Robert Wood Johnson University Hospital
New Brunswick • Somerset

Picking the Perfect Pillow

When it comes to picking the right pillow, it is important to understand there are two distinct types of sleepers:
  1. Individuals with no anatomical abnormalities or sleep disorders
  2. People who have atypical anatomy of the head and neck, which leads to a diagnosable sleep disorder. The National Sleep Foundation estimates that nearly 40 million Americans have sleep disorders with at least estimated 18 million falling into the group with anatomical abnormalities. 

For "normal" sleepers, the type of pillow is a personal preference and a matter of picking pillow materials that are comfortable and soothing so that the right environment is created for sleep. For those people with a sleep disorder, such as obstructive sleep apnea, underlying muscle and skeletal abnormalities and medical conditions that contribute to sleep disorders may make getting a restful night's sleep difficult even with the right pillow.

With all the pillow choices how is it possible to know which one to pick? There is little available in the medical research to guide the process of pillow selection. However, for both groups there are some tips you can follow that might improve your chances of finally securing that night of dreams.

Options for Those Without Sleep Disorders

  • Cosmetic choices and comfort are key. The focus should be on creating a relaxing environment that will help a person transition into sleep as well as choosing soothing materials that would help limit sleep disruption.
  • Choose materials that are soft and comfortable. Higher thread count means the pillow will be softer. Anything that is irritating to the skin can disrupt sleep.
  • Pillows with silk or organic materials such as cotton are not only hypoallergenic but can be kinder to the skin, which can make for a more restful night.
  • Wool pillow covers discourage mold and mildew growth and are flame resistant.
  • Some will also prefer the softness provided by down or other organic fill.
  • Although research in the medical literature is limited, one study has shown that a cooler pillow can help maintain deeper sleep. This could be accomplished with a water pillow or by simply making sure the environment in the room is a slightly cooler temperature.
  • Choose soothing colors and peaceful graphics, as this will help create a relaxing environment conducive to sleep. This is not just about aesthetics; anything that stimulates that brain can limit the ability to get a good night's rest.
  • A pillow that maintains its shape or responds to adjustments in your position may mean you will not have to fluff your pillow as often to accommodate the change in body contour.
  • Pillows with special materials, such as goose down, buckwheat pillows or Dux pillows, are worth the expense if you feel they are more comfortable and allow for a more restful night.

Options for Those With Sleep Disorders

Cosmetic choices and comfort also are important. However there are some additional considerations in this group.

For people who snore: 

Snoring can be benign; however, it can be a sign of a more serious disorder called obstructive sleep apnea, which can be lethal for some. Sleep apnea is believed to affect 30 million Americans with 85% having yet to be diagnosed. 

  • Traditional pillows do not alleviate snoring. However, pillows are available that promote side sleeping, such as the Sona Pillow from Brookstone. These pillows help keep a person off their back and on their side. Side sleeping maintains the jaw and tongue in a more forward position and stops the tongue from falling into the throat, which can contribute to snoring and positional sleep apnea.
  • Pillows that allow the individual to sleep on an incline also can help. However, none of these pillows would resolve more serious sleep apnea. Whether these pillows would be appropriate for a snorer or sleep apnea could only be determined after medical evaluation and a sleep study to rule out a more serious concern.

For people with arthritis or chronic pain:

  • Review of the available literature indicates for these individuals the ideal pillow should have good shape and consistency and with firm support for cervical lordosis. This means pillows with a special shape or ones able to conform and cradle the neck, such as "memory pillows," might be the best bet. The ideal pillow should be soft and not too high. Pillows that included supporting cores for neck lordosis received the best rating.
  • Also for this group, a study done at Johns Hopkins demonstrated that patients had better ratings for sleep quality with water pillows, which allowed the pillow to contour to the neck.
  • Roll pillows were found to be too difficult to maintain their shape, remain in place or provide adequate support.
  • Pillow studies in patients with fibromyalgia were inconclusive to be of any benefit and here personal preference would be the best.

For people with asthma or allergies:

  • Hypoallergenic pillows are available for people with chemical sensitivities or allergies and have successfully improved sleep quality. Studies have shown that these pillows may improve the subjective quality of sleep but may not improve the overall condition.
  • Despite down's softness and comfort, it was traditionally believed that people with asthma and allergies may need to avoid this material or choose a variety of hypoallergenic down which is available in some pillows. Pillows made of latex, silk or down were considered other options. Newer studies, however, are showing that synthetic fillers and not feathers are more likely to cause wheeze and that feathers may actually reduce the sensitivity to house dust mite allergens. Organic choices are then likely the best for allergy sufferers.
  • For those with dust mite allergies, pillow cases that limit exposure to dust mites are suggested. The pillow otherwise would be personal preference. Choosing cases with a higher thread count will not only mean the case is soft and comfortable but that the dust mites will have a harder time getting access to the fill material and breeding in your pillow. Of course you will need cases with zippers, or dust mites will still get into your pillow. Cases that limit dust mites exposure will reduce allergy symptoms such as wheeze and nasal congestion that may disrupt the quality of your sleep. Latex pillows also limit dust mites. Some cases are little more than plastic covers that make noise every time the person rolls over disrupting sleep. Plastic cases would also make it difficult for those who like to scrunch up their pillows. Although more expensive, organic material or high thread count materials would likely be a better choice. Research published in the New England Journal Medicine concluded that despite the effectiveness in reducing exposure to dust mite allergies, there was no reduction in symptoms in patients with allergic rhinitis with these casings.
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