Side sleeper with poor posture

In the course of a typical work day, I get asked this question at least once, if not, several times. The truth is that everyone is different with varying body types and divergent opinions. That saying, there are some postural concerns to consider. We sleep, on average, one third of our lives. That is a lot of time lying down. A pillow that does not support the head and neck properly can certainly lead to discomfort, joint and muscle imbalance, and degenerative changes. Here are my general suggestions for the best pillow based upon sleeping positions. At the end of the article I will share the pillow brand I use and a link with a discount code if you are interested in trying one out for yourself. So, without more delay, here we go!

1. Keep the head and neck in a neutral position. If you are sleeping on your back the pillow should relatively flat for most people. Unless you have kyphosis (think hunchbacked) a thick pillow will push your head forward into kyphosis which will strain the posterior muscles in your neck and upper back. If you are a side sleeper you need a pillow that will take up the space between yours shoulder and head. If not, you will end up with your head bent toward the pillow or toward your other shoulder. Either way can lead to a stiff neck in the morning. A thicker pillow if you have broad shoulders is the one of the bigger challenges with pillows. There are some good options out there, though.
2. Firm vs. soft. Like a mattress, my advice is to get a firmer pillow that is still comfortable enough to stay asleep all night. Softer pillows feel great but during the night they tend to compress causing your neck to bend and move from neutral. A firmer pillow will hold its shape better. That saying, I have had some pillows that were so hard my ear hurt after sleeping for an hour or two. You don’t want it to lose its shape but you still have to be comfortable.
3. Be cautious about the “orthopedic” pillows. I see so many pillows that have bumps, grooves, holes, and unsubstantiated promises. They always show a picture of the spine cradled by their revolutionary design. Most of these pillows are really only good for back sleepers. And while I am a big fan of having a proper curve in your cervical spine, it is not the norm. So, when you lie on this pillow and it forces the curve in your neck, you may wake up very sore. It takes work to restore a cervical lordosis. If you already have a nice curve, then these pillows could work out. If not, it might take a very long time before you get a good night sleep. If you are a side sleeper these pillows are rarely effective. they are not usually thick enough for side sleeping and most people don’t have a gentle curve from ear to shoulder that matches the pillows. In general, a little curve to the pillow can be good but most are just gimmicky.
4. Stomach sleeping pillows. My advice for stomach sleepers is simple. Don’t!  With a regular pillow or even no pillow there is no way you can sleep on your stomach and still breath without turning your head to one side or the other. This goes back to rule number, keep your head in neutral. However, I do understand that some of you out there just can’t sleep any other way. Who am I to judge? If you have to sleep on your stomach there are pillows that will allow you to keep your head in neutral much like a massage table head piece. The issue with most of these is that there has to be some elevation that causes extension to your mid or low back. This can cause other issues. But, if you insist, these pillows are the lesser of the evils.
5. So, is there an answer to the question? While there is no perfect pillow that is right for everyone, there are options that are better, in general. An adjustable pillow is nice because you can add filling if you have broad shoulders or sleep on your back you can take some out. These pillows look like a basic pillow but with a zipper on the end. The filling is usually shredded foam. I have used these pillows in the past and really like them. There is no pillow, that I know or could even conceive of that would work for all sleeping positions. However, they are starting to figure out pillows that work for side sleepers who also switch to the back. These pillows are thicker on the sides with a cut-out in the middle for when you are on your back. They are formed so they are not adjustable. These two types of pillows are the best for most people.

I am currently sleeping on the pillow I last described that is good for side and back sleeping. It is working well for me. I find that the dip for back sleeping is a little too thick, though, but the height of the pillow when I am on my side is great. It is a pretty firm pillow but still soft enough for me. Like I said, the versatility of the adjustable pillow can make a big difference for people. There are several companies that make good pillows. I am currently working with Dosaze. They have a hybrid adjustable pillow called Bamboo that looks like an excellent choice. I have been sleeping on the Contoured Orthopedic pillow. So far, I am enjoying it, though I was skeptical, at first. The contours are not that dramatic and I got the one that is firm and extra thick. If you are interested in buying a pillow from Dosaze, here is the link. If you do use this link you will get an automatic 20% discount. If you get there a different way you can use the coupon code: DrThomas.