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Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review

Article  in  Indian Journal of Science and Technology · March 2015

DOI: 10.17485/ijst/2015/v8iS5/62330

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Indian Journal of Science and Technology, Vol 8(S5), 135–139, March 2015 DOI: 10.17485/ijst/2015/v8iS5/62330

Optimal Pillow Conditions for High-Quality Sleep: A

Theoretical Review
Jong Eun Yim*
Department of Physical Therapy, Sahmyook University, Seoul, 139-742, Republic of Korea; [email protected]

Abstract
It is widely believed that using a pillow that allows appropriate neck support to maintain cervical lordosis during sleep
can lead to better quality sleep.Conversely, use of the wrong type of pillow can compromise pain-sensitive structures and
produce waking symptoms, such as cervical pain and stiffness, headaches, and arm pain; and this in turn results in reduced
sleep quality. Therefore, the optimal pillow should have neutral cervical lordosis, prevent waking cervical symptoms, and
increase sleep quality by optimizing the sleeping position. A factor critical to a suitable pillow is proper support for cervical
lordosis. The main role of a pillow during sleep is to support the cervical spine in a neutral position, which prevents loss
of cervical spine curvature and waking cervical symptoms by minimizing end-range positioning of the spinal segments.
Another critical characteristic of a suitable pillow is reduction of the temperature of the head and core during nighttime
sleep. Because, sympathetic nervous system innervation was less excited with a cool pillow, which is important for deep
sleep. In addition to neck support and temperature control, the pillow comfort is another critical characteristic of a suitable
pillow. However, no association between pillow comfort and waking symptoms has been reported, suggesting that the
participants’ perceptions of pillow comfort and their reports of waking symptoms are independent of one another.
In conclusion, a neck pillow with a firm support and low temperature may reduce neck pain and improve sleep quality.
Therefore, a cool and not too hard pillow with enough support for cervical lordosis is considered optimal and is
recommended for high quality sleep and cervical pain relief.

Keywords: Cervical Lordosis, Neck Pain, Pillow, Sleep, Temperature

1. Introduction tion and concentration, poorer work performance, and

in increased day-time sleeping and disruption to the
Sleep comprises one-third of a person’s life, and thus individual’s daily routine2. To ensure a regular sleeping
occupies 24 years of the average life span of 72 years. pattern, an appropriate sleeping duration and environ-
Comfortable and suicient sleeping helps relieve daily ment are required. he appropriate amount of sleeping,
physical and mental tiredness, restore balance in our considering slight diferences among individuals, is rec-
bodily metabolic functions, ease accumulated fatigue, ommended to be about 7 hours per night, and too long or
and in nerve cell re-synthesis. For these reasons, sleeping too short sleeping hours can result in aggravated fatigue.
is indispensable for humans1. For us, sleeping functions he sleeping environment is afected by external factors
to relieve physical and mental fatigue from the day and such as bedroom temperature, humidity, lighting, and
helps us staying healthy, and suicient amounts of quality bedding. he quality of sleep is considered to afect not
sleep thus require a favorable environment. Conversely, only the health of the individual, but also their quality of
in the case of insuicient sleeping, the tiredness cannot life3; and therefore, to ensure comfortable and suicient
be resolved, which may in turn lead to reduced atten- sleep, an appropriate environment is required. Here, good

*Author for correspondence

 Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review

bedding is of particular importance. Beddings include during the day. he reasons for such symptoms devel-
the bed, bedclothes, and pillows, which all help support oping seem to include the individual’s pillow failing to
the human body in terms of maintaining an appropriate support the neck and head during sleep or neck move-
body temperature and natural and comfortable postures ment7. Changing to a more appropriate pillow can result
during sleeping, while preventing possible in-sleep physi- in signiicant improvements in terms of post-sleep neck
cal fatigue accumulation4. Pillows support the human stifness, neck pain, headaches, and scapular pain, among
body and head in a supine position naturally and stably other symptoms8. As such, the main function of a pillow
for physically comfortable sleep. hey also assist diverse is considered to be support of the neck in natural posi-
in-sleep body movements, prevent noises or vibrations tions. People who cannot sleep easily tend to have a stif
from the loor, and ease the pressure from the loor to the neck and shoulder muscles, which in turn can result in
human head. In addition, they also reinforce the cervical chronic pain. Together with exercise, using a proper pil-
vertebrae during movements while sleeping, thus allow- low supporting the neck has been reported to be one of
ing comfortable in-sleep postures. he optimal height the most efective ways to reduce this chronic neck pain.
and material of pillows have been researched actively for For good sleep, the conditions of pillows that need to be
many years4, and it can be concluded that, as such, pillows considered include its heat conduction properties, height,
are an indispensable daily necessity. For a good sleep, pil- size, elasticity, morphostasis, hygroscopic properties,
lows also need to meet several conditions, including the breathability, and temperature. In other words, the ther-
sanitary aspect. mal characteristics, form, height, and texture of the pillow
Conventionally shaped pillows are too sot and sup- all need to be considered.
port only the head while failing to help maintain the
cervical vertebral curvature properly, and hence, they 2.1 Cervical Lordosis
tend to concentrate pressure only to the head. Moreover,
First, the height and size of an ideal pillow should be con-
as people’s heads are buried deeper into these pillows,
sidered. he pillow height and size are closely related to the
their head temperature is increased5. More recently, latex
cervical vertebral angle during sleep. High pillows increase
or memory foam pillows have been increasingly used.
the cervical vertebral angle and disturb its curvature by
hese are sot and cover the head and neck well to pro-
bending the neck vein and disturbing blood circulation. If
vide comfort. However, these materials may be too sot
used in the long-term, such pillows may cause stroke and
to support the neck suiciently, causing cervical verte-
cervical vertebral problems, as well as tensing of the neck
bral deformation. Furthermore, as they cover up large
muscles8. Furthermore, if the neck is bent, the interver-
parts of the head and neck, their contact surface with the
tebral nerves may become compressed, resulting in pain
human skin is relatively wide, thus reducing ventilation
and disturbed sleep. If such a situation continues, it can
and raising the head temperature while retaining sweat.
cause chronic neck muscle pain, which, in particular, can
For these reasons, pillows made of such materials may
negatively afect the skeletal development of growing chil-
not be appropriate for a pleasant sleep. In addition, given
dren. In the case of sleeping in the wrong position, people
the characteristics of the materials, these pillows are dif-
may ind it hard to turn the head the next day or may feel
icult to wash and may become unhygienic by retaining
pain in their neck and shoulder. Especially, when sleeping
moisture or dusts particles etc., and these issues represent
in the prone or other “bad” positions, people tend to feel
some of the main limitations of these pillows.
pain due to tensed neck muscles9. In the supine position,
the normal cervical vertebral curvature needs to be main-
2. Theory tained to reduce muscular tension. In the lateral position,
the cervical and thoracic vertebrae should be in line, and
Neck pains are reportedly experienced by 35~80% of all the head should be lited upward, away from the loor, to
people at least once in their life, and most of these people ease muscular tension10. Good pillows should be low to
also complain of additional symptoms such as neck-chest support the neck in the supine position rather than the
or spine-related pain, stifness, headaches, and scapular head in order to allow for suicient support of both the
pain6. Neck pain is reported to oten become worse when head and neck while efectively illing the space between
waking up in the morning ater sleep and to get better the bottom of the head and neck. Additionally, depending

136 Vol 8 (S5) March 2015 | www.indjst.org Indian Journal of Science and Technology
 Jong Eun Yim

on the individual’s shoulder width, the pillow size should illing material that can efectively support the neck while
be adjusted to support both the head and neck at the same presenting lower thermal conduction, high breathabil-
time11,12. herefore, in the supine position, the optimal ity, and, in particular, minimum head contact needs to
pillow should have a higher neck support than head sup- be developed12,17. Conventional pillows, especially those
port in order to efectively support the neck to allow for made of cotton, latex, or memory foam, comfortably cov-
normal neck curvature. In the lateral position, the neck ers the head and neck; however, their skin contact area
and back should be in line and the pillow should be high is wide and they tend to reduce ventilation, resulting in
enough to minimize the stress in the neck imposed in the raised head temperature, while retaining sweat12,16. A
supine and lateral positions, thereby elevating the overall previous study showed that a cool material pillow could
satisfaction with the pillow13. lower the rectal, forehead, and whole body temperatures,
In a previous study using lateral radiographs of the resulting in all subjects falling asleep more easily and
cervical spine in patients exposed to regular or roll-shaped sleeping better. Moreover, this pillow clearly slowed the
pillows, the roll-shaped pillow was found to restore cer- heart rate of the subjects, suggesting that the sympathetic
vical lordosis and to decrease neck pain and discomfort nervous system was less excited16. Taken together, these
while sleeping14. In another study, Hagino et al. evaluated results suggest that a cool material pillow can reduce the
the efectiveness of the Align-Right Cylindrical cervical body temperature and may improve the quality of sleep.
pillow in reducing chronic neck pain severity. he authors Furthermore, a study by Okamoto et al. also showed that
found that there were clinically and statistically signii- the cool pillow design could reduce sweating and whole
cant reductions in neck pain severity upon waking and body temperature, and indirectly improve the quality of
at bedtime in this sample of chronic neck pain subjects, sleep. hese indings suggest that the thermal charac-
and suggested that the Align-Right Cylindrical cervical teristic of pillows may be related to the type of materials
pillow may represent an efective therapy for a target pop- used18. Regarding the type of materials, Jeon, et al. evalu-
ulation resembling their sample population of 25-45 year ated the temperature of 3 diferent types of pillows ater
old subjects. Some subjects reportedly found the pillow 30 minutes of lying down, and showed that the degree of
very uncomfortable at the start, but experienced positive temperature increase was signiicantly lower for orthope-
results when they persevered15. In conclusion, a neck pil- dic pillows than for the memory foam and feather pillows.
low with a good shape and graded consistency may reduce It is likely that this inding is because the capsules in each
neck pain and improve night rest. herefore, a sot and segment of the orthopedic pillow are open-ended, which
not too high pillow with irm support for cervical lordosis helps to evenly distribute the heat of the pillow as well
appears to be the optimal type of pillow, and prescribing as to promote air circulation. Consequently, this prevents
a good cervical support pillow is an important adjunctive an increase in temperature and may improve sleep qual-
therapy in the management of neck pain. ity. In contrast, the memory foam pillow is more dense
and molds to the neck and head closely; therefore, while it
2.2 Pillow Temperature gives a feeling of comport and stability, it decreases the air
circulation and prevents thermal dissipation to the sur-
Second, it has been reported that for an ideal sleep, people
roundings, ultimately increasing the temperature of the
generally need to keep their head cooler and feet warmer.
pillow. Duck or goose feathers are good at retaining heat,
In other words, pillows need to maintain a lower temper-
and accordingly, the feather pillow showed the highest
ature to allow for a pleasant sleep16. Pillows show diferent
temperature among the 3 pillows. Moreover, these pillows
efectiveness depending upon their temperature charac-
can emit an unpleasant odor due to the poor air circu-
teristics, and cooling materials can help lower the overall
lation. Taken together, these indings indicate that the
body temperature, including that measured rectally and
orthopedic pillow might be more efective in preventing
on the forehead, to slow the heartbeat16. As a result, this
an increase in neck and head temperatures, which may
temperature decrease is helpful to ensure a good sleep.
improve the sleep quality and result in improved sanitary
Especially, the under-pillow temperature increase time
conditions compared with the other 2 pillows12. he China
varies according to the pillow-and-head contact surface
pillow, also known as ‘Tochin’, and the stone pillow have
area, pillow iller thermal conduction, and the breath-
traditionally been used in China and Japan. Presumably,
ability of the pillow. Taking this into consideration, a new
the China and stone pillows can conduct heat from the

Vol 8 (S5) March 2015 | www.indjst.org Indian Journal of Science and Technology 137
 Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review

head to the pillow efectively, resulting in reduced brain A strong signiicant association was observed between
temperature and increased extremity skin temperatures, reported poor-quality sleep and waking with cervical
and hence, deep sleep16. People have known for a long that stifness and scapula pain, whereas no association was
that cooling the head is important to ensure deep sleep. noted between pillow comfort and waking symptoms,
hus, it can be concluded that the moderate cooling of the suggesting that people’s perceptions of pillow comfort
head by the pillow during night sleep is of physiological and their reports of waking symptoms are independent
signiicance for deep sleep. from one another.
Many patients complain of symptoms related to the
2.3 Pillow Comfort cervical spine such as pain, stifness, headaches, and scap-
ular pain22,23; and many people appear to make poor pillow
Lastly, in addition to neck support and temperature,
choices, as low sleep quality, low pillow comfort, and wak-
pillow comfort is another critical characteristic of the
ing cervico-thoracic symptoms are commonly reported4.
optimal pillow. he stability of the pillow form is achieved
Especially, the nighttime sleeping posture should be taken
using an optimal shape based on a dynamic structure and
into consideration, as any long-lasting inappropriate pos-
an appropriate iller for maintaining this shape. Pillow
ture of the spine can irritate the capsular ligaments of
stability is essential for evenly distributing the pressure
the motor segments24. hese patients’ complaints revolve
of the parts of the head and neck touching the pillow. If
mostly around pain sensations that appear primarily dur-
such pressure is not evenly distributed and instead con-
ing the night and in the morning, and which frequently
centrated on a speciic part, local pressure is generated. If
cause sleep disturbances. It is diicult to alleviate such
continued, such local pressure can cause pain in the corre-
symptoms by physical therapy and postural exercises
sponding pressure point, disturbing the sleep19. According
alone, and therefore, the night-time sleeping position
to previous studies on the topic, regular or memory
must be changed to achieve physiological positioning of
foam pillows use high compressibility materials, which
the spine by using a suitable pillow with appropriate sup-
concentrate the pressure to a single point. Conversely,
port of the head in order to maintain a natural curvature
pillows with relatively hard materials generally maintain
of the spine during the sleep, consequently resulting in a
an appropriate shape for supporting the head and neck,
higher quality sleep19,24.
thus distributing the pressure evenly. Using harder mate-
rials as illers has been demonstrated to show an initial
efect on sleep quality, whereas no long-term efects have 3. Conclusion
been found17. he study by Shields et al. showed that some
subjects may initially ind cervical pillows uncomfort- Rhere is still considerable controversy over the optimal
able. However, these subjects tend to accept them ater an design, material, and contents of pillows, with little pub-
extended period of use20. Carskadon performed a similar lished research supporting any particular type of pillow in
study with mattresses and found that the mattress mate- terms of cervical lordosis, pillow temperature, and pillow
rial afected the quality of sleep in subjects who could not comfort. herefore, many people still make poor pillow
adapt to a new bed, namely that the material afected the choices, and low sleep quality, low pillow comport, and
sleep quality in the early stages. However, ater a period of waking cervical pain are commonly reported. Based on
adaptation, the mattress material no longer had an efect the previous studies on the topic, we here reached the
on the sleep quality21. Furthermore, hard Chinese pil- conclusions that a sot, not too high pillow with irm sup-
lows, such as those made of jade or ceramic, were widely port for cervical lordosis is the optimal type of pillow, and
accepted in ancient China. hus, these studies indicate that prescribing a good cervical support pillow represents
that the time required for adaptation is an important fac- an important adjunctive therapy in the management of
tor for determining the comfort provided by the pillows. neck pain. Moreover, the moderate cooling of the head
In addition, Ambrogio et al. used 3 types of neck support by the pillow during night sleep is of physiological signii-
pillow designs on 35 ibromyalgia patients. heir research cance to allow for deep sleep.
showed that the primary factor of a good pillow design In conclusion, a neck pillow with a irm support and
was the comfort level, even though the most comfortable low temperature may reduce neck pain and improve
pillow did not directly improve the patients’ symptoms. sleep quality. herefore, a cool and not too hard pillow

138 Vol 8 (S5) March 2015 | www.indjst.org Indian Journal of Science and Technology
 Jong Eun Yim

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