London: Choosing the right pillow depends largely on your sleeping position, body shape, and mattress, according to physiotherapy guidance. Sleepers generally fall into three groups: side sleepers, back sleepers and front sleepers.
Physiotherapists generally discourage sleeping on the front because keeping the neck turned to one side for a prolonged period can stretch and irritate muscles or ligaments. There is broad agreement in physiotherapy that people experiencing spinal pain should avoid sleeping on their front.
For back sleepers, pillow height should take into account the natural curve at the top of the spine. This curve can become more pronounced with age. People with a greater curve may require a slightly thicker pillow, while those with a flatter back may need less height.
For side sleepers, shoulder width is an important factor. Broader shoulders generally require a thicker pillow to keep the head and neck properly supported. However, the mattress also affects the required pillow height.
A firm mattress allows the shoulder to remain higher, meaning a side sleeper with broad shoulders may need a thicker pillow. On a softer mattress, the shoulder sinks further into the surface, so a thinner pillow may provide the appropriate height. This difference is less significant for back sleepers because they generally do not sink into the mattress as much.
A simple way to test pillow height is to place a folded towel underneath the pillow. The number of folds can be adjusted until the height feels appropriate, providing a rough guide when selecting a new pillow.
What about pillow shape?
Pillows marketed as contoured, ergonomic or orthopaedic are designed to provide additional support, but evidence for their effectiveness is not conclusive.
Some evidence suggests that a pillow with a slightly raised front section supporting the neck may benefit side sleepers. This can also be tested by rolling a towel and placing it underneath the pillow.
Side sleepers should aim for a position that keeps the back straight. Some pillows designed for back sleepers feature a depression in the centre with raised sides, which can help maintain a suitable sleeping position. However, the shape may not feel comfortable for everyone.
Pillow firmness and thickness should also take head size into account. People with larger or heavier heads may require a thicker and firmer pillow for adequate support.
Feather, foam or fibre?
Feather and down pillows can help keep the head cool because they can move heat away from the body. However, they may change shape during the night, particularly for people who move frequently while sleeping.
As the filling shifts, a pillow that initially provides an even surface can become bunched up towards the head of the bed. This can create a wedge-shaped surface and leave the neck bent upwards.
Hollow-fibre and microfibre pillows generally retain their shape better, although they may not dissipate heat as effectively as feather and down fillings. Some designs use firmer material in the lower section to help the pillow maintain its structure during the night.
There is no single pillow design that works equally well for everyone. The most suitable choice depends on individual sleeping position, shoulder width, spinal shape, mattress firmness, head size and personal comfort. Where available, using a manufacturer’s trial period can help determine whether a pillow provides the right level of support.
Trying different pillow heights and materials can also help identify what feels most comfortable and supportive. A pillow that keeps the head and neck in a natural position may contribute to more comfortable and restful sleep.
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