March 18, 2006 | Episode 11

Feather pillows
Pillow talk: How to find the best support for your head and neck
Real Simple Television Productions Inc.


No Pain in the Neck

How to choose (and use) a good pillow

You’d think with all the hours we spend on it — and how it effects our day — the humble pillow would be the subject of countless studies and, yes, tireless research. Think again. “There hasn’t been a whole lot of research conducted on optimal types,” says Clete Kushida, a sleep physician and neurologist who serves on the board of the American Academy of Sleep Medicine. Even the American Association of Orthopaedic Surgeons suggests good old intelligent trial and error as the best system for finding a pillow that suits. To help you avoid too much tossing and turning while you try to find a pillow that’s perfect for your posture, Real Simple narrowed the field.

If You’re a Back Sleeper

Pay attention to the curve at the base of your neck. “If your pillow’s too big and fluffy, sometimes your head sinks into it — and if you’re a back sleeper, your head will hyperextend,” says Nicholas DiNubile, M.D., a spokesperson for the American Academy of Orthopaedic Surgeons and the author of FrameWork: Your 7-Step Program for Healthy Muscles, Bones, and Joints (Rodale Books, $18).

Holly Rudnick, a senior physical therapist who specializes in the spine at New York’s Hospital for Special Surgery, recommends making a personalized support system to prevent that hyperextension: “If you roll up a towel lengthwise and you put it about a quarter of the way up inside the pillowcase, you’ve built in a neck support to use while you’re lying on your back,” she says. “That way, you can play around with the thickness of it and come to a better idea of what is going to work for you. And then if you want to go out and spend money on a prefab pillow that simulates that, you can do that.”

Another trick beyond the pillow: “If you’re sleeping on your back, generally you want to make sure the spine is in a relaxed position,” says Rudnick. “We recommend people put some kind of towel roll along the small of their back. Putting a pillow underneath your knees is another way of taking up the slack in that space between your spine and the bed.”

If You’re a Side Sleeper

“Keep the head, neck, and spine in a relatively horizontal plane,” Kushida says. DiNubile agrees. “With a side sleeper, a small to medium pillow works well,” he says. “Otherwise your head is cocked a little too far upward, which is not great for your neck. You want it in what we call neutral position, which is that position that you normally stand in, where the head is centered and looking straight ahead.”

Rudnick suggests creating a cushion for the space between your neck and shoulder. “You want to have that curve taken up and supported,” she says. “Some people can do that with just a pillow.” Choose a squishable but sturdy feather variety, she suggests. “Other people need an additional support, whether it’s a towel roll or neck rolls. And there’s an abundance of neck rolls on the market.” A second pillow placed between the knees and the ankles will prevent torque on the hips and maintain proper alignment.

If You’re a Stomach Sleeper

“You’re probably going to need less of a pillow or a very thin one — or maybe none,” says DiNubile. “Because if you use a bigger, fluffy pillow, it’s going to throw your neck into a little bit of an extension.” But if you’re what Rudnick calls a “quasi” stomach sleeper, then you have a separate prescription. “A quasi stomach sleeper is half on her stomach, half on her side,” she explains, “in which case, the bottom leg is more straight and the top leg is bent. But instead of being stacked on top of the other hip, the leg is forward and half rolling into the stomach.” For proper support in this position, she says, “you’d have a pillow under the knee of the top leg. In that case, most people don’t really need the support at the waist, but they do still need support at the neck. The idea is you want to take any twisting out of the spine while you’re sleeping.”

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