When was the last time you thought about your bed pillows? If your answer is “it’s been a long time,” or “not at all,” you’re not alone. I treat many patients who, when they think about their sleep equipment, focus primarily on their mattresses. Mattresses get a lot of attention, for good reason. Your mattress is the largest, most important financial investment you’ll make in your sleep. But when it comes to sleep quality, pillows are almost as important as your mattress.
If you’re sleeping on a worn-out pillow, scrunching and folding it up every night to get comfortable, that’s a red flag that it’s time to update. Even if your pillow isn’t old and deflated, it might not be the best choice for your comfort and support.
Why your pillow matters
A good sleeping posture is key to sleeping soundly, night after night, and to waking without pain and stiffness. Your pillow helps to support a healthy sleep posture. What does that posture look like? A body in alignment, from the knees and hips, through the spine to the chest and shoulders, head and neck.
If your neck and shoulders don’t get sufficient support, or are propped at an angle that causes twisting, craning, or crunching, this puts your spine and body out of alignment, leading strain and discomfort in your neck, shoulders, and back, as well as sleeplessness.
As with your mattress, comfort and support are both important in selecting the right pillow. The best pillow for you is one that feels comfortable to rest your head on, and supports your head, neck, and shoulders and matches your mattress.
There are several factors that go into choosing a pillow—so let’s do some pillow talk.
When is it time to replace your pillow?
As a general rule, bed pillows need to be replaced after 18 months. Memory foam pillows typically last longer, up to three years. Natural pillows tend to last longer than synthetic pillows. And higher quality pillows will last longer than inexpensive ones. If you’re using pillow that’s five or six years old, you’re not getting the support you need—and you’re not sleeping as comfortably as you could.
It may seem like a short life, but think about it: your pillow gets used about 7-8 hours a night—that’s more than 2,500 hours a year! Like your mattress, your pillow is an investment in high-quality sleep, which pays dividends across your waking life.
If you’re not sure whether your pillow has life left in it or not, you can do some simple tests:
First, take off the pillowcase and over, and examine your pillow. Does it have stains from sweat? Is it torn? Does it smell? These are all signs of a pillow that needs replacing. Pillows collect dead skin cells, mildew, mold, fungus, and dust mites (as well as their feces). Over time, as much as half the weight of a pillow can be attributed to these unwelcome organisms, which can trigger allergies, interfere with breathing during sleep, and put out odors that make it harder to sleep well.
If your pillow passes the sight and smell test, it’s time to do the fold test:
Fold your pillow in half. If it just lies there folded, rather than springing back to its original shape, that is a dead pillow. With natural fill pillows, you can do this test over your arm. Does your pillow drape and hang down over your extended arm? That’s a pillow that’s exhausted its useful life.
With synthetic pillows, fold in half and add some weight to the top—a sneaker or shoe works well. Take the weight away, and if your pillow doesn’t spring back to its original shape, it’s time for a replacement.
With large, king-size pillows—whether natural or synthetic—you’ll want to fold into thirds, rather than in half.
Your Pick-a-Pillow guide
Selecting a pillow is a very individual process. When it comes to picking the right pillow, there really is no one pillow-size, shape, or material that fits all. The best way to find the pillow that’s right for you is to determine your individual criteria—using the six elements below as a guide—and then use your instinct about what feels most comfortable and appropriate for you.
There is an array of fill options available for pillows. No one is best—all have advantages and drawbacks, depending on your needs and preferences. Let’s look at the most common types:
Down. These pillows are light and soft—if you like a soft place to rest your head at night, you may like a down pillow. Down pillows are usually made from either goose or duck fibers. Goose down tends to be softer than duck down—and more expensive—though there is also variation in softness within goose down. Down pillows are made of different combinations of down, feathers, and other fillings. Be aware that “pure down” and “all down” pillows may still contain feathers and other fill.
Many people worry about allergic reactions and sensitivity to down. There are people who have hard allergies to down and feathers. Often, however, the allergic reaction to down comes from a lower-quality down filling that hasn’t been sufficiently cleaned. The dirt that remains on the down, rather than the animal fiber itself, can cause allergy and discomfort. You can look for hypo-allergenic down, often called “hypodown,” which is a rigorously cleaned blend of pure down and a natural substance called syriaca, which helps bolster the allergy-free properties of the down, and increases the longevity of the pillow. Good quality down pillows are expensive, but worth it if this is the type of pillow you prefer.
Synthetic down and polyester fill. Synthetic down pillows are less expensive than natural, hypo-allergenic natural down—and will need replacing more frequently. Polyester fill pillows are a relatively inexpensive pillow choice, compared to other pillow types. They tend to be medium to soft, though less soft than down. They will flatten with time, and typically need replacing more frequently than other types of pillows.
What about fill power?
Here’s what you need to know: the higher the number, the better the quality of the pillow—and the longer it will last. A fill-power of 600 and higher is a sign of a high-quality synthetic or natural down pillow. But there are limits to the power of fill power. An 800-plus fill power does not mean your pillow will last for a decade, no matter what the sales pitch says.
Wool. These pillows are naturally hypo-allergenic, and resistant to mold and dust mites. Wool pillows wick away moisture from your head and neck and can be effective at helping regulate your temperature during sleep, keeping you warm in the winter and cool in the summer. Wool pillows tend to be pretty firm. They also have longevity. If you want the benefits of wool without all the firmness, look for alpaca wool, rather than cashmere fibers.
Cotton. Similar to wool in many ways, cotton pillows are also naturally hypo-allergenic and resistant to dust mites and mold. Cotton pillows tend to be somewhat flat and firm. Cotton pillows are often a smart choice for people with allergies and chemical sensitivities.
Latex. Latex pillows tend to be more firm than down, but still very comfortable. These pillows hold their shape. This isn’t the kind of pillow you squish into just the position you like. Latex is resistant to mold and dust mites. Often, contoured pillows designed to deliver extra support to the head and neck, or to restrict movement during sleep, are made of latex.
Memory foam. These pillows have become tremendously popular in recent years. Memory foam conforms to your individual shape. Responding to your weight and body heat, memory foam softens and contours to the lines of your head, neck, and shoulders. It also distributes weight evenly across its surface. These qualities make it a popular choice for people with head and neck pain, or pressure points that cause discomfort during sleep. Memory foam retains heat, which can lead to discomfort and sweating. High-quality memory foam pillows are often made today with ventilation built into the pillow—but make no mistake, this remains a heat-retaining material. These pillows can also give off chemical smells—particularly when they are brand-new—that are bothersome to some people.
2. Fill weight
Down and synthetic pillows are lightweight choices, while memory foam and latex are heavier. The weight of your pillow is about personal preference. If you like to re-shape and move your pillow with you as you rest, a lighter pillow may be a better choice.
3. Quality of fill
With every type of pillow, quality matters to comfort, support, and longevity—and will be reflected in the price. Once you’ve decided on the type of pillow fill that’s right for you, select the highest quality pillow your budget will allow. Remember, you’ll be spending thousands of hours on this pillow over the duration of its life.
For most people, a standard-size pillow is sufficiently large. If you prefer a larger pillow, that’s fine, provided you can keep your sleep posture in alignment. The thickness or thinness of your pillow should enable you to sleep with your head, neck, and shoulders aligned with your spine, as well as provide you comfort. Make sure the pillow cover and pillowcase fit properly. Don’t stuff a big pillow into an undersized cover, or let a standard-size pillow swim in an extra-large pillowcase.
Pillows are also made in specialty shapes, to provide additional support and stability for your head and neck. Some of these can be useful: cervical and contour pillows may help with neck and back pain, and contoured body pillows can provide support, stability, and relief for pressure points along the body. Be aware, though: there’s a marketing element involved in many specialty-shaped pillows.
Use natural, breathable fabrics to cover your pillows. Pillow covers under pillowcases help extend the life of the pillow, protecting it against stains and sweat. Decorative pillows look great on the bed, but should be removed before sleeping.
Synthetic materials like memory foam and polyester are made through chemical processes, and many pillows are put through antimicrobial treatments. Know the chemistry that went into making your pillow, be willing to make an investment in a well-made product, and consider your own allergies and chemical sensitivities when selecting a pillow type.
Does sleeping position matter to pillow choice?
The answer is: YES. There are general guidelines that match sleeping position with pillow type, but they are not hard and fast rules. Why? Because nearly all of us switch sleeping positions throughout the night. You might be a side sleeper who also spends some time during the night on your back. Same goes for the stomach sleeper who shifts occasionally to one side. You want a pillow that works for you in all your sleeping positions.
That said, here are some broad guidelines:
Side sleepers may need a firmer pillow and a pillow on the thicker side. Look for one that’s as thick as the distance between your ear and outside shoulder.
Stomach sleepers may need a soft pillow—or no pillow at all—underneath their head. A pillow under your stomach and pelvis may help prevent back pain.
Back sleepers may need a flatter pillow, to keep your head and neck in alignment. Back sleepers may want a softer pillow—but if you have neck pain and sleep on your back, look for a pillow that provides additional support, while maintaining the softness that’s comfortable for you.
Does your mattress matter to your pillow choice?
Another YES. If you use a firm mattress, then a softer pillow may be better, because the pillow is lying on a firm surface and needs to adapt to the pressure of the weight of your head in your starting sleep position. If you have had a softer mattress, then a firmer pillow may be better to keep your head and neck aligned.
Don’t ignore your pillow! It’s such an important element of your sleep environment, and having the right one under your head can make for more comfortable, restful nights. And, if you still can’t choose, give the pillow I sleep on a try!
Michael J. Breus, PhD
The Sleep Doctor™