Finding just the right pillow

There are many things to take into account when choosing a pillow. PICTURE / GETTY IMAGES

When you hit the hay, you want to be sure that your head stays in the right place and you wake up feeling refreshed and revitalised.

How many of you can attest to the disappointment of waking up with a headache or a sore neck? Pillows are an essential part of our sleeping environment, yet few of us actually know much about what to look for when buying a pillow. What material is best in a pillow's construction and can we have more than one? Will my pillow withstand the same regular use as our All Blacks captain, or is it time for a sabbatical for that old chestnut?
The first thing that a pillow must provide is support of the natural spinal curves. A simple test is to stand up with good posture and then get someone to photograph you from the side. Now turn the camera on its side so that it looks like you are lying on your back. This is how you should look from the side when sleeping on your back. If your pillows are right, the head should stay very close to this neutral position of the neck. If you sleep on your side, once again the same holds true. If your pillow is too high or too low you will have your head on your shoulder either way and this isn't ideal. This is where you might need two.

One of the things that leads me to suspect pillows in part of a person's neck problem is waking repeatedly in the night, or waking up sorer than when you went to bed.
Evaluating your current pillow requires an non emotional objective state, because you may discover the one you use is unsuitable, and have to part ways. Be brave.
Place the pillow on the bed and with a clenched fist, punch the middle of the pillow gently. Watch the pillow, and if it bounces back taut, there is too much recoil in the pillow. It is better that the pillow can accommodate your head without fighting back with too much spring. Obviously if you have a foam, latex or memory pillow it will bounce back, so you want to make sure that the pillow fits your shape perfectly and isn't too big under your neck.

Run your hand across the sleeping surface, and feel for lumps. There should be none. The surface should be smooth. It shouldn't resemble the hill country of Whanganui River National Park, but I have seen pillows that look like this.
The next test requires a naked pillow. Take off the pillow slip. If it's decorated with drool flowers, you will have moisture in your pillow. Its probably less healthy if your pillow looks like a Monet impressionist knock off. You'll also see more lumps in the nude pillow. There really shouldn't be any.

So if you're in the market for a new pillow, what attributes should you be aware of?

Microfibre pillows: These are polyester pillows that have fibres smaller than a single strand of silk (one denier).Often cheap, breathable and hypoallergenic but they flatten over time. If you can access the fibres directly, you can plump them up again.

Feather pillows: Used for centuries, borrowing down from geese, or feathers from ducks, they offer insulating properties, but if not constructed with chambers, you end up with two bunches of feathers either side of your head and no support.

Wool pillows: According to Therapeutic Pillow Australia, it's a natural fibre that packs down so quickly, it becomes hard and crushes your ears. They also absorb moisture and become a hang out for dust mites.

Cotton pillows: Also a firm, sometimes hard pillow and a thirsty moisture absorber.

Foam pillows: These emerged in the 90s, and were not as sophisticated as they are today. A study published this year found that foam latex contoured pillows had a place in treatment or management of neck osteoarthritis and degeneration. The study in the American Journal of Physical Medicine and Rehabilitation seems to be well designed and concludes that pain intensity was decreased in the scenario of pillow use plus physiotherapy. Another older study by Persson and friends (1998) found a firm contour to preserve the neck's natural concave shape or lordosis was the most preferable. A group of Korean researchers in 2016 found in favour of these contoured latex pillows both with in-house testing in hospital, and through an exhaustive review of the literature. These pillows are often expensive and if you spend over $100 on a pillow you will have a vested, or invested, interest in it working, which may cloud objectivity.

Hopefully the retailer will have a few samples available for you to assess the pillow, but if the product does not fit the purpose you intended, the docket is your best asset in getting the right pillow replacement immediately. Perhaps keeping the pillow in the plastic for a few nights may be a very wise thing in preserving an incompatible pillow's exchange-ability.
Memory foam pillows push the scientific frontiers and the purse strings, with pillows soaring above the $300 mark but for some people that is justifiable to achieve that good night's sleep night after night. It's funny how precious sleep can seem when you can't get it!

According to the Physio Company in the UK, you should recycle a pillow every two to three years.
Of course an investigation into pillows is not complete without a critique on hospital pillows.
Allegedly the filling is crafted from the obsidian spewed out of Mount Doom. It is then overpacked into the noisiest vinyl pillow case, impenetrable for fluffers, and then sealed in BPA-free industrial body bag grade plastic. The pillow case is really just a garnish. You can't buy these commercially. I apologise for creating a momentary demand.

Peter Larmer of AUT school of physiotherapy says that any pillow that provides support under the curvature of the neck and keeps it in its neutral position is ideal. A feather pillow or a rolled up towel could do that.
I often advise a rolled up hand or bath towel to about 10cm diameter makes a plain pillow more like the foam pillow conformation. The towel supports the natural curve of the neck, and the pillow case seems to hold it in place.

The bottom line in pillow support is posture. If you can achieve the neutral neck position, that position that looks like you do when you stand up nicely, there isn't really a wrong choice.
Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz