The Right Pillow and Mattress for You (Not the Bestselling One)

"What's the best pillow for neck pain?" is one of the questions I'm asked most often as a chiropractor.

Closely followed by:

"Should I buy a new mattress?"

People are often surprised by my answer.

I don't recommend a particular brand of pillow or mattress.

That's not because they don't matter, they absolutely do, but because the best option depends on you. Your body shape, shoulder width, preferred sleeping position and comfort all play a part. A pillow that's perfect for one person could be completely wrong for someone else.

Instead of telling my patients what to buy, I help them understand what they should be looking for.

Your pillow should keep your neck in a neutral position

Think of your pillow as supporting your head so your neck stays in a comfortable, neutral position while you sleep.

If your pillow is too high, your head is pushed upwards.

If it's too low, your head drops down towards the mattress.

Neither position is ideal if maintained for several hours overnight.

What's the best pillow for side sleepers?

For most people, side sleeping is the position I recommend.

Your pillow should fill the space between your shoulder and your head so your neck stays in line with the rest of your spine.

This means the right pillow height will be different for everyone. Someone with broader shoulders, for example, may need a higher pillow than someone with a smaller frame.

If you regularly wake with neck stiffness or shoulder discomfort, your pillow may simply be the wrong height.

A pillow between your knees can also help keep your pelvis and lower back in a more comfortable position.

What pillow should I use if I sleep on my back?

A slightly lower pillow often works well for back sleepers.

The aim is to support the natural curve of your neck without pushing your head forwards.

Again, there's no particular pillow or height that works for everyone. Comfort and the position of your head and neck are more important than the type of pillow you're using.

What about sleeping on your stomach?

I don't generally recommend sleeping on your stomach.

For most people, it requires the neck to remain rotated to one side for prolonged periods, which isn't a position I generally encourage—particularly if you're already experiencing neck pain or stiffness.

If you're someone who naturally rolls onto your stomach during the night, don't worry—you don't need to force yourself to change overnight. You could instead gradually try to spend more of the night sleeping on your side.

Before buying a new pillow...

Try adjusting the one you already have.

One pillow might be slightly too low, while two pillows may feel too high.

A folded towel underneath your pillow can be a simple way to fine-tune the height before spending money on a replacement.

Also have a look at the condition of your current pillow. If it has noticeably flattened, become lumpy, no longer returns to its usual shape, or you find yourself constantly folding or bunching it to feel comfortable, it may be time to replace it.

Are orthopaedic or contour pillows better for neck pain?

This is another question I get asked frequently.

Orthopaedic (or "contour") pillows are shaped to cradle the head and support the curve of the neck. Some have a raised edge and a lower central area designed to accommodate different sleeping positions.

For some people they work really well.

They're not essential, though, and they're not right for everyone. The shape is fairly fixed, so if it doesn't match your body shape and sleeping position, it can feel just as wrong as an ordinary pillow that's the wrong height.

If you're curious about trying one, choosing somewhere that offers a trial or returns period can be helpful rather than assuming a specialist pillow will automatically solve your neck pain.

Try a rolled towel first

A simple alternative I often suggest is adding a rolled towel.

Roll a small hand towel and tuck it inside your pillowcase, positioned underneath your neck rather than underneath your head.

This can provide a little extra support beneath the natural curve of your neck while allowing you to keep the pillow you already have.

It's also a simple, low-cost way to see whether adjusting the support around your neck feels more comfortable before buying a specialist pillow.

Does it matter what my pillow is filled with?

Memory foam, latex, feather, down and synthetic pillows all provide support in slightly different ways.

There isn't one filling that's best for everyone.

What matters much more is whether the pillow gives you the appropriate height and support for your body and sleeping position.

Choose based on fit and comfort rather than what's currently on trend.

How long does a pillow last?

There's no exact lifespan for a pillow.

Different materials wear at different rates, so rather than replacing yours simply because it has reached a particular age, look at whether it's still holding its shape and giving you the support you need.

If you're constantly adjusting, folding or bunching it, or it has become noticeably flat or uneven, that's probably more useful information than its age alone.

What's the best mattress for back pain?

Just like pillows, there isn't one particular mattress that's best for everyone with back pain.

And you usually don't need to buy the most expensive one.

The important thing is that your mattress supports your body comfortably.

If your mattress is noticeably sagging, uneven or causing you to roll into the middle, it may be time to consider replacing it.

Age can be another consideration, particularly if you've had your mattress for many years and it no longer feels supportive, but there's no need to replace a comfortable, supportive mattress simply because it has reached a particular birthday.

Does a firmer mattress mean better support?

Not necessarily.

Firm and supportive aren't the same thing.

A mattress needs to support you, but that doesn't mean it needs to feel hard. Research involving people with persistent low back pain has suggested that medium-firm mattresses may be more comfortable than very firm mattresses.

Ultimately, comfort and support for your individual body are more useful guides than a label saying "firm" or "orthopaedic".

What about a mattress topper?

A mattress topper can be a useful middle step before committing to a completely new mattress.

A topper may help if your mattress is structurally sound—there's no significant sagging or dip in the middle—but the surface feels uncomfortably firm or you'd simply prefer a different feel.

In this situation, a topper may improve the comfort of an otherwise supportive mattress.

A topper is unlikely to fix a mattress that's sagging, uneven or causing you to roll into the middle. You're essentially adding another layer on top of the underlying problem.

As with mattresses and pillows, there's no single "best" topper. Think about comfort and how well supported you feel rather than focusing purely on brand, price or marketing claims.

What about pillows and sleeping positions during pregnancy?

Sleep can become considerably more challenging as pregnancy progresses, and pillows can be really useful for making things more comfortable.

From 28 weeks of pregnancy, the safest position to go to sleep is on your side, whether that's your left or right side.

Many pregnant women find placing a pillow between their knees and another underneath the bump makes side sleeping much more comfortable. A longer pregnancy or body pillow can also be useful if you prefer having everything supported by one pillow.

And if you wake up on your back during the night, don't panic. Simply roll back onto your side and settle back to sleep.

Remember: your sleeping position isn't the whole story

Although pillows and mattresses can make a difference to comfort, they're rarely the whole story when someone is experiencing pain.

Stress, jaw clenching, daily activities, exercise, workload, previous injuries and general health can all influence how we feel.

If you notice that you hold a lot of tension, particularly around your neck, shoulders or jaw, relaxation techniques can also be worth exploring. A simple body scan is one technique you can try before bed.

If you've tried adjusting your sleeping position or pillow and you're still regularly waking with pain, it's worth getting assessed rather than continuing to buy different products hoping one will solve the problem.

Quick guide: choosing your pillow and mattress

• Side sleeper? Your pillow should fill the space between your head and shoulder. Try a pillow between your knees too.

• Back sleeper? A slightly lower pillow may be more comfortable while still supporting the natural curve of your neck.

• Stomach sleeper? I generally encourage gradually spending more of the night on your side, particularly if you're experiencing neck pain or stiffness.

• Pillow constantly being folded or adjusted? It may no longer be providing the support you need.

• Considering an orthopaedic pillow? Try a rolled towel underneath your neck first and see whether changing the support feels more comfortable.

• Memory foam, latex or feather? The filling matters less than getting the height, support and comfort right for you.

• Firm mattress? Firmer doesn't automatically mean more supportive.

• Mattress sagging or making you roll into the middle? A topper is unlikely to fix the underlying problem.

• Pregnant? From 28 weeks, go to sleep on your side. Pillows between the knees and underneath your bump can make this much more comfortable.

• Still waking with pain? Consider getting assessed rather than repeatedly changing your pillow or mattress.

Still waking with neck or back pain?

If you're regularly waking with neck or back pain and aren't sure whether your sleeping position, pillow or mattress could be contributing, this is something we can discuss during an appointment at Queensferry Chiropractic in South Queensferry or Dalmeny.

Sometimes a few small adjustments are all that's needed.