Is Your Pillow Working Against You?

You'll spend more hours with your pillow this year than with any person you know. If you're waking with a stiff neck more mornings than not, the pillow is the first suspect worth interviewing — before you blame your age, your mattress, or your life choices.

The principle is one sentence: your neck should be a straight continuation of your spine while you sleep, in whatever position you sleep. Everything else is details. But the details matter:

Side sleepers (most of us) need enough pillow to fill the gap between shoulder and ear — usually a firmer, thicker pillow than people buy. If your head tilts down toward the mattress all night, your neck spends eight hours side-bent. A bonus move: a pillow between the knees keeps the hips level and takes a surprising amount of strain off the low back.

Back sleepers need less pillow than they think — enough to support the curve of the neck without pushing the head forward. If your chin points at your chest while you're lying down, the pillow's too tall. Two stacked pillows is almost always too tall.

Stomach sleeping is the position I'd talk you out of if I could: it forces the neck into full rotation for hours at a stretch. If you can't quit it, use the thinnest pillow you own — or none — and know that a pillow under the pelvis can make the position less costly to the low back.

When to replace: fold the pillow in half and let go. If it just lies there folded instead of springing back, it's done supporting anything. Most pillows give up somewhere between one and two years of nightly service — long before most people replace them.

A fancier pillow is not the answer to everything; the right height pillow for your sleep position and shoulder width is. That's a $50 fix for a problem people live with for years.

This article is general education, not medical advice, and doesn't replace an examination. If you're waking with numbness or tingling in your hands, or neck pain that follows you through the day, the pillow may not be the whole story — call the office and let's find out.

— Dr. Kevin Greenspan