Physicians are often asked by their patients, “Which is the best pillow to use?” And the truth is that there's no one answer that works for everybody; there’s no one pillow that works for everybody. We’ll talk about some of the different pillows and the advantages, disadvantages of those pillows. And then, after discussion with your healthcare provider, you can come up with a pillow or series of pillows that works best for you.

The main benefit of a pillow really is for comfort and support. You want to support the neck, support the spine, but also feel well-rested when you wake up in the morning, so it has to be comfortable. For optimum support, it is best to select a pillow that is designed to keep the spine in neutral alignment. That is, in a neutral position, in a straight line, basically. Any cervical pillow that’s too high will cause a malalignment of the cervical spine and can cause pain upon waking in the morning or even throughout the night; this strain and this pain can wake you up from your sleep. The same thing goes for any pillow that’s too flat or too low, in which the neck will bend the other direction, towards the pillow, and lead to malalignment.

The pillow has to feel comfortable. You have to feel well-rested. And it has to be adjustable, meaning that it has to conform to various sleep positions. Most people don’t stay in one position all night long and, therefore, if you change positions the pillow has to accommodate those changes. It has to move with you.

There are certain types of pillows, additional pillows that can be used. For example, a knee pillow. A knee pillow just refers to a regular pillow that’s placed under the knees if you’re a back-lier and a back-sleeper. And the knee flexion will actually cause a flattening out of the lumbar spine, the lower back. And this will allow for less pressure on the back, less pressure on the facet joints.

Body pillows can also be used. Now, a body pillow can be an elongated pillow that’s used to kind of cradle the upper body and knees, and the knees can be draped over the pillow. And this can also help keep the spine in a neutral position.

There’s also contoured neck pillows; these are also called cervical pillows or orthopedic pillows. And this is a pillow that has a deeper depression in the center than at the edges, which allows for more of a natural contour of the cervical spine. Now, this isn’t the end-all-be-all of pillows. Some people swear by them, and others really can’t stand them, so it just depends if it works for you. It may be something you want to try first before investing into a pillow like this because oftentimes they can be expensive.

Travel pillows can also be useful. A travel pillow is simply a “U” shaped pillow that can be used when you’re in the upright or seated position, whether it be in a car or an airplane. And what it does is it allows you—not necessarily to sleep better—but to rest, to stay in that seated position for an extended period of time, but take some of the stress off the neck in traveling.

There’s also other pillows, such as lumbar support pillows or low back pillows, which are also intended to be used when you’re in the seated position. These pillows are placed behind the back over the lumbar spine, the lower spine, in order to help encourage the normal lordotic curve of the lumbar spine and to provide support.

And lastly, a donut pillow could be appropriate for people who suffer from specific conditions, such as coccydynia, which is pain of the tailbone, pain of the coccyx. And, sitting on a donut pillow just simply takes pressure off of that area of the spine.

Proper pillow selection is more of an art than a science. It’s a process of trial and error. So, you may try something, it may work, it may not. But the point is, is that not one pillow will work for all people. So try different things. See what works. If it feels right, it’s probably right for you.

Dr. Marco Funiciello is a physiatrist with Princeton Spine and Joint Center. He has a decade of clinical experience caring for spine and muscle conditions with non-surgical treatments.