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Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review

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Abstract

It is widely believed that using a pillow that allows appropriate neck support to maintain cervical lordosis during sleep can lead to better quality sleep. Conversely, use of the wrong type of pillow can compromise pain-sensitive structures and produce waking symptoms, such as cervical pain and stiffness, headaches, and arm pain; and this in turn results in reduced sleep quality. Therefore, the optimal pillow should have neutral cervical lordosis, prevent waking cervical symptoms, and increase sleep quality by optimizing the sleeping position. A factor critical to a suitable pillow is proper support for cervical lordosis. The main role of a pillow during sleep is to support the cervical spine in a neutral position, which prevents loss of cervical spine curvature and waking cervical symptoms by minimizing end-range positioning of the spinal segments. Another critical characteristic of a suitable pillow is reduction of the temperature of the head and core during nighttime sleep. Because, sympathetic nervous system innervation was less excited with a cool pillow, which is important for deep sleep. In addition to neck support and temperature control, the pillow comfort is another critical characteristic of a suitable pillow. However, no association between pillow comfort and waking symptoms has been reported, suggesting that the participants' perceptions of pillow comfort and their reports of waking symptoms are independent of one another. In conclusion, a neck pillow with a firm support and low temperature may reduce neck pain and improve sleep quality. Therefore, a cool and not too hard pillow with enough support for cervical lordosis is considered optimal and is recommended for high quality sleep and cervical pain relief.
Abstract
It is widely believed that using a pillow that allows appropriate neck support to maintain cervical lordosis during sleep
can lead to better quality sleep.Conversely, use of the wrong type of pillow can compromise pain-sensitive structures and
produce waking symptoms, such as cervical pain and stiffness, headaches, and arm pain; and this in turn results in reduced
sleep quality. Therefore, the optimal pillow should have neutral cervical lordosis, prevent waking cervical symptoms, and
increase sleep quality by optimizing the sleeping position. A factor critical to a suitable pillow is proper support for cervical
lordosis. The main role of a pillow during sleep is to support the cervical spine in a neutral position, which prevents loss
of cervical spine curvature and waking cervical symptoms by minimizing end-range positioning of the spinal segments.
Another critical characteristic of a suitable pillow is reduction of the temperature of the head and core during nighttime
sleep. Because, sympathetic nervous system innervation was less excited with a cool pillow, which is important for deep
sleep. In addition to neck support and temperature control, the pillow comfort is another critical characteristic of a suitable
pillow. However, no association between pillow comfort and waking symptoms has been reported, suggesting that the
participants’ perceptions of pillow comfort and their reports of waking symptoms are independent of one another.
In conclusion, a neck pillow with a firm support and low temperature may reduce neck pain and improve sleep quality.
Therefore, a cool and not too hard pillow with enough support for cervical lordosis is considered optimal and is
recommended for high quality sleep and cervical pain relief.
*Author for correspondence
Indian Journal of Science and Technology, Vol 8(S5), 135–139, March 2015
Optimal Pillow Conditions for High-Quality Sleep: A
Theoretical Review
Jong Eun Yim*
Department of Physical Therapy, Sahmyook University, Seoul, 139-742, Republic of Korea; jeyim@syu.ac.kr
1. Introduction
Sleep comprises one-third of a persons life, and thus
occupies 24 years of the average life span of 72 years.
Comfortable and sucient sleeping helps relieve daily
physical and mental tiredness, restore balance in our
bodily metabolic functions, ease accumulated fatigue,
and in nerve cell re-synthesis. For these reasons, sleeping
is indispensable for humans1. For us, sleeping functions
to relieve physical and mental fatigue from the day and
helps us staying healthy, and sucient amounts of quality
sleep thus require a favorable environment. Conversely,
in the case of insucient sleeping, the tiredness cannot
be resolved, which may in turn lead to reduced atten-
tion and concentration, poorer work performance, and
in increased day-time sleeping and disruption to the
individuals daily routine2. To ensure a regular sleeping
pattern, an appropriate sleeping duration and environ-
ment are required. e appropriate amount of sleeping,
considering slight dierences among individuals, is rec-
ommended to be about 7 hours per night, and too long or
too short sleeping hours can result in aggravated fatigue.
e sleeping environment is aected by external factors
such as bedroom temperature, humidity, lighting, and
bedding. e quality of sleep is considered to aect not
only the health of the individual, but also their quality of
life3; and therefore, to ensure comfortable and sucient
sleep, an appropriate environment is required. Here, good
Keywords: Cervical Lordosis, Neck Pain, Pillow, Sleep, Temperature
ISSN (Print) : 0974-6846
ISSN (Online) : 0974-5645
DOI: 10.17485/ijst/2015/v8iS5/62330
Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review
Indian Journal of Science and Technology
Vol 8 (S5) March 2015 | www.indjst.org
136
bedding is of particular importance. Beddings include
the bed, bedclothes, and pillows, which all help support
the human body in terms of maintaining an appropriate
body temperature and natural and comfortable postures
during sleeping, while preventing possible in-sleep physi-
cal fatigue accumulation4. Pillows support the human
body and head in a supine position naturally and stably
for physically comfortable sleep. ey also assist diverse
in-sleep body movements, prevent noises or vibrations
from the oor, and ease the pressure from the oor to the
human head. In addition, they also reinforce the cervical
vertebrae during movements while sleeping, thus allow-
ing comfortable in-sleep postures. e optimal height
and material of pillows have been researched actively for
many years4, and it can be concluded that, as such, pillows
are an indispensable daily necessity. For a good sleep, pil-
lows also need to meet several conditions, including the
sanitary aspect.
Conventionally shaped pillows are too so and sup-
port only the head while failing to help maintain the
cervical vertebral curvature properly, and hence, they
tend to concentrate pressure only to the head. Moreover,
as people’s heads are buried deeper into these pillows,
their head temperature is increased5. More recently, latex
or memory foam pillows have been increasingly used.
ese are so and cover the head and neck well to pro-
vide comfort. However, these materials may be too so
to support the neck suciently, causing cervical verte-
bral deformation. Furthermore, as they cover up large
parts of the head and neck, their contact surface with the
human skin is relatively wide, thus reducing ventilation
and raising the head temperature while retaining sweat.
For these reasons, pillows made of such materials may
not be appropriate for a pleasant sleep. In addition, given
the characteristics of the materials, these pillows are dif-
cult to wash and may become unhygienic by retaining
moisture or dusts particles etc., and these issues represent
some of the main limitations of these pillows.
2. Theory
Neck pains are reportedly experienced by 35~80% of all
people at least once in their life, and most of these people
also complain of additional symptoms such as neck-chest
or spine-related pain, stiness, headaches, and scapular
pain6. Neck pain is reported to oen become worse when
waking up in the morning aer sleep and to get better
during the day. e reasons for such symptoms devel-
oping seem to include the individuals pillow failing to
support the neck and head during sleep or neck move-
ment7. Changing to a more appropriate pillow can result
in signicant improvements in terms of post-sleep neck
stiness, neck pain, headaches, and scapular pain, among
other symptoms8. As such, the main function of a pillow
is considered to be support of the neck in natural posi-
tions. People who cannot sleep easily tend to have a sti
neck and shoulder muscles, which in turn can result in
chronic pain. Together with exercise, using a proper pil-
low supporting the neck has been reported to be one of
the most eective ways to reduce this chronic neck pain.
For good sleep, the conditions of pillows that need to be
considered include its heat conduction properties, height,
size, elasticity, morphostasis, hygroscopic properties,
breathability, and temperature. In other words, the ther-
mal characteristics, form, height, and texture of the pillow
all need to be considered.
2.1 Cervical Lordosis
First, the height and size of an ideal pillow should be con-
sidered. e pillow height and size are closely related to the
cervical vertebral angle during sleep. High pillows increase
the cervical vertebral angle and disturb its curvature by
bending the neck vein and disturbing blood circulation. If
used in the long-term, such pillows may cause stroke and
cervical vertebral problems, as well as tensing of the neck
muscles8. Furthermore, if the neck is bent, the interver-
tebral nerves may become compressed, resulting in pain
and disturbed sleep. If such a situation continues, it can
cause chronic neck muscle pain, which, in particular, can
negatively aect the skeletal development of growing chil-
dren. In the case of sleeping in the wrong position, people
may nd it hard to turn the head the next day or may feel
pain in their neck and shoulder. Especially, when sleeping
in the prone or other “bad” positions, people tend to feel
pain due to tensed neck muscles9. In the supine position,
the normal cervical vertebral curvature needs to be main-
tained to reduce muscular tension. In the lateral position,
the cervical and thoracic vertebrae should be in line, and
the head should be lied upward, away from the oor, to
ease muscular tension10. Good pillows should be low to
support the neck in the supine position rather than the
head in order to allow for sucient support of both the
head and neck while eectively lling the space between
the bottom of the head and neck. Additionally, depending
Jong Eun Yim
Indian Journal of Science and Technology
137
Vol 8 (S5) March 2015 | www.indjst.org
on the individual’s shoulder width, the pillow size should
be adjusted to support both the head and neck at the same
time11,12. erefore, in the supine position, the optimal
pillow should have a higher neck support than head sup-
port in order to eectively support the neck to allow for
normal neck curvature. In the lateral position, the neck
and back should be in line and the pillow should be high
enough to minimize the stress in the neck imposed in the
supine and lateral positions, thereby elevating the overall
satisfaction with the pillow13.
In a previous study using lateral radiographs of the
cervical spine in patients exposed to regular or roll-shaped
pillows, the roll-shaped pillow was found to restore cer-
vical lordosis and to decrease neck pain and discomfort
while sleeping14. In another study, Hagino et al. evaluated
the eectiveness of the Align-Right Cylindrical cervical
pillow in reducing chronic neck pain severity. e authors
found that there were clinically and statistically signi-
cant reductions in neck pain severity upon waking and
at bedtime in this sample of chronic neck pain subjects,
and suggested that the Align-Right Cylindrical cervical
pillow may represent an eective therapy for a target pop-
ulation resembling their sample population of 25-45 year
old subjects. Some subjects reportedly found the pillow
very uncomfortable at the start, but experienced positive
results when they persevered15. In conclusion, a neck pil-
low with a good shape and graded consistency may reduce
neck pain and improve night rest. erefore, a so and
not too high pillow with rm support for cervical lordosis
appears to be the optimal type of pillow, and prescribing
a good cervical support pillow is an important adjunctive
therapy in the management of neck pain.
2.2 Pillow Temperature
Second, it has been reported that for an ideal sleep, people
generally need to keep their head cooler and feet warmer.
In other words, pillows need to maintain a lower temper-
ature to allow for a pleasant sleep16. Pillows show dierent
eectiveness depending upon their temperature charac-
teristics, and cooling materials can help lower the overall
body temperature, including that measured rectally and
on the forehead, to slow the heartbeat16. As a result, this
temperature decrease is helpful to ensure a good sleep.
Especially, the under-pillow temperature increase time
varies according to the pillow-and-head contact surface
area, pillow ller thermal conduction, and the breath-
ability of the pillow. Taking this into consideration, a new
lling material that can eectively support the neck while
presenting lower thermal conduction, high breathabil-
ity, and, in particular, minimum head contact needs to
be developed12,17. Conventional pillows, especially those
made of cotton, latex, or memory foam, comfortably cov-
ers the head and neck; however, their skin contact area
is wide and they tend to reduce ventilation, resulting in
raised head temperature, while retaining sweat12,16. A
previous study showed that a cool material pillow could
lower the rectal, forehead, and whole body temperatures,
resulting in all subjects falling asleep more easily and
sleeping better. Moreover, this pillow clearly slowed the
heart rate of the subjects, suggesting that the sympathetic
nervous system was less excited16. Taken together, these
results suggest that a cool material pillow can reduce the
body temperature and may improve the quality of sleep.
Furthermore, a study by Okamoto et al. also showed that
the cool pillow design could reduce sweating and whole
body temperature, and indirectly improve the quality of
sleep. ese ndings suggest that the thermal charac-
teristic of pillows may be related to the type of materials
used18. Regarding the type of materials, Jeon, et al. evalu-
ated the temperature of 3 dierent types of pillows aer
30 minutes of lying down, and showed that the degree of
temperature increase was signicantly lower for orthope-
dic pillows than for the memory foam and feather pillows.
It is likely that this nding is because the capsules in each
segment of the orthopedic pillow are open-ended, which
helps to evenly distribute the heat of the pillow as well
as to promote air circulation. Consequently, this prevents
an increase in temperature and may improve sleep qual-
ity. In contrast, the memory foam pillow is more dense
and molds to the neck and head closely; therefore, while it
gives a feeling of comport and stability, it decreases the air
circulation and prevents thermal dissipation to the sur-
roundings, ultimately increasing the temperature of the
pillow. Duck or goose feathers are good at retaining heat,
and accordingly, the feather pillow showed the highest
temperature among the 3 pillows. Moreover, these pillows
can emit an unpleasant odor due to the poor air circu-
lation. Taken together, these ndings indicate that the
orthopedic pillow might be more eective in preventing
an increase in neck and head temperatures, which may
improve the sleep quality and result in improved sanitary
conditions compared with the other 2 pillows12. e China
pillow, also known as ‘Tochin’, and the stone pillow have
traditionally been used in China and Japan. Presumably,
the China and stone pillows can conduct heat from the
Optimal Pillow Conditions for High-Quality Sleep: A Theoretical Review
Indian Journal of Science and Technology
Vol 8 (S5) March 2015 | www.indjst.org
138
A strong signicant association was observed between
reported poor-quality sleep and waking with cervical
stiness and scapula pain, whereas no association was
noted between pillow comfort and waking symptoms,
suggesting that people’s perceptions of pillow comfort
and their reports of waking symptoms are independent
from one another.
Many patients complain of symptoms related to the
cervical spine such as pain, stiness, headaches, and scap-
ular pain22,23; and many people appear to make poor pillow
choices, as low sleep quality, low pillow comfort, and wak-
ing cervico-thoracic symptoms are commonly reported4.
Especially, the nighttime sleeping posture should be taken
into consideration, as any long-lasting inappropriate pos-
ture of the spine can irritate the capsular ligaments of
the motor segments24. ese patients’ complaints revolve
mostly around pain sensations that appear primarily dur-
ing the night and in the morning, and which frequently
cause sleep disturbances. It is dicult to alleviate such
symptoms by physical therapy and postural exercises
alone, and therefore, the night-time sleeping position
must be changed to achieve physiological positioning of
the spine by using a suitable pillow with appropriate sup-
port of the head in order to maintain a natural curvature
of the spine during the sleep, consequently resulting in a
higher quality sleep19,24.
3. Conclusion
Rere is still considerable controversy over the optimal
design, material, and contents of pillows, with little pub-
lished research supporting any particular type of pillow in
terms of cervical lordosis, pillow temperature, and pillow
comfort. erefore, many people still make poor pillow
choices, and low sleep quality, low pillow comport, and
waking cervical pain are commonly reported. Based on
the previous studies on the topic, we here reached the
conclusions that a so, not too high pillow with rm sup-
port for cervical lordosis is the optimal type of pillow, and
that prescribing a good cervical support pillow represents
an important adjunctive therapy in the management of
neck pain. Moreover, the moderate cooling of the head
by the pillow during night sleep is of physiological signi-
cance to allow for deep sleep.
In conclusion, a neck pillow with a rm support and
low temperature may reduce neck pain and improve
sleep quality. erefore, a cool and not too hard pillow
head to the pillow eectively, resulting in reduced brain
temperature and increased extremity skin temperatures,
and hence, deep sleep16. People have known for a long that
that cooling the head is important to ensure deep sleep.
us, it can be concluded that the moderate cooling of the
head by the pillow during night sleep is of physiological
signicance for deep sleep.
2.3 Pillow Comfort
Lastly, in addition to neck support and temperature,
pillow comfort is another critical characteristic of the
optimal pillow. e stability of the pillow form is achieved
using an optimal shape based on a dynamic structure and
an appropriate ller for maintaining this shape. Pillow
stability is essential for evenly distributing the pressure
of the parts of the head and neck touching the pillow. If
such pressure is not evenly distributed and instead con-
centrated on a specic part, local pressure is generated. If
continued, such local pressure can cause pain in the corre-
sponding pressure point, disturbing the sleep19. According
to previous studies on the topic, regular or memory
foam pillows use high compressibility materials, which
concentrate the pressure to a single point. Conversely,
pillows with relatively hard materials generally maintain
an appropriate shape for supporting the head and neck,
thus distributing the pressure evenly. Using harder mate-
rials as llers has been demonstrated to show an initial
eect on sleep quality, whereas no long-term eects have
been found17. e study by Shields et al. showed that some
subjects may initially nd cervical pillows uncomfort-
able. However, these subjects tend to accept them aer an
extended period of use20. Carskadon performed a similar
study with mattresses and found that the mattress mate-
rial aected the quality of sleep in subjects who could not
adapt to a new bed, namely that the material aected the
sleep quality in the early stages. However, aer a period of
adaptation, the mattress material no longer had an eect
on the sleep quality21. Furthermore, hard Chinese pil-
lows, such as those made of jade or ceramic, were widely
accepted in ancient China. us, these studies indicate
that the time required for adaptation is an important fac-
tor for determining the comfort provided by the pillows.
In addition, Ambrogio et al. used 3 types of neck support
pillow designs on 35 bromyalgia patients. eir research
showed that the primary factor of a good pillow design
was the comfort level, even though the most comfortable
pillow did not directly improve the patients’ symptoms.
Jong Eun Yim
Indian Journal of Science and Technology
139
Vol 8 (S5) March 2015 | www.indjst.org
with enough support for cervical lordosis is considered
optimal and is recommended for high quality sleep and
cervical pain relief.
4. Acknowledgement
is research was supported by a Sahmyook University
Research Grant.
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... Many health care practitioners prescribe cervical support pillows as an adjunctive therapy for the conservative management of patients with neck pain and cervical disc disease. 1 Various pillows with different shapes and materials are available in the market, and their effectiveness has been clinically examined by many researchers. 2,3 A significant amount of research supports the ability of cervical pillows to attenuate the symptoms of pain and disability and improve sleep quality. ...
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Objectives Cervical pillows have frequently been reported to attenuate the symptoms of pain and disability. Although the main role of pillows is to optimize head and neck posture and relax the neck muscles, limited studies have examined the effectiveness of pillows from aspects beyond subjective outcome measures, especially their effect on head and neck posture and muscle performance. This study examines the effect of ergonomic latex pillow on the craniovertebral (CV) angle and cervical flexor and extensor muscle endurance in patients with cervical spondylosis. Methods This parallel-group, randomized, controlled trial was conducted from January to June 2017. The patients with cervical spondylosis were randomly allocated to the experimental and control groups, who both received identical standard physiotherapy 3 × a week for 4 weeks. The experimental group received an ergonomic latex pillow, but the control group was asked to continue sleeping on their usual pillow. The CV angle and flexor and extensor muscle endurance were measured before and after the intervention. The independent-sample t test was used to compare changes in the CV angle, whereas the Mann-Whitney test was used to compare changes in flexor and extensor muscle endurance between the groups, respectively. Results The experimental group showed significant changes in the CV angle and extensor muscle endurance. A significant increase was observed in extensor muscle endurance in the experimental group compared with the control group. Conclusion The ergonomic latex pillow may affect neck extensor muscle endurance and CV angle in patients with cervical spondylosis, although further studies are needed before any recommendations.
... This has raised awareness among users of the possibility that both memory foam and regular polyurethane foams could, over time, release toxic gases which may cause health hazards [10][11][12]. Further to that, it is wellknown that petrochemical-based foam materials contribute to health and environmental issues as well as challenging waste management and disposal problems [6,[13][14][15]. Moreover, with the growing awareness concerning the rising risk of global warming and fossil fuel depletion, as well as new legislation that has been implemented by several countries to encourage the use of "green materials" in product manufacturing, it is both timely and necessary to develop pillows that not only offer pressure-relief features but also that are made from less hazardous materials. ...
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Currently, there is significant demand for pillows with improved pressure-relief features made from natural materials, alternatives to petrochemical-based foams. To meet the requirements, this study’s approach is to develop latex foam pillows from deproteinized natural rubber (DPNR) latex with a unique dual-density cervical-shaped structure. In this work, DPNR latex foam pillows were produced at three different density levels which are high-density, medium-density and low-density. Extractable protein content of latex foam made from DPNR was confirmed lower than latex foam made from low ammonia NR latex (LATZ) and of commercial NR latex foams, making DPNR pillows more hypoallergenic than others. The physical properties of the produced DPNR latex foams were examined in accordance with Malaysian Standard MS679, and were found to comply with all requirements stipulated in standard specifications. A novel dual-density cervical-shaped DPNR latex foam pillow prototype was produced, where the pillow has lower density at the upper part and higher density at the lower part. Pressure-mapping was used to visualize the pressure distribution patterns and to measure the average peak pressure when a mannequin head was placed on top of the pillow. The study observed that decreasing the density increases the softness of the DPNR latex foam. Softer latex foams led to larger surface contact area, and hence a reduced average peak pressure value. This cervical-shaped structure further increased the surface contact area between the pillow and mannequin head, and thus reduced further the average peak pressure value.
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When positioning for sleep, the spine must be in optimal alignment. For that, during sleep, the use of a proper sleeping system constituted by a head pillow, a mattress and its surface is a must. Therefore, the sleeping system should have different elastic properties, the so-called custom-made arrangement, as we differ individually from biotypes, anthropometry, bodyweight distribution, height and weight, and sleeping habits. Individuals with different sleeping characteristics require different zonal stiffnesses in the mattress in order that the mattress maintains their spine in natural alignment during the recumbent posture we adopt to sleep. Physiotherapists should encourage patients/clients to have an individually adapted sleep system according to their physical needs and conditions.
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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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Many patients ask for advice about choosing a pillow. This research was undertaken to determine if pillow type alters cervico-thoracic spine position when resting in the side-lying position. To investigate the effect of different pillow shape and content on the slope of cervico-thoracic spine segments when side lying. The study was a randomized blinded comparative trial set in a laboratory that replicated a bedroom. The subjects were side sleepers aged over 18 years. Exclusion criteria were history of surgery to the cervico-thoracic spine, an injury or accident to the cervico-thoracic spine in the preceding year, or currently receiving treatment for neck symptoms. Each participant rested in a standardized side-lying position for 10 minutes on each of the trial pillows: regular shaped polyester, foam, feather, and latex pillows, and a contour shaped foam pillow. Reflective markers were placed on external occipital protuberance (EOP), C2, C4, C7, and T3, and digital images were recorded of subjects at 0 and 10 minutes on each pillow. Images were digitized using each reflective marker and the slope of each spinal segment calculated. Univariate analysis of variance models were used to investigate slope differences between pillows at 0 and 10 minutes. Significance was established at P < 0.01 to take account of chance effects from repeated measures and multiple comparisons. At 0 and 10 minutes, the EOP-C2, C2-C4, and C4-C7 segmental slopes were significantly different across all pillows. Significant differences were identified when comparing the feather pillow with the latex, regular and contour foam pillows, and when comparing the polyester and foam contour pillows. The regular and contour foam pillows produced similar slopes at all spinal segments. Cervico-thoracic spinal segment slope alters significantly when people change from a foam, latex, or polyester pillow to a feather pillow and vice versa. The shape of a foam pillow (contour versus regular shape) does not significantly alter cervico-thoracic spinal segment slope.
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Pillows are intended to support the head and neck in a neutral position to minimize biomechanical stresses on cervical structures whilst sleeping. Biomechanical stresses are associated with waking cervical symptoms. This paper adds to the scant body of research investigating whether different pillow types produce different types and frequencies of waking symptoms in asymptomatic subjects. A random-allocation block-design blinded field trial was conducted in a large South Australian regional town. Subjects were side-sleepers using one pillow only, and not receiving treatment for cervicothoracic problems. Waking cervical stiffness, headache and scapular/arm pain were recorded daily. Five experimental pillows (polyester, foam regular, foam contour, feather, and latex) were each trialed for a week. Subjects' 'own' pillow was the control (a baseline week, and a washout week between each experimental pillow trial week). Subjects reported waking symptoms related to known factors (other than the pillow), and subjects could 'drop out' of any trial pillow week. Disturbed sleep unrelated to the pillow was common. Waking symptoms occurring at least once in the baseline week were reported by approximately 20% of the subjects on their 'own' pillow. The feather trial pillow performed least well, producing the highest frequency of waking symptoms, while the latex pillow performed best. The greatest number of 'drop outs' occurred on the feather pillow. The foam contour pillow performed no better than the foam regular pillow. 'Own' pillows did not guarantee symptom-free waking, and thus were a questionable control. The trial pillows had different waking symptom profiles. Latex pillows can be recommended over any other type for control of waking headache and scapular/arm pain.
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Study reported a pillow with a uniform height was not suitable for sleeping in supine and lateral positions. The study aims to determine the pillow dimensions for fitting supine and lateral positions for Taiwanese. Ten females and ten males subjects with a mean age of 21.9 years (SD= 1.07 years) participated in the study. Body dimensions of head, neck and shoulder in crown and sagittal planes were measured with the Martins' anthropometer and a curve measurer to determine the pillow's sizes. The results showed that the basic form of pillow for both genders is a U form from the front view. The middle area of the pillow is for supine position and the both side areas are for lateral positions. The base of pillow is a rectangle from the top view. The pillow is designed with a width of 75 and 70 cm for male and female, and a depth of 40 and 35 cm for male and female. The height in middle area and both side are 4 and 14 cm for male, and 2 and 12 cm for female. A neck rest with a height of 1.5 cm was proposed for neck support.
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Because sleep comprises one-third of a person's life, using an optimal pillow for appropriate neck support to maintain cervical curve may contribute to improve quality of sleep. Design of orthopedic pillow conforms to orthopedic guidelines to ensure the right support of the cervical curve. The aim of this study was to investigate effect of different pillow shape and content on cervical curve, pillow temperature, and pillow comfort. A feather pillow is regarded as a standard pillow, and a memory foam pillow is one of the most popular pillows among pillow users. We, therefore, compared these two pillows with an orthopedic pillow. Twenty healthy subjects (10 men and 10 women; age range, 21-30 years) participated in the study. Each subject was asked to assume the supine position with 3 different pillows for 30 minute in each trial and then cervical curve, pillow temperature, and pillow comfort were measured. When comparing the cervical curve of the 3 different pillows, that of the orthopedic pillow was significantly higher than that of the other 2 pillows (p < 0.001). The degree of temperature increase was significantly lower for the orthopedic pillow than for the memory foam and feather pillows (p < 0.001). The visual analog scale (VAS) score of pillow comfort was significantly higher in orthopedic pillow than the other 2 pillows. This study shows that pillow shape and content plays a crucial role in cervical curve, pillow temperature, and pillow comfort and orthopedic pillow may be an optimal pillow for sleep quality.
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Objective: Few studies have analyzed the shapes of pillows. The purpose of this study was to investigate the relationship between the pillow shape design and subjective comfort level for asymptomatic subjects. Methods: Four basic pillow designs factors were selected on the basis of literature review and recombined into 8 configurations for testing the rank of degrees of comfort. The data were analyzed by the analytic hierarchy process method to determine the most comfortable pillow. Results: Pillow number 4 was the most comfortable pillow in terms of head, neck, shoulder, height, and overall comfort. The design factors of pillow number 4 were using a combination of standard, cervical, and shoulder pillows. A prototype of this pillow was developed on the basis of the study results for designing future pillow shapes. Conclusions: This study investigated the comfort level of particular users and redesign features of a pillow. A deconstruction analysis would simplify the process of determining the most comfortable pillow design and aid designers in designing pillows for groups.
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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.
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This Classic article is a reprint of the original work by Ruth Jackson, MD, FACS, The Cervical Syndrome. An accompanying biographical sketch on Ruth Jackson, MD, FACS, is available at DOI 10. 1007/ s11999-010-1277-9. The Classic Article is ©1949 by The Dallas County Medical Society and is reprinted with permission from Jackson R. The cervical syndrome. Dallas Med J. 1949;35:139–146. A second Classic Article, The Cervical Syndrome, is attached to this article as Electronic Supplementary Material (supplemental materials are available with the online version of CORR). This article is ©1955 by Lippincott Williams and Wilkins and is reprinted with permission from Jackson R. The cervical syndrome. Clin Orthop Relat Res. 1955;5:138–148.