The Best Pillow For A Great Night’s Sleep

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.

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5 thoughts on “The Best Pillow For A Great Night’s Sleep

  1. I have been finding some success with a Hullo buckwheat pillow (with a lot of hulls removed), with a second softer, thin pillow on top of it. The Hullo pillow provides a firm base, the smaller pillow on top provides a little added height and softness. The removalable hulls of the Hullo ( pillow allow me to experiment with varying pillow sizes/heights.

    (My situation: mild apnea, not currently using my CPAP, side sleeper, Leesa foam mattress.)

  2. My best pillow is a combination of 2 pillows both made from shredded latex. sells latex pillows. I have a large pillow that acts as a wedge. On top of this, I have a smaller pillow that I customized by buying an allergy control dust mite pillow case cover and adding the shredded latex material until I got a satisfactory thickness. One standard pillow from Plushbeds makes me 2 small pillows. The latex is great because it conforms to the body’s shape. You can mold it so that it supports the neck.

  3. I have several sleep-breathing issues requiring me to sleep with my head facing downward, into the mattress or pillow. So I have had problems finding the right pillow to allow me to sleep in this position. I have UARS, OSA, and acid reflux and have found that I must sleep face-down, so that gravity can draw my whole tongue forward so it won’t clog my throat when asleep, and so my acid reflux can leak out my mouth without being inhaled. I also use a CPAP for OSA. The CPAP is indispensible for providing a reliable air supply so that the surface supporting my head doesn’t smother me. However, the lower edge of my CPAP full-face mask tends to press painfully on my lower lip and teeth when I rest it on the mattress or a regular pillow. Sometimes this pressure on my lip and teeth wakes me up and sometimes loosens my lower front teeth during sleep.

    What I found that works for me is a combination of two different pillows; 1. one for the shape, for which I use a memory foam pillow called a “neck pillow,” that is shaped like a Pac-Man, which I lie flat. 2. The other, smaller, pillow is placed under the neck pillow mainly for the purpose of elevating the flat “neck pillow” so that there is enough clearance below my CPAP mask and the bed’s mattress. I will describe how both are used:

    1. The neck pillow (the one on top):
    I lie with my face on the “neck pillow,” which I position in a way that if it were a Pac-Man, it’s mouth would open toward the foot end of the bed. I rest my mouth over the open end of the Pac-Man’s mouth. That is, with the two arms of the neck pillow facing the foot end of the bed fairly equally. The pointed top of my CPAP mask, that goes up my forehead, rests in the groove between the neck pillow’s two arms, closer to their union (nearer the headboard of the bed).

    2. The other pillow:
    The other pillow, that is used to elevate the neck pillow, is a foam knee pillow that I adapted for this purpose. When purchased, the knee pillow was in the shape of an “8,” and still is, only now it is not so thick. I have taken the covering off the knee pillow and sawed it down with a long bread knife to a thickness slightly less than half it’s original thickness. I place it horizontally under the middle of the other pillow (the neck pillow). It gives support and has the feature that it can be turned slightly under the neck pillow to give a different angle for supporting parts of my head.

    Other notes:
    1. I like to stick my tongue out when lying face downward because it lets me breath better.
    2. I use other pillows to support my sides, especially at the shoulders, so that my neck isn’t bent back so much when resting my head on the elevated neck pillow.
    3. I am a think 64 year old woman who has been offered a UPPP by my ENT, but I turned it down.
    4. My front teeth are stained quite gray, from the action of my acid reflux running over them due to my facing downward during sleep. The source of the grayness is most likely my gold fillings, my dental hygienist says, because the gold fillings are pitted but the mercury ones aren’t, she says (I haven’t found a solution for this, but my hygienist says that my mouth is actually healthy but just doesn’t look like it. She said that polishing the stain off would require me to loose some tooth enamel so I turned it down last visit).


  4. I have been finding some success with a Hullo buckwheat pillow (with a lot of hulls removed), with a second softer, thin pillow on top of it. The Hullo pillow provides a firm base, the smaller pillow on top provides a little added height and softness. This reviews also give the 10 best pillow for side sleeper.

    (My situation: mild apnea, not currently using my CPAP, side sleeper, Leesa foam mattress.)

  5. Hello,
    I generally have a problem of lower back pain. I thought sleeping on the floor would reduce it, but it never helped. While searching measures to cure lower back pain, I found your article. It was really helpful.