Neck, shoulder or back pain during sleep may be blamed on a bed or mattress, but the pillow can also be the cause. Dr. Chris McCarthy, an associate professor at the Manchester School of Physiotherapy and a physiotherapist, says sleep position, shoulder width and mattress firmness should guide pillow choice.
In a podcast interview, McCarthy said people generally sleep in three positions: on their side, back or stomach. He discourages stomach sleeping because the neck remains turned to one side for long periods, potentially straining muscles or ligaments and causing discomfort.
Back sleepers should consider the natural curve of the neck. The curve in the upper spine often increases with age, and people with a more pronounced curve may need a relatively thicker pillow.
For side sleepers, shoulder width is especially important. Wider shoulders generally require a thicker pillow, but mattress firmness also matters. Shoulders sink less into a firm mattress, which may call for a thicker pillow, while a softer mattress may make a thinner pillow sufficient.
If a pillow feels too thin, McCarthy suggests placing a folded towel underneath it. Adding or removing folds can help determine the right height. A rolled towel beneath the pillow can also test whether a side sleeper needs extra support under the lower neck.
McCarthy said evidence is not conclusive on the effectiveness of pillows marketed as contoured, ergonomic or orthopedic. A slightly raised front edge may, however, help some side sleepers.
Pillow material matters too. Feather and down pillows may keep the head and neck cooler, but movement during the night can shift the filling to one side, creating a slope that bends the neck. Hollow-fiber and microfiber pillows usually hold their shape better, although they may dissipate less heat.
McCarthy prefers a foam pillow. He bought one for about 50 pounds about five years ago with special gaps for airflow, and he adjusts its height with a folded towel because he sleeps on his side. He says no single pillow works for everyone and recommends using a trial period, when available, to find one suited to a person’s sleeping position and comfort.
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