillow should support the head and neck such that the spine maintains a straight and natural horizontal line. Weight should be evenly distributed so as not to create unnatural bending or pressure. Some people may prefer placing a small pillow or rolled up towel under their waist while lying on the side for additional support.
o Stomach - if sleeping or resting on the stomach is preferred, the pillow should be relatively flat, or the head should rest directly on the mattress, so that the head and neck aren’t turned unnaturally to either side. In this position, it is often best to place another relatively flat pillow under the stomach to help the spine keep its natural alignment.
Over time, most pillows will begin to lose their firmness and no longer support the neck adequately. When the pillow has reached this stage, it should be replaced.
Rest and sleep are the body’s chance to heal itself from the postural, physical and nervous insults of the previous day. The use of some of the following pillows can improve the quality of rest and repair, allowing one to wake up more rested and ready to face another day.
It is important to note that not all pillows work well for everyone. A short trial of one week should be enough time to decide whether or not the pillow is providing benefit.
Knee pillows - using a traditional (mattress top) pillow either between the knees (when sleeping on the side) or below the knees (when sleeping on the back) is important to alleviate strain on the lower back.
• When sleeping on the side, bending the knees and placing a pillow between the knees prevents the knees from coming together and keeps the spine in the neutral position. When there is no support between the legs, the upper leg rotates downward, pulling the pelvis, and distorting the natural line of the spine. Adding support between the knees can prevent back pain induced by these types of forces and allow the back to heal and more properly rest while sleeping.
Usually, a firm pillow between the knees works better than a softer pillow because it serves somewhat as a kickstand to keep the upper leg from rotating over the lower leg.
When sleeping on the back, placing a pillow underneath the back of the knees helps reduce the load on the lower back. Some people even prefer to have two pillows to elevate their knees higher. With two or more pillows underneath the knees, the lumbar spine is flattened, putting less force on the pain sensitive facet joints of the spine. this position is the best overall to help the back rest comfortably, and many people find that this is the only way they can sleep during an acute phase of back pain or while recovering from spine surgery.
Body pillows - a pillow that is as long as the body can serve several functions for people who prefer to sleep on their side, as the top portion can be used to support the head and neck, while the bottom portion supports the knees and legs. Some people find this more comfortable than using separate pillows for the head and knees. In particular, women who are pregnant may find that a body pillow that provides added support for the abdominal area helps them rest comfortably. Throwing the top leg over the body pillow while side sleeping should be avoided, as this places torque (twisting force) on the lower thoracic and lumbar spine.
Neck pillows - a pillow that is contoured to fill the spaces under the head and neck can be helpful for people with neck pain. Also called cervical pillows or orthopedic pillows, this type of pillow has a deeper depression where the head lies, and extra support under the neck. People with neck pain may favor these pillows, as they fill the hollow space created by the neck and help keep the neck in alignment with the spine. Some orthopedic pillows tend to wear out after one or two years and may need replacing.
Travel pillows - a"U" shaped pillow that is curved to fit snuggly around the neck can be used for sleeping or supporting the head when in a seated position. This type of pillow prevents the head from bending too far to one side or the other. It also creates a support so that the weight of the head is partially taken care of by the pillow. This relieves some of the work done by the muscles keeping the head up and may be beneficial while sleeping in a sitting position, such as in an airplane or in a car.
Lower back support pillows - a lower back support pillow helps provide support for the inward curve in the lumbar spine. Sitting for extended periods of time without any lower back support can create muscle tension and pain in the lower back and legs (e.g. sciatica). Used when in a seated position, a lumbar support pillow fills the natural gap that is created between the lower spine and the chair. Lumbar back support is also helpful when sitting in a car. When the lumbar curve is supported, the downward forces of gravity and driving are absorbed much like a coiled spring, as opposed to a non-supported straight or slouched lumbar spine.
Donut pillows - as the name implies, this is a donut-shaped pillow that is placed on the seat portion of a chair. With either a depression or a hole in the center of the pillow, one can sit with much less pressure in the coccyx region (the tailbone). People who have suffered a broken or bruised tailbone or have coccygeal pain (such as coccydynia) may need this type of pillow in order to sit without pain.
Use of a variety of pillows for both comfort and support can make a big difference in alleviating or avoiding back pain or neck pain and getting a good night’s sleep. For people with spinal disorders, the right type of support can be especially important in helping the spine rest comfortably.
For example, most down or feather pillows offer very little structural support compared to pillows filled with firmer materials. People who suffer from moderate or severe spinal disc degeneration, spinal stenosis, myofascial pain, or trauma often seem to experience a more restful night’s sleep with a firmer pillow. Pillows filled with grain or buckwheat hulls are often effective for people with any of the above-mentioned conditions.