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Your Pillow May Not Guarantee a Good Night's Sleep or Symptom-Free Waking

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Purpose: To describe the performance of the pillow that participants usually slept on with respect to retiring and waking cervico-thoracic symptoms, pillow comfort, and sleep quality. Methods: Participants (n=106) were systematically recruited for a field trial comparing their own pillow and five trial pillows. Participants provided daily retiring and waking symptom reports and sleep-quality and pillow-comfort ratings prospectively for 1 week on each pillow. Linear and logistic regression models were used to investigate the relationship between pillow use, age, gender, sleep quality, pillow comfort, and waking and temporal (overnight) symptom reports. Results: No waking symptoms were reported by 42.5% of participants on their own pillow. Regular waking symptoms, failure to relieve retiring symptoms, uncomfortable pillows, and/or poor-quality sleep were reported by over 50% of participants. All participants who reported poor sleep quality also reported poor pillow comfort. Pillow-comfort reports were not related to any waking symptom report; however, reports of poor sleep quality were significantly related to waking cervical stiffness (adjusted odds ratio [AOR]=4.3 [Confidence Interval (CI): 1.3–15.6]) and scapula pain (AOR=6.1 [CI: 1.1–31.6]). Feather pillow users provided consistently low reports of pillow comfort and sleep quality. Conclusion: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common. Further research is required to understand why people choose particular pillows to sleep on, as well as to identify the best fit between person and pillow to optimize sleep quality and reduce waking symptoms.
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ARTICLES
Your Pillow May Not Guarantee a Good Night’s Sleep
or Symptom-Free Waking
Susan J. Gordon, Karen Grimmer-Somers
ABSTRACT
Purpose: To describe the performance of the pillow that participants usually slept on with respect to retiring and waking cervico-thoracic symptoms, pillow
comfort, and sleep quality.
Methods: Participants (n¼106) were systematically recruited for a field trial comparing their own pillow and five trial pillows. Participants provided daily
retiring and waking symptom reports and sleep-quality and pillow-comfort ratings prospectively for 1 week on each pillow. Linear and logistic regression
models were used to investigate the relationship between pillow use, age, gender, sleep quality, pillow comfort, and waking and temporal (overnight)
symptom reports.
Results: No waking symptoms were reported by 42.5% of participants on their own pillow. Regular waking symptoms, failure to relieve retiring symptoms,
uncomfortable pillows, and/or poor-quality sleep were reported by over 50% of participants. All participants who reported poor sleep quality also reported
poor pillow comfort. Pillow-comfort reports were not related to any waking symptom report; however, reports of poor sleep quality were significantly
related to waking cervical stiffness (adjusted odds ratio [AOR] ¼4.3 [Confidence Interval (CI): 1.3–15.6]) and scapula pain (AOR ¼6.1 [CI: 1.1–31.6]).
Feather pillow users provided consistently low reports of pillow comfort and sleep quality.
Conclusion: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common.
Further research is required to understand why people choose particular pillows to sleep on, as well as to identify the best fit between person and pillowto
optimize sleep quality and reduce waking symptoms.
Key Words: cervical spine, headache, pain, pillow, sleep quality, stiffness, temporal change
Gordon SJ, Grimmer-Somers K. Your pillow may not guarantee a good night’s sleep or symptom-free waking.
Physiother Can. 2010;preprint. doi:10.3138/ptc.2010-13
RE
´SUME
´
Objectif : De
´crire le rendement de l’oreiller sur lequel les participants dorment habituellement en ce qui a trait aux sympto
ˆmes cervicothoraciques d’e
´veil et
de retrait, au confort de l’oreiller et a
`la qualite
´du sommeil.
Me
´thode : Les participants (n¼106) ont e
´te
´syste
´matiquement recrute
´s pour un essai sur le terrain dont l’objectif e
´tait de comparer leur propre oreiller a
`
cinq autres mode
`les qu’ils essaieraient. Les participants ont pre
´pare
´des rapports quotidiens sur leurs sympto
ˆmes d’e
´veil et de sommeil et sur la qualite
´de
leur sommeil, et ils devaient e
´valuer le confort de chaque oreiller de manie
`re prospective pendant une semaine. Des mode
`les de re
´gression line
´aires et
logistiques ont e
´te
´utilise
´s pour e
´tudier la relation entre l’utilisation de l’oreiller, l’a
ˆge, le sexe, la qualite
´du sommeil, le confort de l’oreiller, l’e
´veil et les
rapports temporels de sympto
ˆmes (sur toute une nuit).
Re
´sultats : Aucun sympto
ˆme d’e
´veil n’a e
´te
´signale
´chez 42,5 % des participants lors de l’utilisation de leur propre oreiller. Des sympto
ˆmes d’e
´veil
re
´guliers, une incapacite
´a
`soulager les sympto
ˆmes de retrait, un oreiller inconfortable et un sommeil de mauvaise qualite
´ont e
´te
´signale
´s par 50 % des
participants. Tous les participants qui ont de
´clare
´avoir un sommeil de pie
`tre qualite
´ont dit aussi avoir un oreiller peu confortable. Les rapports sur le
confort des oreillers n’e
´taient pas lie
´sa
`quelque rapport d’e
´veil que ce soit ; toutefois, des rapports qui signalaient un sommeil de mauvaise qualite
´e
´taient
lie
´s de manie
`re significative a
`une raideur cervicale a
`l’e
´veil (ratio d’incidence approche
´[RIA] de 4,3 [intervalle de confiance (IC) de 1,3–15,6]) et a
`une
douleur a
`l’omoplate (RIA de 6,1 [IC de 1,1–31,6]). Les utilisateurs d’oreillers de plumes fournissaient constamment des rapports de faible confort de
l’oreiller et de pie
`tre qualite
´de sommeil.
Conclusion : Plusieurs participants semblent avoir fait un mauvais choix d’oreiller, puisqu’un sommeil de pie
`tre qualite
´, de l’inconfort avec leur oreiller et
des sympto
ˆmes d’e
´veil e
´taient communs. Plus de recherches seront ne
´cessaires pour comprendre pourquoi ces personnes ont choisi ces oreilles pour
dormir, et pour identifier le meilleur oreiller pour chaque personne, afin d’optimiser la qualite
´de leur sommeil et de re
´duire les sympto
ˆmes d’e
´veil.
Mots cle
´s:changement temporel, colonne cervicale, douleur, maux de te
ˆte, oreiller, qualite
´du sommeil, raideur
183
The authors have no conflicts of interest to declare.
Ethics approval was provided for all studies by the University of South Australia.
Susan J. Gordon, PhD: School of Public Health, Tropical Medicine and Rehabil-
itation Sciences, James Cook University, Townsville, Queensland.
Karen Grimmer-Somers, PhD: International Centre for Allied Health Evidence
(iCAHE), University of South Australia, South Australia.
Address correspondence to Dr. Susan Gordon, Discipline of Physiotherapy,
James Cook University, Townsville, 4811 QLD Australia; Tel.: 07-4781-6734;
Fax: 07-4781-6868; E-mail: susan.gordon2@jcu.edu.au.
DOI:10.3138/ptc.2010-13
INTRODUCTION
Anecdotally, patients often report being unhappy with
the performance of the pillow they sleep on. Health care
practitioners are often asked by patients to recommend
pillows that will improve the quality of their sleep and/
or alleviate waking cervical symptoms.
1
There is a grow-
ing body of evidence on the interaction between the
human body and sleeping surfaces; however, this has
not led to clear recommendations on the best fit be-
tween pillows, mattresses, and people.
2–5
With a myriad of pillow designs and a wealth of un-
substantiated information about different pillow types
currently available, patients and health care providers
may well be confused about which pillow to choose and
what waking symptoms should be expected following a
‘‘usual’’ night’s sleep. There is a slowly growing body of
evidence on sleeping posture, pillow performance and
comfort, and waking symptoms that largely supports the
individual nature of satisfaction with specific sleeping
surfaces.
6–14
Our large-scale telephone survey reported a high
frequency of waking symptoms reported by generally
healthy people in a ‘‘usual’’ week, sleeping on a range of
pillow types.
15,16
We recently compared the frequency of
waking cervical pain during a random-allocation field
trial of five new commonly used pillows (polyester,
foam regular, foam contour, feather, and latex) and par-
ticipants’ own pillows. The trial pillows produced clearly
different frequencies of prospectively reported waking
pain, again indicating the variable fit between person
and pillow even when using new pillows. New latex,
polyester, and foam contour pillows produced consis-
tently lower frequencies of waking cervical pain than
new foam regular or feather pillows.
17
The findings of
this trial provide further support for the variable perfor-
mance with respect to waking pain of pillows on which
individuals sleep. By comparing the responses of a sub-
group of subjects who participated in both the survey
and the experimental study, we found that waking symp-
toms, pillow comfort, and sleep quality attributable to
participants’ own pillows were reported consistently
over time.
17
Participants mostly discarded foam regular
and feather pillows for another pillow type within 18
months, while polyester, foam contour, and latex pillows
showed greater longevity.
17
This paper reports the frequency of waking symptoms
(cervical pain, stiffness, headache, and scapula pain),
overnight (temporal) change in these symptoms, pillow
comfort, and sleep quality when participants slept on
their own pillow (presumed to be their pillow of choice).
We hypothesized that fewer waking symptoms would be
reported and that retiring symptoms would be relieved
overnight in participants who reported a comfortable
‘‘own’’ pillow and a good night’s sleep.
METHODS
Study Purpose
This paper reports data on the performance of
participants’ own pillows, which were extracted from
our previously reported pillow trial.
18
This field trial
tested differences in performance of five experimental
pillows with respect to retiring and waking symptoms
(pain, stiffness, headache, and scapula pain) compared
with participants’ usual pillow. Individuals were eligible
to participate if they were over 18 years old, generally
slept on their side with one pillow, had not suffered an
injury to the neck in the previous 12 months, and were
not actively seeking treatment for cervico-thoracic spine
pain.
All further reference to pillows in this paper refers
to participants’ own pillows (the pillow on which each
participant was usually sleeping during the trial).
Ethics approval for this study was provided by the
Human Research Ethics Committee of the authors’
university.
Sample Size
No previous similar studies had been conducted that
could assist with sample-size calculations. We considered
that a sample size of 100 participants was the largest fea-
sible, given the study’s time and funding constraints.
Participants were systematically age-cluster-sampled
from the pool of randomly selected participants in the
earlier survey,
16,17
supplemented as required by respond-
ents to newspaper advertisements. Age clusters were
young (<40 years), middle (40–59 years), and old (b60
years), in accordance with the categories used by the
Australian Bureau of Statistics.
19
Data Collection
Participants were asked to provide 7 consecutive
days’ data on their pillow, recorded in a tick-box diary
each evening (retiring symptoms) and each morning
(disrupted sleep, waking symptoms, sleep quality, and
pillow comfort).
17,18
They were asked to report the
presence of ‘‘neck pain,’’ ‘‘neck stiffness,’’ ‘‘headache,’’
and ‘‘pain between the shoulder blades.’’ If these symp-
toms were present on waking, participants were asked
to report the duration of the symptoms (1 hour or less,
half a day, or all day). Participants also reported if
they believed their sleep had been disrupted or that
their waking symptoms were related to a factor other
than the pillow. Where participants provided a known
reason in the daily diary for disrupted sleep or waking
symptoms—for example, illness or a noisy environment—
the data for these days were excluded from analysis of
symptom production, as the study sought information
on waking symptoms and disrupted sleep potentially
184 Physiotherapy Canada, Volume 63, Number 2
related to pillow use only. When reporting overnight pillow
comfort, participants chose from the categories perfectly
comfortable, quite comfortable, barely comfortable, and
uncomfortable; when reporting sleep quality, they chose
from the categories poor, fair, good, and excellent.
Data Management
For each night during which there was no known
reason for sleep disturbance, waking symptoms were
collated into the categories no problems,occasional
short-term problems (lasting up to 1 hour, 1–3 /week),
regular short-term problems (lasting up to 1 hour,
>3/week), occasional longer-term problems (lasting
half a day, 1–3 /week), or regular longer-term problems
(lasting half a day, >3/week). To evaluate temporal
symptom patterns, change in symptoms overnight was
classified into four groups (1 ¼no retiring or waking
symptoms, 2 ¼retiring as well as waking symptoms,
3¼retiring symptoms not present on waking, and
4¼no retiring symptoms but waking symptoms). Where
symptoms were not present on retiring but were present
on waking (group 4), in the absence of other reasons
for waking symptoms, we assumed that pillow type
contributed to symptom production. Conversely, where
symptoms were present on retiring but not on waking
(group 3), we hypothesized that the pillow might have
contributed to symptom relief. Where there was no
change in retiring symptoms on waking (groups 1 and
2), we assumed that the pillow had no role to play. Pillow
comfort ratings of perfectly comfortable and quite com-
fortable were considered to indicate high pillow comfort,
while ratings of barely comfortable and uncomfortable
were considered to indicate low pillow comfort. Sleep-
quality ratings of poor and fair were combined to indi-
cate low sleep quality, while good and excellent indicated
high sleep quality.
Daily diary scores of sleep quality and pillow comfort
were collated into consistently low, variable, and con-
sistently high sleep quality and pillow comfort for each
participant.
Data Analysis
Waking symptoms were compared for six gender and
age groups: young women (aged 18–39 years), older men
(aged 60þyears), and so on. We considered differences
between those participants who reported no waking
symptoms of any kind and those who reported one
or more waking symptoms. Linear regression models
(reported as r
2
values) were used to establish the asso-
ciation between interval measures of pillow comfort
and sleep quality. Step-wise addition of age (as an
equal-interval measure) and gender (as a dummy binary
variable) to this model tested their potential confound-
ing influences. A significant confounding effect was
identified when the r
2
value changed by more than 0.1
after each addition.
Logistic regression models, reported as odds ratios
(ORs) with 95% confidence intervals (95% CI), were used
to establish the association between binary forms of
pillow comfort, sleep quality, and waking symptoms.
Crude ORs are overall measures of the association be-
tween the outcome (in this case, any event of stiffness,
headache, or scapula/arm pain compared with none)
and exposures (in this case, poor/fair sleep quality vs.
good/excellent quality and barely comfortable / uncom-
fortable pillows vs. perfectly comfortable / quite com-
fortable pillows). Adjusted odds ratios (AORs) were then
reported, which took into account the influence of age
and gender. When we adjusted the crude ORs by the
potential confounders, the true nature of the association
between exposure and outcome became clearer. The
confounding effect of age was considered using three
independent levels of age ( young , middle, old ), with
the young level designated as the default comparator.
Gender was treated as a binary variable, with male as
the default comparator. At each logistic regression step,
when the confidence interval did not incorporate the
value 1, the association was deemed significant. A
significant confounding effect was identified when the
likelihood ratio (a measure of the variance in the model)
changed significantly with the addition of the indepen-
dent variables to the model (p<0.05).
Generalized linear models tested the influence of
pillow type on the mean interval ratings of sleep quality
and pillow comfort. Statistical Analysis System (SAS)
version 9.2 (SAS Institute Inc., Cary, NC) was used for all
analysis.
RESULTS
Participants
A total of 58 participants in the telephone survey
15,16
and 48 participants recruited via newspaper advertising
were invited to participate in the study, and all agreed
to do so. All 106 participants provided 7 days’ retiring
and waking data on the pillow they chose to sleep on
at the time of the study (n¼742 observations). Known
reasons for disturbed sleep were provided on 107 morn-
ings, and these data were excluded from the analysis
reported here. The remaining observations (n¼635)
were classified as valid.
No Waking Symptoms
Forty-five participants (42.5% of the sample) reported
no waking symptoms of any type on their pillow. The
demographic details of this ‘‘no symptom’’ group are
reported in Table 1. There was a difference that trended
toward significance in this group’s gender composition
(37.7% male (95% CI: 23.6%–52.0%, p¼0.06). There was
Gordon and Grimmer-Somers Your Pillow May Not Guarantee a Good Night’s Sleep or Symptom-Free Waking 185
no significant difference in gender–age group distribu-
tion (w
2
¼0.90, df ¼2, p¼0.26). When each symptom
type was considered separately, we found that 43.5%
of the sample reported no waking cervical pain, 34.9%
reported no waking stiffness, 42.6% reported no waking
headache, and 43.5% reported no scapula pain.
Waking Symptoms
The majority of waking symptoms occurred occa-
sionally and lasted up to 1 hour; stiffness was the most
commonly reported symptom. There was, however, a
group of participants who regularly reported long-term
symptoms from sleeping on their pillow (see Figure 1).
There were no gender or age associations with the type
or duration of waking symptoms.
Temporal Change in Symptoms
Retiring symptoms alleviated by morning (potentially
influenced by sleeping on participants’ own pillows)
were reported by only a small percentage of participants.
Alleviation of retiring symptoms was reported at least
once during the trial week by 8.5% of participants
for cervical pain, 4.7% for cervical stiffness, 10.5% for
headache, and 8.6% for scapula pain. On the other
hand, production of symptoms overnight or mainte-
nance of retiring symptoms was reported more com-
monly—at least once in the trial week—by 17.9% of
participants for cervical pain, 35.8% for cervical stiffness,
16.0% for headache, and 19.9% for scapula pain. Only
three participants (2.8%) reported production and/or
maintenance of all four retiring symptoms over the trial
week; 10.2% (n¼11) reported production and/ or main-
tenance of three out of four retiring symptoms over the
week, and 24.0% (n¼25) reported production and/or
maintenance of two out of four retiring symptoms.
Cervical stiffness was the symptom most commonly
reported as being produced overnight or not relieved by
sleep on participants’ own pillow and potentially related
to pillow performance (see Figure 2).
Pillow Comfort, Sleep Quality, and Waking Symptoms
The study found that pillow comfort and sleep quality
were moderately associated (r
2
¼0.55, p¼0.02) and that
neither age nor gender exerted a significant influence
on this association (r
2
values changed by less than 0.1
with each addition). However, pillow comfort and sleep
quality did not necessarily correlate with reports of
waking symptoms: some participants reported an un-
comfortable or poor-quality night’s sleep but no waking
symptoms, while others reported a comfortable or good-
quality night’s sleep and yet had waking symptoms.
Figure 3 reports on a subset of data for participants who
reported no waking symptoms at all (n¼45), highlight-
Table 1 Age and gender proportions of subjects reporting no retiring or
waking symptoms
Age <40 years Age 40–59 years Age 60þyears
Women 13.5% (n¼14) 24.4% (n¼26) 24.4% (n¼26)
Men 6.6% (n¼7) 20.1% (n¼21) 11.0% (n¼12)
Figure 1 Frequency and type of waking symptoms for participants who
reported any waking symptom and who did not have disturbed sleep
Figure 2 Temporal symptom patterns
Figure 3 Reports of high-quality sleep and high pillow comfort by
participants reporting no waking symptoms of any type
186 Physiotherapy Canada, Volume 63, Number 2
ing the fact that even though these participants regularly
woke with no symptoms, their reports of sleep quality
and pillow comfort were not always high. Conversely,
up to 5.3% of participants who reported high pillow
comfort also reported waking symptoms, while up to
9.6% of those who reported high sleep quality also re-
ported waking symptoms (see Table 2).
Pillow Comfort, Sleep Quality, and Temporal Change
in Symptoms
Neither high pillow-comfort nor high sleep-quality
ratings guaranteed symptom-free waking. This was most
common with respect to production or maintenance of
cervical stiffness (see Table 3). We therefore rejected our
hypothesis that those participants whose symptoms
were relieved overnight, or who had no symptoms,
would rate their sleep quality and pillow comfort high
and that those whose symptoms were produced or main-
tained overnight would rate their pillow comfort and
sleep quality lower.
Table 4 reports on the association between pillow
comfort, sleep quality, and waking symptoms using
ORs (both crude and adjusted by gender and age) and
95% CIs. Poor sleep quality and poor pillow comfort
were so strongly related that their association could not
be calculated as an OR: all participants who reported
poor sleep quality also reported poor pillow comfort.
After adjustment for gender and age, sleep quality was
strongly and significantly related to waking stiffness and
scapula pain, and its association with waking headache
trended toward significance.
The data were further investigated to identify whether
specific pillow shapes and fillers were associated with
better sleep quality or better pillow comfort. All partici-
pants in the field trial had been invited to present their
pillows for inspection, and 81 participants did so (76.4%
of the sample). Polyester pillows were by far the most
popular choice to sleep on (58.9%), followed by foam
contour (15.8%), latex (rubber) (14.7%), foam regular
(5.2%), feather (3.2%), and wool (2.1%).
There was no significant difference in sleep-quality
Table 2 Longevity of waking symptoms reported by participants who reported high pillow comfort, high sleep quality, and waking symptoms
Occasional
Short-Term
Occasional
Longer-Term
Regular
Short-Term
Regular
Longer-Term
High pillow comfort (% participants in each symptom category)
Cervical pain 0 1.8 5.3 1.8
Cervical stiffness 5.3 5.3 0 1.8
Headache 5.3 0 0 0
Scapula pain 3.6 0 1.8 4
High sleep quality (% participants in each symptom category)
Cervical pain 1.3 2.5 4.9 1.3
Cervical stiffness 9.6 3.7 1.3 1.3
Headache 3.7 1.3 2.5 0
Scapula pain 3.7 1.3 2.5 0
Table 3 Percentage of participants in categories of high pillow comfort and high sleep quality who reported no retiring or waking symptoms, retiring but no waking
symptoms, and waking symptoms that were either present on retiring and not relieved or occurred overnight (not present on retiring, but present on waking)
No Retiring or
Waking Symptoms
Retiring But No
Waking Symptoms
Production of Waking
Symptoms or Maintenance
of Retiring Symptoms
High pillow comfort (% of participants in each category)
Cervical pain 84.2 1.7 14.1
Cervical stiffness 77.2 1.8 21.0
Headache 82.6 10.6 6.9
Scapula pain 79.4 8.3 12.3
High sleep quality (% of participants in each category)
Cervical pain 79.6 4.8 15.7
Cervical stiffness 67.5 4.8 27.7
Headache 75.9 12.1 12.0
Scapula pain 73.5 9.6 16.9
Gordon and Grimmer-Somers Your Pillow May Not Guarantee a Good Night’s Sleep or Symptom-Free Waking 187
or pillow-comfort scores for the different pillow types
(p¼0.52). Nevertheless, Figures 4 and 5 highlight how,
over 7 consecutive days of data collection, the feather-
pillow users all rated their sleep quality and pillow com-
fort consistently low, while users of polyester and latex
pillows rated their sleep quality and pillow comfort con-
sistently high. Figures 4 and 5 report the frequency of
each pillow type in each category of sleep quality and
pillow comfort. Feather-pillow users were most likely to
report both poor sleep quality and poor pillow comfort,
while latex-pillow users consistently reported high pillow
comfort and high sleep quality. Use of a foam regular
pillow resulted in consistently high pillow comfort rat-
ings but variable reports of sleep quality.
DISCUSSION
We hypothesized that individuals would choose to
sleep on a pillow that supports good-quality sleep, is
comfortable, and is not associated with waking symp-
toms. However, regular waking symptoms, retiring symp-
toms that persist on waking, uncomfortable pillows, and
poor-quality sleep were reported by more than 50% of
participants sleeping on their own pillows. After adjust-
ment for age and gender influences, there remained a
strong and significant association between reported
poor-quality sleep and waking with cervical stiffness
and scapula pain. However, there was no association be-
tween pillow comfort and waking symptoms, despite ad-
justing the association for gender and age effects, which
suggests that participants’ perceptions of pillow comfort
and their reports of waking symptoms are independent.
This finding suggests that for healthy side-sleepers with-
out known reasons for disrupted sleep, the choice of
pillow may be only one factor related to a poor night’s
sleep.
Our study found that feather pillows were associated
with lower ratings of sleep quality and pillow comfort,
while latex and polyester pillows were consistently asso-
ciated with higher ratings. Our experimental study con-
sidering new (trial) pillows of the same type and waking
cervical pain produced similar findings.
18
The high correlation between reports of low sleep
quality and reports of low pillow comfort may indicate
that participants blamed their pillows for poor-quality
sleep. In fact, however, other factors that significantly
Table 4 Crude (COR) association between pillow comfort, sleep quality, and waking symptoms, adjusted for age and gender (AOR)*
Pillow Comfort Waking Cervical Pain Waking Cervical Stiffness Waking Headache Waking Scapula Pain
Sleep quality: Poor, Fair
OR (95% CI) Not calculable** 2.66 (0.77–10.24) 2.64 (0.98–7.82) 3.83 (0.92–15.97) 3.23 (0.82–13.75)
AOR (95% CI) 2.73 (0.75–10.48) 4.32 (1.25 –15.61) 4.12 (0.93–18.82) 6.13 (1.12–31.56)
Pillow comfort: Uncomfortable or Barely comfortable
OR (95%CI) n/a 2.44 (0.58–11.83) 1.15 (0.34 –3.56) 2.32 (0.62–8.65) 1.72 (0.44– 6.97)
AOR (95%CI) n/a 2.33 (0.44– 11.55) 2.12 (0.56–8.86) 2.32 (0.52–10.66) 4.12 (0.73–25.13)
* Figures in bold type indicate statistically significant findings.
** All subjects who reported poor sleep quality also reported poor pillow comfort.
OR ¼crude odds ratio; AOR ¼adjusted odds ratio; 95%CI ¼95% confidence interval
Figure 4 Patterns of ‘‘own’’ pillow type for sleep-quality reports over 1
week
Figure 5 Patterns of pillow comfort reports over 1 week for participants
using their own pillows
188 Physiotherapy Canada, Volume 63, Number 2
constrain sleep quality, such as the presence of a medi-
cal condition, past history of injury or accident to the
cervical spine, sleep position, and nocturnal bruxism,
may all contribute to reports of low sleep quality.
15
We
attempted to control these effects by including only
healthy individuals without recent neck injury who slept
in side-lying position with a single pillow. However,
psychological distress was not measured in this study,
and as this factor has the capacity to constrain sleep
quality, it should be considered in future studies.
20
Further, the effect of a past history of significant cervical
or thoracic injury should be considered. A tendency to
misattribute blame for low sleep quality to one’s pillow
may account for the patient population who endlessly
search for the ideal pillow.
The high rate of waking symptom reports and the
variability in reports of pillow comfort and sleep quality
for participants’ own pillows underscore the difficulty
that individuals may have in choosing a pillow and de-
ciding when to change pillows. A high percentage of
participants reported that their retiring symptoms were
not relieved by sleeping overnight on their pillow, which
suggests that participants’ own pillows, in many instances,
did not provide adequate support to the head and neck.
Given the cost of new pillows and the variable claims
made by manufacturers about pillows’ performance,
consumers are faced with a difficult decision every time
they decide to purchase a new pillow, unless they belong
to the minority who have no regular waking symptoms,
whose sleep is of good quality, and whose previous
pillow choice was comfortable.
LIMITATIONS
Limitations of this study include bias introduced
by volunteer sampling and reliance on participant self-
report of confounders such as work and recreational
activities, stress, illness, and alcohol use that may con-
tribute to symptom production. Further, although pillows
were grouped according to content and shape, variation
due to pillow age, thickness, and hardness is likely to
have been present.
CONCLUSION
The findings of this study suggest that many people
may be sleeping on the wrong pillow (for them), as indi-
cated by compromised sleep quality, low pillow comfort,
and the presence of waking symptoms. Thus, when con-
ducting comparative research on pillow performance,
researchers cannot assume that individuals’ usual pillow
is an appropriate comparator, nor that it will consistently
perform well in terms of alleviating retiring symptoms,
ensuring an absence of waking symptoms, being com-
fortable, or contributing to high-quality sleep. There ap-
peared to be a strong relationship between sleep quality
and waking symptoms (stiffness, headache, and scapula
pain); when the relationship was adjusted for gender
and age, however, the associations between sleep quality
and waking cervical pain and between pillow comfort
and any waking symptom were less convincing. This
finding highlights the potential for men and women in
different age groups to be suited to specific types of
pillows.
An important direction for pillow research is to under-
stand how individuals decide which type of pillow to use
regularly and when and why they decide to replace their
current pillow or change to a new pillow type. On the
basis of our study findings, an individual’s own pillow
cannot be assumed to lead to symptom-free waking or
to reflect the performance of an ‘‘ideal’’ pillow.
KEY MESSAGES
What Is Already Known on This Topic
There is scant knowledge about how different pillows
perform in terms of waking symptoms, temporal relief
of symptoms, pillow comfort, or assisting quality sleep.
Thus, there is little information to assist individuals in
choosing a pillow for personal use.
What This Study Adds
This study provides rare information on the perfor-
mance of pillows on which individuals usually sleep
with respect to waking symptoms, temporal relief of
symptoms, pillow comfort, and sleep quality. The find-
ings indicate that latex, foam contour, and polyester
pillows perform better than foam regular or feather
pillows, and that men and women of different ages may
have different pillow preferences.
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190 Physiotherapy Canada, Volume 63, Number 2
... According to the Global Burden of Disease Study 2017, the incidence of neck pain was high, with an agestandardized point prevalence of 3551.1 per 100,000 population (Hoy et al., 2014;Safiri et al., 2020). Furthermore, sleep disturbances are commonly found in individuals with neck pain (Gordon and Grimmer-Somers, 2011). Sleep disorders are prevalent among patients suffering from neck pain, and approximately 40% of neck pain patients taking analgesics slept for less than 4 h per day (Artner et al., 2013). ...
... Inadequate support to the neck and shoulder regions offered by pillows may adversely alter the cervical alignment and has been suggested to be related to neck pain, waking pain, neck disability, and poor sleep quality (Chen and Cai, 2012;Gordon et al., 2009;Gordon et al., 2010;Gordon and Grimmer-Somers, 2011). A wide variety of pillows are marketed with promises of offering the optimal alignment for the cervical spine as well as claim to reduce neck pain and improve sleep quality (Persson and Moritz, 1998). ...
... Gordon et al., (2011aGordon et al., ( , 2011b reported that >50% of participants who had made inappropriate pillow choices experienced discomfort with their pillows, waking symptoms and poor sleep quality. It is common that some people who report buying few pillows to report that the pillows do not fit them and suffer discomfort during sleep (Gordon et al., 2011b;Gordon and Grimmer-Somers, 2011). It has been reported that the optimal pillow height is not necessarily correlated with individual anthropometrical dimensions such as the length or width of the head-shoulder region (Erfanian et al., 2004;Wang et al., 2015;Wicke, 2004). ...
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Background Neck pain is a prevalent condition that can adversely affect quality of life, productivity at work, and sleep quality. The aim of this systematic review and meta-analysis was to identify clinical trials assessing the effect of different types of pillows on neck pain, waking symptoms, neck disability, sleep quality, and spinal alignment. Methods We systematically searched CINAHL Complete, Cochrane Library, EMBASE, Medline, Pubmed and Psychinfo databases from inception to September 2020. Two reviewers independently assessed the articles and evaluated the methodological quality using PEDro. Findings Thirty-five articles fulfilled the inclusion criteria of the study. There were nine high-quality studies involving 555 participants. The meta-analysis revealed significant differences favouring the use of rubber pillows to reduce neck pain [standardized mean difference (SMD): -0.263; P < 0.001). Moreover, waking pain (SMD: -0.228; P < 0.001) and neck disability (SMD: -0.506; P = 0.020) were reduced while the satisfaction rate was enhanced (SMD: 1.144; P < 0.001) with pillow use. Pillow designs did not influence sleep quality (SMD = 0.047; P = 0.703) in patients with chronic neck pain. Interpretation The use of spring and rubber pillows are effective in reducing neck pain, waking symptoms, and disability and enhancing pillow satisfaction in patients with chronic neck pain. Moreover, there may be no change in the alignment of the cervical spine in the side-lying position, regardless of the use of rubber or feather pillows. Rather, the cervical alignment may be significantly impacted by the shape and height of the pillow.
... Previous reports have demonstrated that the middle trapezius muscle demonstrates the greatest activation when an individual is laying on their side with a pillow of the least comfortable height (Sacco et al., 2015). Moreover, the use of uncomfortable pillows with increased neck tension results in regular waking and poor sleep quality (Gordon & Grimmer-Somers, 2011). In contrast, a less significant decrease in muscle activity in the abdominal oblique muscle, which governs ipsilateral side-bending and contralateral rotation of the lower trunk, was seen. ...
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... However, selecting an appropriate pillow height is difficult. Most studies usually evaluate pillow height based on subjective methods, such as subjective comfort evaluation and questionnaires [10,[13][14][15]. However, subjective evaluation is easily affected by age, gender, individual perception, and long-term sleeping habits, which makes the conclusion disputable and unreliable. ...
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... Previous reports have demonstrated that the middle trapezius muscle demonstrates the greatest activation when an individual is laying on their side with a pillow of the least comfortable height [19]. Moreover, the use of uncomfortable pillows with increased neck tension results in regular waking and poor sleep quality [20]. In contrast, a less signi cant decrease in muscle activity in the abdominal oblique muscle governs ipsilateral side-bending and contralateral rotation of the lower trunk. ...
Preprint
Full-text available
Although ample evidence has demonstrated that daytime napping is beneficial for health and cognitive performance, bedding for napping has not yet been scientifically investigated. In this study, we assessed the effect of a bean bag chair (BC), which would automatically adjust according to body shape and size, on daytime napping and physiological parameters related to sleep, such as electroencephalogram (EEG), electromyogram (EMG), and heart rate variability (HRV). Fourteen healthy participants were enrolled within the context of a randomized, single-blind, crossover study to evaluate the effects of a BC in comparison with those of a urethane chair manufactured to have a similar shape (UR). EEG analyses revealed no significant differences in sleep architecture or frequency components; however, a significant decrease was found in EMG recordings in the trapezius muscle, which represents the neck region (p = 0.024). Additionally, a significant main effect of bedding in the LF/RF ratio (F [1, 20] = 4.314, p = 0.037) was revealed. These results suggest that napping with a BC may provide a comfortable napping environment involving muscle relaxation and proper regulation of autonomic nervous function.
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... 13 Pain was measured in all studies, which is appropriate given cervical and lumbar pain are leading contributors across all age groups and countries to musculoskeletal disability. 1 However, characteristics like intensity, frequency or the onset time of pain were not consistently measured and are important to better understand the overall impact pain is having on daily function. 53 With regard to the relationship between sleep posture and time of onset of spinal symptoms, only half of the studies examined waking symptoms. 13 42 Waking spinal symptoms are rarely present every morning, which may be due to an individual's variation in sleep posture routine. ...
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... A comparison of five different types of pillows in studies conducted by Gordon et al (8,12,13) suggests that latex pillows are the most successful in improving the quality of sleep and reducing the waking symptoms in healthy subjects. However, the effectiveness of this type of pillow has not been studied in patients with cervical disorders. ...
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Article
Importance: Scapular protraction and retraction are often essential for occupational performance; however, clinical assessment of these movements is uniquely challenging. Objective: To analyze the interrater reliability of a novel goniometric method to measure scapular protraction and retraction. Design: An observational, descriptive design was implemented to evaluate interrater reliability between two experienced occupational therapists who were also certified hand therapists. Setting: Academic institution. Participants: Convenience sample of graduate students (N = 80). Outcomes and Measures: The hypothesis, developed before study implementation, was that the technique would demonstrate clinically acceptable interrater reliability, defined as a standard error of measurement (SEM) <8°. Goniometric measurements of the scapula at rest, in maximal protraction, and in maximal retraction were independently obtained from each participant by each evaluator. The goniometer was aligned on the scapula using the superior angle as the axis of motion to measure the movement of the acromion relative to the frontal plane. The SEM was calculated in each position using the intraclass correlation coefficient values and the average of the standard deviations from the two raters. Results: The SEM values between the two evaluators for the resting, protracted, and retracted positions were 3.46°, 2.93°, and 2.74°, respectively. Conclusions and relevance: The SEM between the two evaluators for each scapular position was <4°, suggesting that the technique may be clinically reliable. However, additional research regarding the reliability and validity of the technique is recommended. What This Article Adds: The findings of this study support the use of goniometry to measure scapular protraction and retraction in relation to occupational performance. The technique provides a way to quantify baseline scapular mobility and track progress.
Article
Background: There are currently no reports of biomechanical changes in patients with forward head posture (FHP) that result in altered muscle activation throughout various functions with muscle activation response during diverse sleep postures. Objective: This study investigated neck and back muscle activity in individuals with and without FHP during a maintained side-sleeping position by incorporating various pillow designs. Methods: Thirty-four participants (i.e. 17 in each group) were enrolled. The muscle activity was investigated via surface electromyography during the use of three trial pillows: orthopedic pillow, hollow pillow, and Thai neck support pillow. Results: With the application of all three trial pillows the FHP group demonstrated significantly greater lower trapezius muscle activity than the normal head posture group (p< 0.05). Sternocleidomastoid and upper trapezius (UT) muscle activity were similar between the two groups (p> 0.05). Only UT muscle activity was affected by variations in pillow design. In the normal group no difference was observed in the muscle activity between all three pillows (p> 0.05). Conclusions: Feasibly, the ability to appropriately modify a pillow configuration without creating undesired muscle activation was limited to those exhibiting FHP. Therefore, specially designed pillows or mattresses should be investigated in terms of their relevance to muscle fatigue and potential musculoskeletal pain in FHP patients.
Article
Introduction: Sleep is beneficial and necessary for nearly every tissue in and function of the human body. A lack of sleep can lead to many health hazards including depression, heart disease, obesity, hypertension, and diabetes. Utilizing an appropriate pillow can promote optimal spinal alignment, thus improving sleep quality and duration. The purpose of this study was to analyze available literature and determine the level of evidence that different pillow parameters have (material, height, shape, and thermal properties) to promote and enhance sleep quality, spinal alignment, and to decrease waking symptoms. Methods: Following detailed and systematic search in major ergonomics-related data bases (PubMed, CINAHL, Science Direct, & Google Scholar) by independent searchers applying systematized search processes, eleven articles qualified for inclusion in this review (309 participants). The methodological qualities of included articles were assessed by two independent raters utilizing the PEDro scale and the Modified PEDro Scale for Ergonomics Research (MPSER). Similarly, the authors utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of evidence that these articles established. Results: There is moderate evidence that some of the following pillow parameters could improve sleep quality/spinal alignment, and decreasing sleep-related neck pain. The parameters are; a latex pillow material, a contoured pillow design (higher sides to accommodate side sleepers and a lower, flattened middle to accommodate back sleepers), a seven to eleven centimeters height of the unloaded central part of the pillow, and a cooling surface. Conclusion: Patients/clients are encouraged to consider as many of the above mentioned parameters as possible when choosing a new pillow that fits their individual needs of promoting sleep comfort.
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Full-text available
Purpose: An epidemiological study was undertaken to investigate the association between sleep position, age, gender, sleep quality and prevalence of waking cervical pain and stiffness, headache and aching between the scapulae and/or in the arm. Method: A randomly administered telephone survey was completed by 76% of prospective participants, yielding 812 completed surveys. Results: This study confirmed that the majority of subjects sleep in the side lying position and that this sleep position significantly protected against waking cervical, scapular and arm pain and significantly promoted high sleep quality ratings. Anecdotally, supine sleep position has been recommended for the prevention of cervical symptoms however, this study identified no advantage in adopting the supine sleep position in relation to the prevalence of waking symptoms. The adoption of an upright sleep position was significantly associated with increased prevalence of all waking symptom categories and low sleep quality ratings. These findings were of greater significance in the presence of medication use, or a medical condition which affected sleep quality. Prone sleep position was not significantly related to waking symptom reports. Small subject numbers confounded this analysis and further research in this area with larger subject numbers is required. Conclusions: The findings of this study support the need for health professionals to consider individuals’ sleep position and waking symptom history when developing a management plan for troublesome waking symptoms.
Article
Neck support pillows are widely used in patients with neck pain to reduce pain and get better quality of sleep. To test whether specific neck pillows have any effect on neck pain, headache and quality of sleep in people with chronic non-specific neck pain and to find the optimal characteristics of such a pillow, 52 patients with chronic neck pain tested four different pillows (three specially designed neck pillows and one normal pillow) with different shapes and consistency randomly over 4–10 weeks. The patients graded them according to comfort and described the characteristics of an ideal pillow. The effects of the pillows on neck pain, sleep quality and headache were stated on a questionnaire. Forty of the 52 patients found a positive effect on the neck pain, 24 of 31 (77%) reported a positive effect on night's sleep and 19 of 31 (61%) a positive effect on headache. There were no differences in graded comfort between two of the specially designed neck pillows and the “normal pillow” in the test. The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis can reduce neck pain and headache and give a better sleep quality.
Article
Objective. To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support. Methods. Thirty-five patients with FMS chose the order of application and used each type of neck support for a 2-week period, followed by a 2-week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram. Results. Analysis using Friedman's 2-way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow. Conclusions. The results of this study are inconclusive due to the small sample size. However, from a patient's perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted.
Article
To determine the effectiveness (at the 0.1 level of statistical significance) of the Align-Right (roll-shaped) cervical pillow (ARCP) on neck pain severity and headache/neck pain medication use in chronic neck pain subjects. The design was a "before/after" (i.e., a "pre/post" trial). Twenty-eight subjects, 25-45 yr of age with cervical spine pain of biomechanical origin of > 2 on an 11-point ordinal pain scale. The primary outcome measure was severity of morning and evening neck pain. The secondary outcome measure was daily quantity of analgesics ingested. The data were analyzed descriptively and inferentially for clinically and statistically significant pre/post intervention differences. Eligible subjects who successfully finished a 2-wk baseline data-gathering period by mailing in two properly completed diaries each received a pillow and four more diaries (to be filled in over the subsequent 4 wk). Three repeated-measures analyses of variance were performed using the Bonferroni-corrected level of statistical significance of 0.03. Ninety-five percent confidence intervals (for paired-samples mean differences) were also calculated for those pre/post differences that seemed descriptively clinically important. The clinically and statistically significant reductions in neck/shoulder pain severity in this sample of chronic neck pain subjects suggest that the ARCP is an effective therapy for target populations with the same profile as this sample. Patient characteristics predicting suitability were not studied in this project. The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. Further randomized clinical trial research comparing the ARCP with other commonly used cervical pillows is recommended.
Article
A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N=106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects' own pillow in most instances. Subjects' own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.
Article
To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow. Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods. Outpatient neurology and physiatry clinics. Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments. Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows. The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow. Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.
Article
Special neck support pillows claiming to improve rest and reduce neck pain are currently being advertised. To test whether neck pillows have any positive effect on neck pain and quality of sleep compared with usual pillows and, if so, to find the optimal characteristics of such a pillow. Thirty-seven hospital employees and 18 neck patients were asked to test six neck pillows with different shapes and consistency randomly over the course of 3 wk, to grade them according to comfort and to describe the characteristics of an ideal pillow. Thirty-six of 55 persons found the pillows positively affected sleep and 27 of 42 found that they positively affected neck pain. The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating. A neck pillow with good shape and consistency and with firm support for cervical lordosis can be recommended as a part of treatment for neck pain.
Article
The ergonomic evaluation of mattresses is largely ignored in the current literature. This is somewhat surprising given their importance and the length of time spent using them. This study considers some ergonomic aspects of their design, including body contact pressure and subjective ratings of comfort. Subjects (12 females) found all of the mattresses tested to be significantly more comfortable than an incompressible wooden reference surface. However, no significant differences were found between mattress types, which included orthopaedic and normal designs. Analysis of body contact pressures (measured at the shoulder, elbow, hip, knee and ankle) found few significant differences between experimental conditions. It is argued that limitations in the methodology may not take account of the change in surface area and anatomical sites of contact under different conditions of mattress compressibility. No significant associations were found between comfort ratings and peak body contact pressures. It seems likely that subjective ratings of mattress comfort are dependent on a wider set of factors than contact pressure alone, a finding reported elsewhere in studies of seating.