What should a pillow actually do for your neck?

People often ask me what sort of pillow they should use.

There are hundreds of options out there: soft pillows, firm pillows, shaped pillows, memory foam pillows, high pillows, low pillows, expensive pillows, and occasionally pillows that look as though they were designed by someone who also designs spaceships.

But before worrying about the type of pillow, it is worth asking a much simpler question:

What is a pillow actually meant to do?

The answer is fairly simple.

A pillow should support your head and neck in a reasonably neutral position while you sleep.

That does not mean your neck has to be held perfectly still, or perfectly straight, or locked into one “correct” position. But ideally, your pillow should help your head and neck rest in a position that is comfortably roughly neutral but with the option of having small, comfortable variations and not obviously strained.

The problem is that we do not need the same pillow height in every sleeping position.

If you lie on your back, the gap between the back of your head and the mattress is usually quite small. For many people, it is only a few fingers’ width.

But if you roll onto your side, the situation changes completely. Now the pillow has to fill the space between the side of your head/neck and the mattress. That space is usually much larger, because the distance between your neck and tip of shoulder is greater.

So the same person may need a relatively low pillow when lying on their back, and a much higher pillow when lying on their side.

That is before we even think about the fact that people are different shapes and sizes.

Someone with broad shoulders will generally need more pillow height when side sleeping than someone with narrow shoulders. A smaller person may need less. A taller person may need more. Even two people of the same height can have quite different shoulder width, neck shape, and sleeping habits.

So there is no single “correct” pillow height that works for everyone.

There is also no single correct pillow height that works for the same person all night.

Most of us move around in bed. We may start on our side, roll partly onto our back, tuck one shoulder forward, shift slightly towards the front, or end up somewhere between side sleeping and back sleeping. We do not usually sleep like a diagram in a textbook.

This is where pillow choice becomes more interesting.

A pillow is not just about softness or firmness. It is about whether it can support you in the positions you actually use.

For back sleeping, it needs to avoid pushing your head too far forward.

For side sleeping, it needs to stop your head dropping down towards the mattress.

For the in-between positions, which are very common, it needs to be forgiving enough to let you find a comfortable middle ground.

This is why I am cautious about choosing a pillow purely because it looks clever. A shaped pillow might make good sense in theory. It may have a lower section for back sleeping and a higher section for side sleeping. But the real question is whether those shapes and heights actually suit you.

Are the high parts the right height for your shoulder width?

Will you stay in exactly the right place on the pillow?

Do you always sleep in the same position?

For some people, the answer may be yes. For many people, probably not.

So, when thinking about pillows, I would start with the basic job description:

Does this pillow let my head and neck rest comfortably in the positions I actually sleep in?

That is the main question.

Not whether it looks technical.

Not whether it has an impressive name.

Not whether it is the latest material.

Just whether it supports your head and neck sensibly when you are on your back, on your side, or somewhere in between.

A good pillow does not need to be complicated. But it does need to suit the person using it. 

Why I keep coming back to feather pillows

Not because they are clever.

Not because they look technical.

Not because they promise to hold your neck in one perfect position.

But because they can be changed.

• Flattened.

• Scrunched.

• Plumped up.

• Reshaped during the night.

I have not found another pillow filling that is as adjustable or as malleable. Feather pillows may not be perfect, but they are still the type I recommend without hesitation.

About the author: Martin Rooke is a registered osteopath in New Zealand and inventor of Morfit. His writing focuses on practical solutions to musculoskeletal health that affect comfort and pain.