It wasn’t exactly a pleasant Christmas present—a car accident on Boxing Day a few years ago left me with chronic neck pain. I had tense shoulder, neck and jaw muscles to begin with, but the accident made things worse, and made it difficult to turn my head all the way to the left. I’ve seen physiotherapists, chiropractors and massage therapists, and, while I always leave the appointments feeling looser and less sore, the pain and loss of mobility slowly returns.
Then a couple of months ago I noticed I was waking up to an extremely stiff and sore neck—which was new. (Previously the pain and stiffness usually got worse as the day went on.) Was it the tension from having my kids home doing online schooling? Or the dining room chair I was working at, which clearly didn’t have enough back support? Was I clenching my jaw again, even though I was dutifully wearing my mouthguard at night? And then it dawned on me—maybe my pillow was to blame.
I checked with Carol Kennedy, an instructor in the Department of Physiotherapy at the University of British Columbia and a partner at Treloar Physiotherapy Clinic in Vancouver, who specializes in neck pain. It turns out I was on the right track. Kennedy explains that neck pain, neck stiffness and headaches can all be caused by sleeping with the wrong pillow—but finding the right pillow isn’t simple. Here’s what I learned.
Pillow height matters
The height of your pillow determines the position your neck will be in overnight. “We want you to be supported by your pillow so that your head and neck stay in neutral,” says Kennedy, meaning they are aligned with your spine. If the pillow is too high, your head will be cranked up to the ceiling, and if it’s too low it will be tipped down towards the pillow. Kennedy explains that while 10 cms is the ballpark ideal height, the right height for you will depend on the size and shape of your body. “The main thing is to try and fill in that space between your head and the width of your shoulder,” she says.
In recent years, many people have gotten away from down and feather pillows due to allergy concerns.Kennedy says this is also good for necks, because down and feather compress in the night, changing your neck’s position. The bad news is that people often opt for polyester fill instead. “It’s not the best performing either,” she says. Kennedy recommends her patients try memory foam or latex pillows, which cradle the neck and relieve pressure points.
It’s not just the pillow—it’s your sleep position
I tend to move around in the night and change positions, which likely isn’t doing my neck any favours. For one, while both back sleeping and side sleeping can be comfortable for your neck, the optimal pillow height with each isn’t the same—you need a lower pillow if you’re on your back. “I think the people that get into trouble are the ones that go back and forth between side and back, because one pillow doesn’t really work,” says Kennedy. (Since learning this I’ve tried to stick to my side, and—when feeling the need to change positions—turning all the way to the other side instead of flopping onto my back.)
Also, sleeping on your stomach can really do a number on your neck, says Kennedy. “Because you have to breathe, you need to turn your head to the side. You will be lying in a sustained extreme rotation of your neck all night.”
After speaking with Kennedy, I tried a few new pillows to see if they made a difference.
First up was the $159 Blu Sleep Aloe Ice pillow made with gel foam, which the company says is more cooling than memory foam. (Cooling pillows, which are designed to draw heat away from you and improve airflow, don’t help with neck pain, but are said to improve sleep comfort generally.) I immediately noticed a difference in comfort when I laid down on this pillow—with my old pillow I could actually feel my neck tense up when I lay down at night, but with this one I could feel my head sink into the pillow and relax. I didn’t wake up feeling sore or stiff. The only problem with this pillow is the height—it was pretty good for when I was sleeping on my side, but I tend to switch positions in the night, and it was a bit high for when I was on my back. (Blu Ice offers a few different pillow heights for different types of sleepers.)
Next I tried the $85 Endy Pillow by mattress maker Endy. The concept behind this pillow is pretty ingenious—there’s a removable insert filled with crushed memory foam so you can customize the height and firmness to your liking by adding or removing foam. The pillow was comfortable, but the first night I tried it I found it too high. I removed a bunch of foam but then the softness encouraged me to roll onto my stomach and I woke up with a stiff neck. I’ll need to keep adjusting it to get it right.
Finally I tried the $97 Mediflow Elite Fibre Water Pillow. I was really excited about this pillow, because of its high reviews on Amazon with many people saying it helped their neck pain and the fact that a Johns Hopkins University School of Medicine study found it the best for reducing neck pain when compared to other pillows. This pillow has an interior bladder that you fill with water to your desired firmness. The water plays the same role as memory foam—it cradles your neck and adjusts as you move around at night. I was not disappointed—the pillow was comfortable and a huge upgrade compared to what I had been using. My neck wasn’t any more stiff or sore in the morning than it was going to bed.
So how do you find a pillow that works for you?
After trying these pillows for a few weeks I’ve figured out some things. Number 1: It pays to invest in a good pillow. In the past I’ve tended to purchase the cheapest one on the shelf, telling myself I didn’t need anything luxurious. There’s a difference between luxurious and supportive, and my neck deserves to be supported.
The second thing I learned is that finding the right pillow isn’t a straightforward process. “There’s going to be a little bit of trial and error. Keep monitoring your sleep quality during the night, as well as your waking symptoms,” suggests Kennedy. I’m not sure I’ve found the best pillow for me yet, although I’m definitely better off than I was with my old pillow. My neck pain and stiffness hasn’t gone away entirely—after all, the pillow wasn’t the only reason for my discomfort. But now my pillow isn’t working against me, and that’s enough to make me sleep better.
This story was originally published in 2021; updated in 2022.
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