Typical sleep positions are: back, side, stomach or combination. The optimal pillow maintains spinal alignment reducing neck strain. Neck strain leads to neck pain. Most importantly, if the pillow provokes neck pain, it is the wrong pillow, regardless of whether it follows the guidelines outlined below.
Back sleepers:
Lying flat in bed with head facing the ceiling or one side requires a pillow to support the neck without propping the head too high. Ideally, the chin should be in the same plane as the sternum. A relatively low, medium firm, pillow best accomplishes this. Medium-firm pillows are typically filled with materials such as down, down-alternative microfiber, natural latex, or cotton. Pillows that are too firm or too tall or too elevate the head too much.
Side sleepers:
For side sleepers, a pillow that is too low or too high disrupts spine alignment. The most suitable pillows are generally higher with firm support. The pillow should be tall enough to prevent the head from dipping towards the mattress. The ideal pillows are usually between 4 to 6 inches tall. Compressible fill materials such as wool, down or feather may not provide enough neck support for side sleepers.
Additionally, side sleepers must consider body shape. For example, a larger person with broad shoulders likely requires a higher pillow than a petite person for adequate head support. For people with broad shoulders, it is often worth considering a high-loft and extra firm pillow.
Stomach sleepers:
Stomach sleeping places the most stress on the neck because the head is turned for the duration of the night. For stomach sleepers, a low-loft, soft pillow best maintains spinal alignment. Soft, plush pillows, such as those filled with shredded memory foam or microfiber are ideal. Contoured pillows can provide neck support while supporting the head are often ideal for stomach sleepers.
Combination sleepers:
Many people shift positions throughout the night. For these people, finding the optimal pillow is obviously more difficult. Changing positions can disrupt sleep if the new position aggravates the neck. A pillow allowing smooth transitions between positions is ideal. Typically, these sleepers are most comfortable with materials that respond to movement, such as shredded memory foam or latex foam. A firm pillow pushes the neck forward when back sleeping, and a soft pillow does not provide enough support for side sleeping.
