How to choose a pillow: height by sleep position, fill, and when to replace one

How do I find out which pillow is best for me?

The best pillow for you is found lying down, in the position you wake up in, on a mattress close in firmness to your own. A second person helps, since nobody can judge their own neck angle.

1. Lie in your usual position. Give the pillow a minute or two, so the fill compresses the way it will at night.
2. Check from the side. Your helper looks along your spine. A head tipped toward the ceiling means the pillow is too high, and a head dropping toward the mattress means too low.
3. Check a side position from the foot of the bed. HealthLink BC's test is a pillow that lets you "align your nose with the centre of your body when you lie on your side".
4. Check a back position. HealthLink BC asks for a pillow "that doesn't force your head forward when you lie on your back".
5. Change one thing at a time. Swap pillows, or take fill out of an adjustable one, and look again.

The mattress moves the answer, so a pillow is best judged on the bed it will sit on. Your shoulder sinks by different amounts into a soft bed and a firm bed, and that changes the gap the pillow has to fill.

Get the right pillow height for your sleep position

Pillow height for each sleep position follows from the gap between your head and the mattress. Sean Wilging, a physical therapist at Ohio State Wexner Medical Center, walks through each position in the university's pillow guide.

Side sleepers have the widest gap, set by the shoulder. Wilging says enough height "to bridge the gap created by your shoulder is important to help maintain a neutral neck position". The bed half of that problem is in the side sleeper guide.

Back sleepers need less height and more shape under the neck. Wilging's priority is "a pillow that supports the natural curve of the neck". A contoured neck pillow does that by its shape, with a raised roll under the neck and a lower dip for the head. Anyone rethinking the bed too can read about mattresses that suit back sleepers.

Stomach sleepers turn the head to one side for hours, so lower is better. Wilging suggests "a short-height pillow to avoid having your neck extended while rotated". HealthLink BC goes further: "Don't sleep on your stomach with your neck twisted or bent".

Combination sleepers change position through the night, and Tempur-Pedic marks its ProBlend for them, with one solid side and one side of adjustable fill. Among our own pillows, an adjustable one can be set to the middle height.

Pillow fill: memory foam, latex, down and adjustable fibre

Pillow fill decides how the height behaves under your head, and Merit lists three of the four main types. Solid foam and solid latex keep one shape all night. Down and fibre compress and need plumping, and shredded fills can be added or taken out.

Memory foam moulds to the head slowly. Our listing describes Natura's Luscious pillow as a solid memory foam core in a zippered shell, at $139.00 for a queen.

Latex pushes back faster than memory foam. Natura describes the solid Talalay core of its latex core pillow as "uniform, springy support for your head and neck that instantly returns to its original shape". That pillow is $169.00 for a queen, and the solid Talalay Natura Exquisite is $159.00. Natura also calls its latex pillow "breathable, hypo-allergenic", which matters to anyone reading about beds for hot sleepers.

Down is light and squashes under the head. None of the pillows we list today is down; the nearest is the down alternative fill in the Hotel Comfort.

How do adjustable pillows work?

Adjustable pillows put loose fill inside a zipped cover, so the height changes when some fill comes out. Ohio State's guide says that way "you can customize the height of the pillow to support your neck at an even level with your head and body". Health Guard's instruction for the Hotel Comfort is simply "just remove the fill". Natura's Aloe Dream Mate does the same with an "adjustable, granulated" latex core, at $129.00 for a queen.

What's a good pillow for neck pain?

A pillow for neck pain is not a treatment, and the health sources here stay careful about it. HealthLink BC's advice is the same straight-neck rule as above. It also says that when neck pain is worse in the morning, the pillow and sleeping position are worth a look.

Ohio State's Wilging says "the most important aspects of a pillow are comfort and support". Neither source names one best pillow. A contoured neck pillow is one shape to try, sized by the same side-view check as any other.

Neck pain that comes with numbness or weakness is a different matter. HealthLink BC says to call a doctor now if "you have new or worse numbness in your arms" or new weakness in the arms or legs. A doctor or physiotherapist can say whether a pillow change is worth trying.

What type of pillows do 5 star hotels use, and what is the 2-2-1 rule?

Hotel pillows vary from chain to chain, and hotels publish no single standard, so there is no one hotel type to copy. Health Guard named one of the pillows Merit carries the Hotel Comfort. It describes it as "plush, customizable support wrapped in silky soft Tencel comfort".

The 2-2-1 pillow rule is a decorating formula for a made bed, usually read as two sleeping pillows, two shams and one accent cushion. It says nothing about loft, so it won't settle which pillow to sleep on.

What else can I do to improve my sleep?

Improving sleep takes more than a pillow, and Ohio State's guide lists habits to go with one. They include "going to bed around the same time every night" and putting the phone or another screen away "an hour or two before bed". It also suggests washing pillows to clear "dust and other allergens". Poor sleep that carries on despite all of this is worth raising with a doctor.