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  • Dori Nissenson

Pillow Talk

Is your neck pain becoming a pain in the neck??? Are you waking up with a stiff or painful neck or numbness and/or tingling down your arms and into your hands??? Whether you wake up with neck pain or experience it during the day, your sleeping positions and pillows may have a significant impact on your pain and should be addressed and modified if necessary. Without addressing these two things, your neck pain may not go away.

While some causes of neck pain are due to wear and tear and age related changes that may not be directly under your control, there are many contributing factors to neck pain that are under your control. One place to start looking is how you sleep and what effect this may have on your neck pain.

Common Causes of Neck Pain:

1. Degenerative disc disease/Herniated cervical discs

2. Neck muscle strain

3. Neck injury such as whiplash

4. Pinched nerves

5. Chronic poor posture: Poor posture in standing, sitting at a desk or driving a car can greatly impact the health of your neck muscles and joints and may be a huge contributor to all of the above causes of neck pain. However, because we spend eight hours a night (hopefully) sleeping, we need to also address our posture when we are sleeping.

What Are The Best Sleeping Positions???

The healthiest sleeping positions are on your back or side. If you are a stomach sleeper... you are out of luck. Avoid sleeping on your stomach because this position places the most stress on your neck muscles. If you MUST sleep on your stomach, go with an ultra-thin pillow or foregoing a pillow all together.

How Do I Choose A Pillow???

Regardless of what position you sleep in, the goal of a good pillow is that it supports the natural curvature of your neck. If you use a feather pillow, you will need to replace it every year as it will collapse over time. Pillow height can affect your neck muscle health. If your pillow is too high, it can cause cervical muscle strain and obstruct your breathing and if it is too low, it may also put stress on your neck muscles.

Back sleepers If you are a back sleeper, it is best to use a thin pillow. AND ONLY ONE!!! You want to make sure that the alignment between your head and neck is the same when lying down as it is when your are standing with good posture of course! Make sure your pillow does not bring your head in front of your shoulder changing the natural curvature of your neck. You can test a pillow before buying it. If the pillow keeps your ear lobe directly in line with your shoulder or close to it, then the pillow does maintain the natural curvature of your neck and is the right height for you when sleeping on your back. If you can’t tell, have a friend take a picture of the position of your head position when you are lying on the pillow and you can better see it.

As a back sleeper, it may also be beneficial to use a small roll shaped pillow or simply roll up a towel and place it under the pillow case at the arch of your neck. This will give you additional support.

Some back sleepers find that it is beneficial to place the pillow slightly under the shoulders. This will position the head slightly in the elevated position without putting the neck in a bent position. This is especially helpful for patients with neck muscle strains.

Side sleepers If you sleep on your side, you typically need a thicker pillow than back sleepers do to ensure that your neck and head are positioned in the middle of your shoulders. Your height and the width of your shoulders will help to determine the kind of pillow you should buy. If you are petite, you will need a slimmer pillow than if you are broad shouldered. You can test this as well. Essentially, your nose should line up with your breast bone when lying on either side.

Different Types Of Pillows

Cervical Pillows: Cervical pillows are also called orthopedic pillows and have a distinctive shape. They are shaped to support the natural curvatures of the spine whether you are on your back or side. They are higher where the neck is and have a depression where the head is supported. They can be made of different materials.

Feather Pillows: Feather pillows can be easily manipulated to offer support where needed. These pillows can be especially helpful for those that change sleep positions frequently throughout the night.

Memory Foam Pillows: Memory foam pillows are pillows that are designed to conform to the head and hold it in one place.

Body Pillows: A pillow that is as long as the body can serve several functions for people that prefer to sleep on their sides. The top portion can support the head and neck while the bottom supports the knee and legs. One style is the j shape with a space for the ear which is designed to keep the head in correct spinal alignment.

Pillow Materials

Pillows can be made from:

down or down alternatives latex

memory foam


buckwheat hulls

Unfortunately, there are no government standards for the terms soft, medium, and firm. Therefore, it is important to buy a pillow that is returnable so that you can try it at home. Buckwheat hull pillows are popular pillows for those suffering from disc degeneration, osteoarthritis, and spinal stenosis and work well for back and side sleepers.

Pillow Temperature

If you find that you run either hot or cold when you sleep, letting your body get to extremes of temperature can disrupt your sleep and affect the health of your neck. Orthopedic or contoured pillows are the coolest and feather pillows are the warmest. The contoured memory foam pillows are in the middle.

Important To Note

1. For those recovering from a neck injury or flare up of a cervical spine condition, different types of pillows may be more comfortable at different stages of recovery. Therefore, it is good to have multiple pillows to choose from to allow for change.

2. Neck pain and pillow use has not been extensively studied by medical researchers. The variety of pillows studied and the number of participants has generally been limited. Without clear medical evidence supporting one type of pillow over another, personal comfort and pain management are the best guide. If the pillow is uncomfortable or results in pain and stiffness, it is time to try a new or different type of pillow.

What Can You Do At Home To Prevent Neck Pain From Sleeping?

  1. Try to avoid reading or watching TV in bed at night with your head propped up on many pillows, even if you lower the “stack” to sleep… keeping your head and neck bent to read in bed will strain your muscles and stress your neck joints.

  2. If you watch TV in bed, it is important to have the TV directly in front of you and at the right height. If you look at a TV screen that is off to one side or too high or too low you will negatively impact your postural alignment and therefore the health of your neck.

  3. Avoid texting at night in bed. Texting requires using your hand and although you don’t realize it… when you text you are using your arm all the way up to your shoulder. If you are texting in bed in the recumbent position with poor posture, you are setting yourself up for arm and neck pain. Texting in bed also requires you bending your neck forward to see the phone screen. This can cause or exacerbate neck pain. In addition, research has shown that the blue light emitted by the phone screen can disrupt the release of melatonin. This may affect your sleep which has been proven to worsen neck pain.

  4. Stretch your neck muscles before going to bed. The more flexible your neck muscles are before bed, the less likely they are to tighten up overnight and cause pain.

  5. Replace your pillow once a year if you use a feather pillow. Otherwise, address your pillow choice if you develop neck pain or your existing pain gets worse.

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