With hundreds - if not thousands - of pillows currently on the market today, it’s a wonder how anyone can still claim they’re having back and neck pain or having trouble sleeping - yet millions of people do. Perhaps it’s because most pillows only address one or two issues that contribute to insomnia and chronic pain when the issue is far more complex than that.
After researching dozens of peer-reviewed studies, we’ve compiled a final word on what the perfect pillow looks and feels like. For the purpose of this investigation, we did not take into account the opinions of any sponsored or affiliate articles but did reference reviews and testimonials of customers.
When creating and choosing the “perfect pillow”, the goal should always be to maintain what’s called normal cervical lordosis. This refers to the alignment of the head and neck and its proper positioning over the rest of the spine. According to Kapandji (Physiology of the Joints, Volume III), every inch that the chin is lowered toward the chest is an additional 10 pounds of pressure on the spine, so keeping everything aligned is important to prevent longterm musculoskeletal damage.
Before addressing cervical lordosis and its overnight maintenance, one of the most important problems to address is the temperature of the pillow. A study by the National Institute of Advanced Industrial Science and Technology found that quality of sleep is highly dependent on the temperature of the head, so keeping one’s face and head cool is the first step to reducing tossing and turning. While many pillows claim to stay cool all night using gel technology, those tend to lose their coolness and shape over time. The physical design of the pillow itself also seldom lends itself to a restful sleep. Therefore, using alternate methods like silver and breathable foam are the best ways to begin designing the perfect pillow.
According to a study performed by Beijing Sport University, the optimal height for a pillow is 7cm. However, what’s important to note is that this study was performed on otherwise able-bodied women without preexisting muscular conditions. Their level of comfort was measured at different pillow heights, and the study found that after a certain level of comfort was achieved past 10cm, that comfort level began to go down. In addition, the study found that comfort levels at the head and neck were different than levels in and around the lower spine. While the pillow height had the greatest impact on shoulder and head comfort, that was not the only factor in determining subjective comfort scores.
This study also noted a positive correlation between shoulder width and pillow height. In other words, a pillow that provides support along the full width of one’s shoulders is more likely to result in a more comfortable experience. Another study published by the Journal of Chiropractic Medicine found that the ideal pillow had little to do with height, and that it was more important to support all of the upper spinal regions during sleep: head, neck, and shoulders.
In comparison with the first study, the second was conducted on a variety of patients who may have already had musculoskeletal damage. The first study found a solution for people who were otherwise content with their pillows, but since sleeping incorrectly or sleeping with a “bad” pillow can cause long-term damage, finding a comfortable solution to meet one’s individual needs is difficult. There is no one-size-fits-all pillow since the damage caused by improper sleeping positions is a highly personal issue.
Furthermore, people frequently toss and turn in their sleep, so most pillows are limiting in their support. Back sleepers can become stomach or side sleepers and back again over the course of a few hours, during which time pressure is increased on the spine and damage continues to occur. The ideal pillow would provide steady support as the head turns from each position to the next, keeping it perfectly aligned with the shoulders no matter which way one faces.
One prototype (left) offers a possible solution for near-universal alignment. The lower portion of the pillow supports the width of the shoulders, and the roll in the middle keeps the spine in the same position no matter how the subject moves over time. The back portion of the pillow is tall enough to reduce nasal blockages and prevent snoring, all while reducing pressure from the cervical spine. This also reduces pressure from the lower spinal region, but to a lesser extent.
It’s also important to note that people who already have preexisting spinal conditions may find it difficult to adjust to a new pillow, since realigning the spine can be an uncomfortable process. Anyone who has switched to a new mattress can attest to this, but on average it takes about 6 weeks for people to feel the effects of proper support. In the meantime, realignment can be mildly painful, but the sooner you start, the sooner you can feel the positive effects.
The perfect pillow looks different for everyone, but there are a few ways you can improve your own sleeping posture while science works out the kinks:
Invest in a silver pillow, or one with silver strands. Silver naturally wicks away bacteria and mold while keeping you cool for hours. It doesn’t lose its coolness or shape the way gel does and doesn’t require pre-refrigeration.
Stick with one pillow rather than multiple to ensure that your neck and head height stays consistent throughout the night. Rolling from one height to another can result in pulled muscles and neck pain.
Measure your pillow’s effectiveness by seeing how well it keeps your ears right above your shoulders. If your head is slightly heavier than average, invest in a firmer pillow for added support, and vice versa.
Start now, not later - once the damage is done, it’s difficult to reverse. Not only will improving your sleep posture result in better overall health, but it’ll contribute to more restful and fulfilling sleep.
Hu H., Liao S., Zhao C., Gui Z., Yang F. (2017) A Research on Effect of Pillow Height on Pressure and Comfort of Human Body’s Prone Position. In: Duffy V. (eds) Digital Human Modeling. Applications in Health, Safety, Ergonomics, and Risk Management: Ergonomics and Design. DHM 2017. Lecture Notes in Computer Science, vol 10286. Springer, Cham
National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1 Higashi, Tsukuba, Ibaragi, 305-8566, Japan. firstname.lastname@example.org
“The Physiology of the Joints. Volume 3. The Trunk and the Vertebral Column.” Postgraduate Medical Journal vol. 51,599 (1975): 682–683.