Dr Chris McCarthy, a physiotherapist and associate professor at the Manchester School of Physiotherapy, admits to being particular about his sleep gear. “I take my pillow with me,” he says, noting that while he doesn’t travel abroad with it, he immediately adjusts hotel bedding to ensure proper support.
McCarthy emphasizes that selecting the wrong pillow can lead to neck pain, describing the right choice as highly individualized. Speaking on the BBC’s Sliced Bread podcast, he outlines a strategy for finding the best fit based on sleeping position and body mechanics.
The first step is identifying whether you are a side, back, or front sleeper. McCarthy advises against stomach sleeping, explaining that keeping the head turned to one side for extended periods can stretch and irritate neck muscles and ligaments. He notes there is strong consensus in the physiotherapy community to avoid this position for those dealing with spinal pain.
For back sleepers, the critical factor is the natural curve of the upper spine. Individuals with greater neck flexion require a thicker pillow than those with a flatter back profile. Side sleepers, meanwhile, must measure their shoulder width to determine pillow height. Generally, broader shoulders necessitate a thicker pillow, but mattress firmness plays a significant role. On a firm mattress, the shoulder does not sink in, requiring more loft; conversely, a soft mattress allows the shoulder to compress, meaning a thinner pillow is necessary to maintain spinal alignment.
If a current pillow feels insufficient, McCarthy suggests a practical trial method: place a folded towel underneath it and adjust the number of folds until the height feels correct. This allows you to gauge the ideal thickness before purchasing a new pillow.
Regarding pillow shape, McCarthy states that evidence for specialized contoured or ergonomic designs is limited. However, a slightly raised front edge may benefit side sleepers. Back sleepers might find pillows with a central dip helpful, though some users report feeling confined by such designs. Additionally, individuals with heavier heads should opt for thicker, firmer options.
Material choice also affects comfort. Feather and down pillows offer breathability, wicking heat away effectively, but they tend to shift and bunch during the night, potentially creating an uneven surface that kinks the neck. Synthetic fills like hollow or microfiber retain their shape better but may not ventilate as efficiently. Some synthetic options feature firmer material in the lower half to provide consistent support.
McCarthy, who sleeps on his side, uses a ventilated foam pillow purchased for approximately £50 five years ago, which he adjusts with a towel. He encourages consumers to take advantage of manufacturer trial periods, warning that no single design suits everyone. “You really have to personalise it,” he concludes.
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