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How to Choose Your Best Mattress and Pillow: A Chiropractic Perspective

Which bed and pillows to choose for your body type, and what is the best sleeping position?

Woman waking up feeling refreshed

Many people have difficulty going to sleep, feel uncomfortable, or wake up with neck pain. Looking for the best mattress and pillow is tough. It’s the ultimate Goldilocks dilemma with them being too hard, or too soft, and not perfect. As a Chiropractor, we find that most of these problems originate from an unhealthy spine, locked joints, and overly-compensated muscles. While we can correct those, we are often asked to recommend beds and pillows to support our patient’s recovery. While the technology has changed considerably from coil-spring beds and feathered pillows, information on what to buy based on your body type and sleep position is not widely known! You may even be eyeing akemiuchi pillows, or other top-line mattresses right now. Let’s dive in with our Chiropractor’s way to find the best mattress and pillow, and learn how to sleep properly on it!

What Is The Best Sleeping Position?

Comic of different sleeping positions and sleep styles

One of the best guiding principles for sleeping is to keep your body and spine in relative neutral. That means your arms, legs, torso, and neck are all relaxed without excessive flexing or bending. Side sleeping and sleeping on your back are generally considered the best sleeping positions when done properly because of the neutral position achieved.

Stomach sleeping causes neck pain and midback pain

Stomach sleeping is terrible for your neck and low back, since laying on your front requires a twisting of your spine in a static position for a long time. Imagine walking around for 8 hours a day with your head turned left 80 degrees. One side of the neck muscles are stretched, the other contracted. Over time this can create poor neurological patterns and muscle imbalances that make it difficult to find a comfortable sleeping position. We don’t want to perpetuate an unhealthy sleep position, so we will focus on back and side sleepers. It is recommended that stomach sleepers (slowly) change to another position, with side sleeping being the closest and most likely. Stomach sleepers can try padding pillows on your front and back to cradle you in a side sleeping position. This will provide comfort and limit your instinct to turn over to your belly.

What Do I Look For In A Mattress?

Woman in bed, under covers

Your first question should be, “What sleep position do I use most?” Side sleepers generally need softer beds than back sleepers because your hips and shoulders are heavier (and more protruding), which pierce the bed more. A very firm bed will increase pressure on those joints making it uncomfortable, and causing you to twist and turn away from the pain and away from ‘relative neutral’. Back sleepers generally need a denser and supportive bed to support your Spinal alignment, as your hips are likely to sink too deep into a soft mattress which can hurt your low back. Note we didn’t say firmer, as a firm mattress doesn’t mean it’s supportive. Support refers to density and thickness of the material while firmness is more so the Indentation Load Deflection (ILD) rating. Think of a thin piece of memory foam that’s very firm laid upon a concrete floor. Now picture yourself laying sideways on it. While firm, it won't support your shoulder and hips at all.

SUMMARY: It’s advised to get a supportive mattress that keeps your

spine straight, medium firmness for side sleepers and a more dense/supportive bed for back sleepers.

Weight Affects Which Mattress You Get

Correct sleeping position and incorrect sleeping position sideways

Ever wonder why the firm/soft scale is so hard to measure? Each person’s weight and body shape changes your perception of the support you feel. Lighter people will find medium firmness beds sometimes too hard, and naturally heavier people will find the opposite. Remember, always check how it feels versus what firmness it rates. If you’re heavier (>90kg), long term support is your focus. We don’t want your bed to sink in 5-10 years. Look for a good coil/spring/hybrid bed, or insure the memory foam is dense enough to withstand the repetitive pressure. If you’re lighter, make sure it’s not too firm or hard. Memory foam may be more recommended since less support is generally needed. For side sleepers, You can test a mattress by having a friend take a photo of you in a comfortable side-lying position.. Look for your nose, chin, sternum, belly button, and pubic bone (front of your pelvis) to be in a linear alignment and check for any deviation.

What Do I Look For In a Pillow?

Proper pillow height for supine and side lying

The best pillow for neck problems depends on many factors. Largely, it goes back to how you’re using it! Two side sleepers who are 193cm and 160cm tall need two very different pillows. The biggest factor we focus on is pillow height. The broader your shoulders, the taller the pillow needs to be to support your head and shoulders in the side position. Laying on your side, the pillow should fit gentle and snug to where your lower neck meets your shoulders and trapezius muscle. Make sure the shoulders are stacked on top of each other, with the top shoulder slightly leaning backwards. If you’re comfortable in this position, your head doesn't sink or tilt excessively, and your body is in a relatively neutral position, you’ve found a good pillow! But for back sleepers, you don’t want a tall pillow. The bigger the pillow, the more your head will protrude forwards (pulling and straining your neck muscles). A small pillow that gently supports your neck into a lordosis is ideal. Sleeping is about restoring health, and allowing your neck to retract from all the FHP (Forward Head Posture) we do daily is a good idea.

What Pillow Material Should I Use?

Man hugging a pillow

Surprisingly, there is a lot of research on pillow material! What works best for most people seems to be rubber pillows (performing BETTER than the subject's own pillow brought in), which helped to reduce tossing and turning, increased sleep quality, and less pain and stiffness reported.

They also found that the highly marketed ‘contour’ pillows performed similarly to foam and polyester pillows. Contour pillows also didn’t show any improvements versus traditional pillows. Interestingly, they also found feather pillows were associated with the worst outcomes of them all!

SUMMARY: Find what works for you, make sure the pillow height is appropriate to your body, and try for rubber-based pillows.

“What About Sleeping Without a Pillow At All?”

Woman sleeping awkwardly on desk arm out

For back sleepers, that’s O.K. as long as their head stays in neutral and doesn’t fall excessively to the side in rotation. We don’t want one side of the neck being pulled and stretched for the entire night. Some people really enjoy rolling up a small towel to place under their lower neck for slight support for their lordosis (neck curve). Find what works best for you. For side sleepers, no pillow is ill-advised since the tendency is to bend or straighten your arm upwards due to the lost support of the head. We name this position the “Superman” since the bottom shoulder is extended past 90 degrees of flexion. This has been known to cause numbness and tingling in the arms as veins, arteries, and nerves get compressed by the shoulder.

Side Sleeping Tips

Cartoon of side sleeping correct pillow height

In a healthy body, we should see a straight spine from the back, and specific curves (lordosis) from the side. It’s very important to not flex the head forward (chin flexing to chest) when laying on your side or having lots of FHP (Forward head posture). Another common mistake is to be excessively curled up into a fetal position (knees to chest, upper back rounded) as this will strain your joints and muscles over time. Sleeping in this rounded position can even affect your posture afterwards since your body becomes “used to” this forward, flexed position. A small to medium amount of leg and knee bending is O.K. but be conscious of how much curling you are doing. Often using a bolster between your legs can help limit hip strain as well. The last tip, try to avoid the superman position. With your bottom arm extended above your head (often used when the pillow is insufficiently supporting the neck), your body weight puts a significant amount of pressure onto your exposed shoulder capsule and can compress the Axillary nerve.

Back Sleeping Tips

This position is one of the easiest to control and modify since you are essentially laying straight and flat. Ensure your pillow is small and not large enough to cause FHP or chin flexion. You can check this by having a friend or significant other take a photo of you from the side and see how high your head is compared to your chest. Research shows that the higher the pillow, the more cranial and cervical (neck) pressure it produces which affects sleep quality and overall health. The most notorious discomfort from back sleeping is low back pain. This can be due to your bed being too soft and not supporting enough to hold your lumbar lordosis. Try placing a small pillow under your knees (knees slightly bent). This can relieve some pressure in the low back by loosening the lumbar and pelvis tension. For some people, this ache comes from irritation of pre-existing injuries like Subluxation, degenerated joints, or slipped discs. If you have already tried Chiropractic for your low back pain (which works incredibly well for the vast majority of our patients), and you have an old mattress, you may want to upgrade your sleep with a new bed.

“What If I Still Have Pain With Sleep, I’ve Bought a New Bed And Pillows But To No Relief”

Pre and post x-ray of cervical lordosis improvement
Structural Correction of a patients forward head posture (FHP) and resolution of chronic neck pain with sleeping.

In this case, it’s likely coming from a structural problem, which Chiropractors are experts at correcting. Countless patients have come to us not because they have day pain, but because they can’t get comfortable sleeping or wake up with aches and stiffness. By performing a thorough examination of your Musculoskeletal system and Nervous System, we can identify and treat the issues that are blocking your health. Contact us today for a free case review, and if we think we can help, we’ll complete an examination and make recommendations. We’re here for you.


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