Sleep: Pillows & Posture

You may have seen this picture on Instagram (https://www.instagram.com/p/BmtadOungGB/) and it does show obvious issues with pillows, however, when it comes to educating our clients about making good decisions in regards to sleep, we need to have an broader understanding of the situation on the complexity of sleep posture and symptoms. Here are some thoughts.

"Hi guys nice pics, but there are some broader points worth considering for our clients' benefits.

True, 57.3% of healthy people wake with cervical symptoms while sleeping on their normal pillow – so potentially not a good choice (Gordon and Grimmer-Somers 2010).

True, the pillow functions to support the head and maintain a neutral cervical spine (Haex 2005), but firstly pillows interact with the base sleeping system and secondly an individual's sleep postures.

Take the most common sleep posture, side lying. A softer mattress allows the lower shoulder to sink deeper, therefore requiring less pillow height to achieve neutral cervical spine positioning. Conversely a firmer bed, will require a thicker pillow, all other factors remaining the same. Furthermore, the type of pillow seems important. Poor quality sleep and poor pillow comfort has been reported specifically on feather pillows (Gordon and Grimmer-Somers 2010).

Some researchers have found that sleep posture had a greater effect on sleep quality than the sleeping system (mattress and pillow) (Verhaert et al. 2011). In the pillow study above, eligible sleepers were self-report side sleepers, and self-report accuracy has been questioned, especially for restless sleepers.(Yu 2018), which means the sleep posture of participants was unknown, perhaps not side lying. However, side lying has been identified as a posture least likely to provoke spinal symptoms (Desouzart et al. 2016; Gordon, Grimmer, and Trott 2007), but given most non-Asian sleepers, spend most time in side lying, it isn't all together a helpful classification. Our research group has been examining the ability to detect 2 different side lying sleep postures, based upon plausible spinal load (provocative and supportive side lying) with infra-cameras and demonstrated good reliability and validity. Using these techniques, our team has recently concluded an investigation into changing sleep posture and noting the effect this had on a range of outcome measures including pain, in a group of neck symptom participants and low back symptom participants. Results have been positive and will be written up and presented over the next 12 months.

An important message at the moment is that pillows are part of the picture, but definitely not the whole picture.

References
Desouzart, G., R. Matos, F. Melo, and E. Filgueiras. 2016. "Effects of sleeping position on back pain in physically active seniors: A controlled pilot study." Work 53 (2):5.
Gordon, SJ., K. Grimmer, and P. Trott. 2007. "Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms." Internet Journal of Allied Health Sciences and Practice (1) 5 (1).
Gordon, SJ., and K. Grimmer-Somers. 2010. "Your Pillow May Not Guarantee a Good Night's Sleep or Symptom-Free Waking." Physiotherapy Canada 63 (2):183-190. doi: 10.3138/ptc.2010-13.
Haex, B. 2005. Back and Bed: Ergonomic Aspects of Sleeping: Boca Raton: CRC Press.
Verhaert, V., B. Haex, T. De Wilde, D. Berckmans, M. Vandekerckhove, J. Verbraecken, and JV. Sloten. 2011. "Unobtrusive assessment of motor patterns during sleep based on mattress indentation measurements." Information Technology in Biomedicine 15 (5):787-794.
Yu, CKC. 2018. "Why is self-report of sleep position sometimes unreliable?" Sleep and Hypnosis 20 (2):105-113. doi: 10.5350/Sleep.Hypn.2017.19.0140.