Sleeping Position and Pillow Type
Most people are aware that the ideal position to sleep is on your back. The main reason being that it keeps your spine in the most neutral position (centered and straight). And though it’s important to try to switch to your back, especially if you find yourself in pain with other positions, some have a difficult time changing a position they’ve slept in for a long time or have tried but ended up in different positions throughout the night. Whichever position that you sleep (or end up in), the important thing is to be aware of your neck and spine position. The pillow you use is an important part of this.
How firm should your pillow be? One general rule of thumb for firmness is to fold your pillow in half and then let go and see if your pillow springs back to its original position. Ideally you want to see it spring back quickly but if it’s slow to get back to its original position or if it stays folded your pillow is likely not giving your head enough support.
What position should your head and neck be in?
For back sleepers, if you lie down on your back with your head on the pillow, your face should be parallel to the floor or slightly slanted up from parallel (your forehead in a slightly higher position from the floor than your chin), as shown in the figure to the right in the picture above. If you have what’s called a “forward head posture” where your head/neck is craning forward in relation to your body, you would likely need a thicker or firmer pillow to keep your head in this correct position. If your pillow is too thick (which most pillows are), it will likely present like the middle figure in the picture above where your neck is in too much flexion (the forehead is in a much higher position from the floor than the chin)… or if your pillow is too thin/soft, it will likely present like the top left figure where your neck is in too much extension (the chin is in a higher position from the floor than the forehead).
If you’re a side sleeper, there is a larger space between your head and the surface because of your torso/shoulder area so you may need a thicker pillow or to fold your pillow in half in order to better support your head/neck. What you want is the line from the middle of your forehead down to midline of your nose and chin to the midline of your neck, to be parallel with the floor (left figure in the picture above). If your pillow is too thick/firm it will side flex your neck upwards or if it’s too thin/soft it will side flex your neck downwards (middle and right figure in the picture above, respectively).
For stomach sleepers a thin pillow or putting your head directly on the mattress is recommended as this would in most cases prevent your neck from being in an extended position when you sleep (the neck angled upwards, as shown in the top figure of the picture below). However this will not prevent rotation of your head to one side for long periods, which is why sleeping on your stomach is not recommended if you can help it.
It’s important to adjust or buy a pillow (firm/soft, thin/thick) that fits your anatomy and position you sleep in. Observing yourself in a mirror, taking a picture of yourself, or having someone observe you would be helpful here.
For some back sleepers who have discomfort in their low back, having a bolster under the legs may be helpful in keeping the lumbar spine neutral (or if you’re a side sleeper, a pillow between your knees).
You may not need to adjust anything at all if you’re not having pain (“if it’s not broke, don’t fix it”), but for the sake of good spinal health in the long run you may want to take these things into consideration.
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