Tears on my Pillow

By March 6, 2017Health

Choosing a pillow is fraught with frustration. If you are in pain, are getting headaches on waking or have an old favourite pillow that is clearly dead and know you need a change – there is big money and a lot of experimentation involved in finding the right pillow for you. Ever walked into a bedding store and asked about pillows? There are lots of opinions and manufacturers pay significant amounts for endorsements and in some instances pay for the research! With all of these issues – it’s hard to be sure how to really pick the right one for you!

Many of our clients ask the physiotherapist’s single most dreaded question – “What kind of pillow should I be using?” When clients have headaches, neck/shoulder pain or neck pain that extends into the arm – there is a lot at stake to answering with the best knowledge that is out there, rather than opinion! But here’s the good news:  pillow research independent of the manufacturers by physiotherapists has finally be done so that you can be rested and reassured that you are making an educated choice!

Only when I’m sleeping: Most people use one pillow and sleep on their side

Surveys and sleep lab studies all confirm that sleeping with one pillow was the most common across all ages. Sleeping on your stomach is more common in the very young but over the teenage and adult years – research show 70% of people are side sleepers.

10% of the population sleep on their backs (more men than women); 5% on their stomachs and 8% vary their position. The least common position (and most uncomfortable) was upright reclined sitting – a position used by those with reflux, major heart or respiratory conditions.

Most people use one of five different types of pillows:

  • Polyester fill
  • Feather or down
  • Latex pillows
  • Foam Contour pillow
  • Foam non- contoured

Wake me up before you go-go: Waking symptoms are common

Regardless of pillow type – we know from Australian research (Dr Susan Gordon) than 50% of people on their own pillow have:

  • regular waking symptoms (think pain/stiffness/headache), or
  • went to bed with symptoms that weren’t relieved
  • reported poor quality of sleep, or
  • reported an uncomfortable pillow

46% of everyone in the study reported waking with symptoms at least once per week. There were differences between men and women – women were more likely to wake with a headache, men with neck stiffness. Mostly these symptoms are occasional, mild and lasting only an hour or two.

Screaming-woman-with-pillow_smlThere are also a small section of people where it didn’t matter which pillow they were on – their own or their trial pillow, they didn’t have any symptoms! There is also another type of person where they had symptoms regardless of trying different pillows – their symptoms were still there, indicating that waking symptoms can be more complex than the posture and surface you sleep on!

40% of people reported interrupted sleep – waking at least once per week for many reasons but not related to their pillow. The conclusion we draw is that many people experience disturbed or non restful sleep regularly!

Side-sleeping is most common, most restful and least likely to give you neck pain/headaches

Side sleeping is associated with much higher sleep quality compared with other positions. If you sleep on your side you are much less likely to report waking up with neck pain, stiffness or headaches compared to those who sleep in any other position.

Those that can’t lay on their side such as people with heart conditions – where they have to lie elevated have the least restful sleep – and were 2.5 times more likely to wake up with symptoms.

Pillow fights – sure we’ve heard all this – just tell me what is best!

“I had a bad experience”: How would you rate your sleep quality last night?

How comfortable you find your pillow actually isn’t related to how often or how much pain/stiffness you wake up with. When you ask someone how comfortable the pillow is and then how often they wake up with symptoms – there actually isn’t a relationship between the two (that has been seen in the research so far!). However what has been found is that if you report your sleep quality as poor  you are more likely to report neck stiffness and arm pain.

Polyester and feather pillows gave the least support in terms of head and upper neck creating less supportive slopes to keep the head and upper neck in a “neutral”– non extreme position.

Latex and Foam pillows are the best for reducing headache or neck pain that goes into the arm

Latex, and foam pillows (both contoured and non-contoured) performed significantly better in showing reduced waking symptoms such as neck pain, headaches and arm pain. Not only could they reduce the frequency of waking symptoms, but they also reduced the duration that these symptoms were felt.

Non contoured Foam pillows perform the same as contoured

Contour high density foam pillows and non-contoured foam pillows perform equally well in terms of waking with less symptoms and supporting a more neutral head/neck position. There is no difference in the performance of these two types of pillows – both performed equally well.

The only advantage to some types of contour pillows is that some brands have adjustable centres – allowing more control over the height of the pillow for the individual.

When it really comes down to it though, we know that personal preference (particularly for feather/down pillows) is the biggest determining factor! If you love this type of pillow, you are more tenacious and devoted to this style of pillow – and there are no expert opinions that sway the most important component of any decision – your own personal preference! It is an important part of the decision making process.  Regardless of what the experts tell you, don’t discount your own previous experiences when considering your pillow choice.


Don’t want to miss a thing – How to pick the right pillow:

Dr Susan Gordon created this excellent website, with some pretty funky photos, going through the most important concepts in creating a great sleep. It has lots of useful tips on deciding what is right for you:

Top tips:

  • Is sleeping on your side more comfortable? If you can sleep on either side you’re more likely to reduce your neck/headache/arm symptoms
  • When thinking about improving your head support in sidelying think about the gap between your ear and the tip of your shoulder. The goal is to keep the head in a relatively neutral position to avoid stretching the pain sensitive bits of your neck joints, nerves and muscles
  • When you are getting off to sleep – try to avoid pulling your head forward to your chest or curling in too far
  • Write down everything you do and don’t like about your current pillow
  • If you think your pillow is too narrow – before you put on the pillowcase – add some extra folded towels to bulk up the bottom side of the pillow
  • If your pillow is too wide – is there another in the house that you can try?
  • Acclimatisation to a new pillow takes at least a week – so if you’re not sure about your new pillow – you do need to give it time.
  • When you sleep on a pillow – ask yourself how would I rate how well did I sleep last night; rather than how comfortable do I find this pillow.
  • Write down each morning whether you woke with pain/stiffness/headache so you can figure out how many days per week you’re waking with discomfort. Also try to note down how intense the symptoms were (0 = nothing, 10 = severe)
  • When you change your pillow do the same – write down each morning whether you woke with pain/stiffness/headache and then compare if there has been a change in how often and how intense the symptoms are

Still want to know more? Call 02 9948 6188 or email enquiries@kineticaphysiotherapy.com.au to book an appointment with one of our physiotherapists.

Deb Wright
Practice Principal


1. Gordon SJ, Grimmer KA, Trott P. Sleep Position, Age, Gender, Sleep Quality and Waking Cervico-Thoracic Symptoms. The Internet Journal of Allied Health Sciences and Practice. 2007 Jan 01;5(1), Article 6.

2. Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Man Ther. 2009 Dec;14(6):671-8. doi: 10.1016/j.math.2009.02.006. PubMed PMID: 19427257

3. Gordon SJ, Grimmer-Somers K. Your pillow may not guarantee a good night’s sleep or symptom-free waking. Physiother Can. 2010;preprint. doi:10.3138/ptc.2010-13

4. Gordon, S. J., Grimmer-Somers, K. A., & Trott, P. H. (2010). Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. Journal of Pain Research3, 137–145.

5. Gordon, S. J., Grimmer-Somers, K. A., & Trott, P. H. (2011). A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying? Journal of Multidisciplinary Healthcare4, 321–327. http://doi.org/10.2147/JMDH.S23028

Deb Wright

Author Deb Wright

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