How to choose a pillow, according to experts

It can be tempting to scoop up the first set of seemingly comfy pillows you see on sale, especially if the ones you own are misshapen, stained or just kinda stale. But experts say that, like choosing a mattress , pillow purchases should be intentional — and that you could be setting yourself up for aches and pains if you're not careful. "Your pillow is just as important as how you sleep because it helps keep your neck lined up with the rest of your spine," explains Dr. Gbolahan Okubadejo , a New York City-based spinal and orthopedic surgeon. "Even small strains can add up over time."

How to choose a pillow comes down to selecting a fill, firmness and height that not only feel good but also best support your dominant rest position and body size. That could mean you need to purchase different pillows for each member of your household, as you and your partner might find you aren't compatible (at least pillow-wise). Here's what doctors and sleep experts say to consider when shopping for new pillows , and how to determine if — and when! — your current cushions need swapping. 

How to choose a pillow

1. Identify your main sleep position.

One of the most important factors to consider when selecting a pillow is your sleep position, say experts, as it generally determines where your head and neck will be and what kind of support you'll need. Once you've identified your dominant sleep position, you can use that as a guide to help determine your pillow's ideal height and firmness. Spoiler: Bigger and cushier isn't always better. 

• Back sleeper:Okubadejo says that sleeping on your back is often easiest on your spine, as it keeps your head, neck and lower back in alignment, especially if you put a small pillow under your knees. A lower, firm pillow for the head often works best, he says. "It should support the natural curve of your neck without pushing your head too far forward, which can strain your neck over time." That said, back sleepers often do not need the same level of firmness as side sleepers, explains Dr. Kevin Lees, a Scottsdale, Ariz.-based chiropractor and director of chiropractic operations for The Joint Chiropractic . "Consistent support is important; material that clumps or compresses will not provide the same support over time," he says.

• Side sleeper:This position, notes Okubadejo, can help with breathing and reduce acid reflux. Again, alignment is key: "If you don't use a pillow between your knees, your hips and lower back can twist. Your shoulders can also start to hurt if your mattress or pillow doesn't give enough support," he explains. That's why side sleepers usually need thicker, firmer pillows to fill the gap between their shoulders and the mattress. Lees adds: "When looking for a pillow, find one that has an extra-wide gusset or rectangular panels along its four sides that add to its thickness."

  • Fetal sleeper:Okubadejo acknowledges that this type of side sleeping, in the fetal position, can feel comforting, and says it may reduce pressure on the lower back for some people. The catch? "Curling up too tightly can strain the neck and upper back and make breathing shallower," he says. Fetal sleepers often benefit from a medium-firm pillow "with adequate loft to keep their head in line with their spine," he explains.

• Stomach sleeper:Sleeping on your stomach is usually the worst choice for your spine, Okubadejo cautions, as it "forces your neck to stay twisted for long periods and puts extra stress on your lower back." As a result, he says this position is often linked to ongoing neck and back pain. If you sleep this way, with your head turned to the side, Okubadejo advises going with a very flat pillow — or forgoing a pillow altogether — to reduce stress on the neck.

2. Understand how different materials operate.

Where your head and neck actually rest in relation to your spine depends not just on the thickness and firmness of your pillow, but also on how responsive the fill is and how likely it is to settle or shape-shift over time. Okubadejo says you should keep your mattress type in mind, as it will affect how you settle on your pillow. For example, soft mattresses often require a slightly thicker pillow.

• Down:Made of feathers, down fill tends to be plush and cushy. The feathers contour around the head and neck, which can feel nice initially, but, as Okubadejo points out, they tend to flatten overnight, offering less support. (As down isn't as responsive as materials like foam and latex, it will also likely require a good amount of fluffing or moulding between uses or sleep positions.)

• Down alternative:This synthetic material (most often polyester microfiber) is designed to mimic the feel of down. This is a common choice for those who like the cushiness of down, but at a lower price and/or without the use of feathers. The downside is that it tends not to be quite as cushy and, like down, has a tendency to flatten (and not rebound)

• Solid memory foam:Often made of polyurethane, this is a dense, responsive foam designed to cradle your head and neck and provide pressure relief. It works well for side sleepers and many back sleepers, says Okubadejo, who like cushioning but with more support and stability. It doesn't flatten like down, and as the foam slowly reverts to its original shape (hence the "memory"), you don't need to worry about fluffing it regularly. Lees says memory foam can be a good choice for side sleepers, but "because it does not breathe as well as some materials, it can sleep warm."

• Shredded memory foam:This fill consists of many smaller pieces of foam rather than a single large piece. "The advantage to this is that it's much easier to shift and manipulate," says Okubadejo, making it ideal for those who toss and turn a lot or "want some cushion without the sinking feeling." (Because air can pass through spaces in the foam, this pillow style also tends to be more breathable than traditional foam options.)

• Latex:Like foam, latex (typically made from the sap of rubber trees) tends to offer more support than down or down alternative pillows, explains Okubadejo — but it's quicker to respond, lending it more of a bouncy quality. He also notes that, similar to foam, latex can trap heat. Choose from solid latex, molded latex for greater stability and support or shredded latex for greater flexibility and breathability.

3. Test out the pillow to assess your alignment.

The info provided so far can help guide you in choosing the best pillows for your sleeping position. But actually sleeping on — or at least rest-testing — a pillow is the only true way to ensure you're in proper alignment.

• Rest your head in a neutral position:Okubadejo suggests lying down on your pillow, on your mattress, with your head in a neutral position (not tilted or angled to either side). "Your ears should line up with your shoulders, and your chin shouldn't be pushed toward your chest or tilted upward," he explains. "If you find yourself constantly needing to shift or tuck your chin in, it means your pillow isn't giving your neck the support it needs, and this is not a good choice." 

• Lie there for a few minutes:Notice how your neck feels. "You should feel cradled comfortably, not hanging or pulled," Okubadejo advises. 

  • If you're a side sleeper,Okubadejo says your nose should line up with the middle of your chest, and not angled up or down toward the pillow, which means it's too high or too low. 

  • If you're a back sleeper,"there should be gentle support underneath the neck but not pushing the head forward." Lees adds, "The pillow only needs to be high enough to hold the head and neck in a neutral position. If someone has an exaggerated upper back curve, a thicker pillow may be more comfortable."

  • If you're a stomach sleeper, and you have to use a pillow, try to find a firm, low one that allows you to get your head as close to the mattress as possible, advises Okubadejo, to keep your spine in neutral alignment and prevent twisting.

If your ideal pillow doesn't seem to align with some of the other advice here, remember that your body size can come into play. "Shoulder width affects the ideal pillow height: wider shoulders typically require more height, while narrower frames prefer a lower-profile pillow," notes Okubadejo. "Heavier body weights also factor into this equation, as heavier sleepers will sink into their mattress more, and can drastically alter the ideal height needed when you're horizontal."

What is the best sleep position?

You may find your sleep position shifting throughout the night, but Dr. Hazel Joseph , a Kentucky-based general surgeon, recommends at least trying to sleep on your back if possible. It's "the superhero of sleeping positions," she explains, for keeping "your spine, neck and head in perfect harmony."  

Dr. Shelby Harris , a New York-based clinical psychologist specializing in behavioral sleep medicine, reinforces Okubadejo's comments that side-sleeping can help with acid reflux and heartburn, thereby reducing snoring. "It may reduce the risk of sleep apnea — and be helpful for those who are pregnant, as it improves blood flow to the fetus," Harris adds.

Stomach sleeping is the least popular position among the experts we interviewed. "It can put a little too much pressure on your neck and spine, which might leave you feeling a tad uncomfortable," explains Joseph. "So while it's cozy for a quick nap, it's not always the best for a full night's rest."

All that said, Okubadejo says it's important to remember there's no such thing as a "perfect" sleep position. "The real goal is to keep your spine as neutral as possible throughout the night," he elaborates. "For most people, that means sleeping on your back or side, using pillows thoughtfully, and having a mattress that supports proper alignment."

What is the best pillow material?

It depends on what's comfortable to you. Fluffier down and fiber fills tend to feel cushy at first but then flatten overnight (offering less support), whereas denser memory foam and latex pillows tend to offer consistent support but can get hot.

Look for gel-infused or otherwise ventilated fill materials — and for breathable, cooling pillowcases — to help keep you comfortable throughout the night. 

How to clean a pillow

Cleaning your pillow regularly can help keep dirt, drool and germs at bay (and eliminate unpleasant odors ). Read your pillow's care instructions for the best way to machine-wash or spot clean your pillow, but in general, allergists say you should be washing your pillows at least once a month. If you can't toss them in the dryer, leave them in a well-ventilated area to help speed drying and reduce bacteria growth.

"Additionally, it's helpful to use non-irritating laundry detergents for your bedding and clothing," notes Dr. Simran Sethi , a board-certified physician specializing in medical aesthetics. "Use detergents that are free from harsh chemicals, fragrances and dyes, as these can irritate sensitive facial skin."

When to replace your pillow

As for how often you should replace a pillow, Harris recommends every one to two years due to "wear, loss of support and/or staining/hygiene concerns." That timeline is flexible, based on how you care for your pillow and how well it holds up over time. "If your pillow still feels good and looks clean, you might not need to replace it as often," Harris explains, "as it does depend on the quality of the pillow and what you find comfortable." 

Meet our experts

• Dr. Shelby Harris , clinical associate professor of neurology and psychiatry, Albert Einstein College of Medicine, and medical adviser, Sleepopolis

• Dr. Hazel Joseph, a general surgeon 

• Dr. Kevin Lees, D.C., director of chiropractic operations, The Joint Chiropractic

• Dr. Gbolahan Okubadejo, orthopedic and spinal surgeon, The Institute for Comprehensive Spine Care

• Dr. Simran Sethi , board-certified physician and host, The Skin Report podcast