One thing that I’m very particular about is to make sure I take my pillow with me when I travel. If I’m not able bring my pillow or I forget, I roll up a towel and shape it in such as way to mimic my regular pillow.
Everyone has their favorite pillow. Some people like soft, down-filled pillows, whereas others may like very hard pillows. There are literally hundreds, if not thousands of different sizes, styles, colors, dimensions, covers, fillers, and even fragrances of pillows. If you start researching pillows and mattresses, I guarantee you’ll go down a rabbit hole of unending safety concerns about various materials used during manufacturing, especially related to flame retardants (another major issue I’ll cover in a later post). There are also lots of websites and recommendations for what type of pillow is best.
But there’s one thing about pillows that’s almost never addressed directly: how pillows can affect your airway and breathing at night. Granted there are generic descriptions of anti-snoring pillows, but an explanation of how they work is not usually given.
We know that for everyone (whether or not you have sleep apnea), the tongue will fall back most when you’re on your back, mainly due to gravity. Things get much worse when you enter deeper levels of sleep (due to muscle relaxation), and especially during REM sleep, when your throat muscles are relaxed completely. This is why many people prefer to sleep on their side or tummies. Even then, it’s usually not good enough to prevent your tongue and other areas of your throat from closing in.
The ABCs of pillows
Basically, the best pillow is one that opens your airway the most when you sleep. If you ever took a CPR course, you’ll remember the ABCs (airway, breathing, circulation). To secure the airway, you’re taught to tilt the head back. If you are able to look at the airway through a tiny flexible fiberoptic camera (like I do every day on my patients), what you see is that the more you tilt your head back, the more the space behind your tongue and soft palate opens up.
The “contour pillows” are a variation of pillows (typically made of memory foam), which gives you more support behind your neck and less support behind your head. This allows you to keep your head tilted back a bit, preventing your head from bending forward, which can narrow your airway.
How smelling the rose and help you sleep better
Even before we had fiberoptic cameras, otolaryngologists (ENTs) are taught to use a small mirror through the mouth to see the voice box. The patient is told to lean forward, with the nose lifted up a bit, like “you’re smelling a rose.” This head-forward position also will open the space behind the tongue, allowing you to see the voice-box more easily. This technique supports how pillows that can position your head and neck has potential to help you breathe better and snore less.
In people with small jaws and small airways, a common finding is that they will keep a “head-forward” position, so that it’s easier to breathe during the day. Although it helps with breathing, poor posture that results can lead to a cascade of neck and back problems.
What about side or stomach sleepers?
Many of you are probably thinking that these examples don’t apply to you since you like to sleep on your side or your stomach. Even then, your head position plays a critical role in how open your airway is, especially in deep or REM sleep. I’ve even had patients experiment with using soft neck collars while sleeping on their sides to prevent the chin from dropping too much.
Why some people don’t use pillows
For various reasons, such as after surgery, or due to a back, neck or shoulder injury, some people who normally prefer to sleep on their side (or tummy) must sleep on their backs. Most will figure out a way to find a pillow to tilt the head back. But if this is not possible, some prefer to sleep without a pillow at all. This forces you to bend your head back maximally, which also opens your airway significantly.
Re-evaluate your pillow
If you’re not able to get the quality of sleep that you want, before investing in a new mattress, think about finding the right pillow. Does it allow you to tilt your had back when on your back, as well as during side sleep? You’ll need to experiment with different sizes, shapes, and configurations. With some troubleshooting as well persistence, you should be able to find the right pillow for a great night’s sleep.
What is your favorite pillow? What has worked for you in the past? Please enter your answers in the text box below.