< Focus Physio Blog

Which pillow is right for me?

The average person will spend around 26 years of their life sleeping and an additional 7 years just trying to get to sleep!

< Focus Physio Blog

Which pillow is right for me?

The average person will spend around 26 years of their life sleeping and an additional 7 years just trying to get to sleep!

That is a third of your lifetime spent with your head resting on a pillow which is why investing in a decent one is very worthwhile. A good pillow should support the natural curve of your spine, particularly your cervical lordosis (where your neck curves in a backwards C-shape) in order to distribute load evenly through the intervertebral discs (IVD) and minimise stress on your neck and shoulder muscles. If you’re waking up with sore and stiff neck/shoulder muscles a change of pillow may make a world of difference.

The pillow plays a vital role in your sleep cycle and can greatly affect your quality of sleep. Your musculoskeletal system’s job while sleeping is to support your body weight thereby allowing your muscles and intervertebral discs to recover from continuous load through the day. To achieve this, sleep posture will require bilateral symmetrical and minimal electrical activity. Research has associated higher and longer electromyographic (EMG) activity of muscles during sleep with greater pain and discomfort which will inevitably end up in broken or unrefreshing sleep.

Sleep is considered poor when it lasts less than six and a half hours each night and if you wake up multiple times throughout the night. Growing evidence has found that the time at which you go to sleep can be just as important as how many hours you sleep each night as a misaligned circadian rhythm will affect essential processes and functions that happen during sleep. One example of an important process that happens is called waking cognition which is your ability to stay alert and focused throughout the day. The new skills you acquired during that day are consolidated during sleep where your brain decides which ones to dispose or commit to memory.

A lot of emotional processing also occurs which is mainly regulated by the amygdala; a part of the brain responsible for coordinating your response to emotional triggers in your environment. This may explain why you’re snapping at your colleague for accidentally touching your coffee cup when it wouldn’t normally elicit such a response from you if you weren’t sleep deprived.

Poor sleep has also been associated with reduced muscle mass and decreased grip strength as the anabolic hormone IGF-1 plays an important role in protein synthesis and is rapidly reduced with sleep deprivation, thus implying that optimal sleep can increase or maintain muscle mass thus strength.

So good sleep is very important for our psychological and physical health. Understandably, there are a lot of pillows to pick from and the sleep industry has spent decades trying to create the “perfect” pillow. However, this likely does not exist as the pillow that is right for you will depend mostly on your body dimensions and what position you sleep in. As mentioned earlier, the most important goal of the pillow is to maintain neutral alignment of your spine throughout your sleep and minimize pressure on your skull which will depend on the pillow's “loft”. The loft is the compressed height of the pillow when your head is resting on it. Below are some guidelines to help you pick a pillow that is comfortable for you depending on your sleep position.

If you are a back sleeper:

You will want a pillow with medium loft and medium firmness. If it is too thin, your neck will crane into extension, increasing pressure on the muscles under your skull. If it is too thick, your neck will be forced into cervical flexion, compressing your IVD and straining your posterior neck muscles. A thickness of around 10cm was suggested to be the most suitable pillow height as EMG levels in the trapezius and sternocleidomastoid muscles were highest at 5cm and 14cm pillow thickness and lowest at 10cm. Again, this is just a guideline thickness and will depend on the distance of your skull to the bed to maintain neutral cervical lordosis. Materials that are designed to mould to support the shape of your spine throughout the night such as pillows that contain memory foam may or may not be helpful. Some have found a fullair or B-shaped pillow to be helpful as there is a curve that conforms to your cervical lordosis but a rectangular pillow is still a popular and comfortable option.

If you are a side sleeper:

Because there is a bigger gap to fill between your shoulder and your ear than when you are lying on your back, a thicker loft is suggested to keep your neck from side bending towards either the bed or towards the ceiling. It is common for someone to tuck their arm underneath the pillow throughout the night therefore a thicker, fluffier pillow will also minimise the risk of one’s circulation getting cut off to their arm, resulting in the dreaded “dead arm”. Materials that are therefore firmer and don’t compact overnight such as latex are usually preferred otherwise there is a risk of your neck flexing to one side, potentially increasing pressure on the shoulder or tensioning one part of your neck over the other side.

If you are a stomach sleeper:

Researchers have suggested avoiding this position altogether if possible as you will have to turn your head to one side to breathe meaning that you won’t be able to maintain neutral position of your spine. Stomach sleeping also puts a lot of pressure on the abdomen and back and can even increase risk of facial wrinkles. A low loft pillow with soft filler is very important to minimise this risk of end-range cervical extension but it is still recommended that getting used to changing your position to either your back or side is more ideal.

In summary, in order to minimise the stress on the spine and muscles, side sleepers will need the most support whilst stomach sleepers will need the least and back sleepers fall somewhere in the middle. Stomach sleeping should be avoided if possible, particularly if you are waking up with pain and stiffness no matter how good your pillow is. A good pillow could drastically improve your quality of sleep by minimising stress on your neck and shoulder thus pain, and can have positive impacts on your cognition, concentration, mood, muscle strength and many other things. These are only loose guidelines and you may find yourself going through many pillows until you find one that feels good for you, but it may be the key to getting a refreshing night’s sleep.


  • minervamedica
  • https://pubmed.ncbi.nlm.nih.gov/33895703/
  • https://sleepopolis.com/guides/right-pillow-how-to-choose/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736423/  
  • https://ultimate-facts.com/1653/lifetime-sleep/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544534/
  • NCBI
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281147/  
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749041/