While traveling around the country to teach one of my favorite things to do is browse the Sky Mall. I always wonder what new and exciting products will be offered and often times cannot help but laugh at some of the things we buy.
One product that recently sparked my interest as I struggled to find a comfortable position to take a nap was the SkyRest. While I had to resist the temptation to order it for my next trip, I could not help but wonder about pillows in general.
I have seen many infomercials claiming the benefits of "cervical pillows" including their capabilities of curing pain, improving sleep and increasing function through proper alignment and organization of your spine. But I always wondered if there was enough evidence to back these claims up.
Let's start at the beginning - with how pillows got their start.
According to first known research, the earliest pillows date back to ancient Mesopotamia ~7,000 B.C. Formed from stone, the top was carved in a half-moon shape to support the neck. The idea obviously wasn’t for "comfort", but instead for a very useful purpose: to keep the head off the ground and prevent insects from crawling into mouths, noses, and ears.
The Chinese had their own pillow design and mythology. They used hard pillows, which were preferred because they were thought to help with increasing blood circulation, providing the brain with energy, curing illnesses and most importantly keeping ancient demons away.
So how did we get these soft things we sleep on now?
Enter the ancient Greeks and Romans who used pillows covered in cloth and filled with materials such as feathers or straw. Initially they were used as a sign of wealth and status, so unless you were of royalty you probably had to make due with something else. By the Middle Ages in Europe, however, pillows had fallen out of favor with many. Many men in particular viewed pillows as a sign of weakness, and their use was primarily limited to pregnant women.
Pillows did not become nearly as universal as they are today until the industrial revolution. With improvements in technology pillows, like most other items, began to be mass produced - meaning everyone could sleep with a pillow at night, and could even afford decorative pillows for chairs and couches! But were we better off without them?
As with most things lately, I began to question the effects/environmental impacts that modern day living has on our bodies. It is not to say modern day living is bad. Heck it is great! I love chairs, I love my computer/TV/phone, I love the fact I can have lunch in NYC and dinner in LA, but it is not without consequence. Most of our technological advancements have occurred in the last 100-200 years respectively, with arguably the most improvement happening in the last 20-30. Now let's think about our bodies which have spent thousands, if not millions of years evolving and accommodating to environmental stresses slowly and surely over time and then suddenly being sling-shoted into a modern day lifestyle to which we have no business living in (i.e. rises in obesity, heart disease, cancer to name a few). So their obviously must be research to support all of these claims of pain alleviation, improved function and better sleep using pillows right? Not so much.
In a systemic review in 2006, 5 low quality studies met the inclusion criteria for review with the conclusion that there was not enough evidence to support the fact cervical pillows reduced neck pain. There have been numerous suggestions made about the "best" sleeping positions and what is easiest on your spine such as this article from Harvard - however can any non-weight bearing position of the spine be "tough" on it? Particularly in the safety of your own home, in your own bed and knowing that the position we fall asleep in is not likely the position we wake up in. Should we be setting alarms throughout the night to check ourselves? Probably not. It has been well documented that people who slept longer each night were less likely to report neck and back pain and had higher scores in functional testing (this was once again proven in a recent study in the European Spine Journal in March 2016).
Now there have been some studies to suggest that cervical pillows can offer some benefit such as a study from 2014. The study had 20 healthy subjects, however the outcomes measured were completely subjective. Read the results of a 2008 study from the Journal of Manipulative Physical Therapy: "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." But what did the others think?
If we give it one last thought, if pillows are so important then why do we not provide them to infants? Initial thinking could be because of the risk of SIDS, which would be understandable. But what about after the first year? My daughter is 2 years old, has been sleeping on her stomach since she was 3 months old and has better posture, mobility and movement than anyone I know. When is the "right" age to introduce her to pillows? Should we even bother? If she has adapted to sleeping without pillows, as we did for thousands of years, and she is comfortable is there a need for them? Are pillows simply a "norm" that she now must have? She does not have to worry about bugs, dirt, or demons after all....
Like I said we live in a great time!
Do you give recommendation to patients regarding sleep? Is your advice anecdotal or do you know of any (good) research we missed?
Until next time, Happy Rehabbing.
Paanalhati, K. "Spinal pain--good sleep matters: a secondary analysis of a randomized controlled trial." Eur SpineJ, National Center for Biotechnology Information. U.S. National Library of Medicine, 25 Mar. 2016. Web. 16 Aug. 2016.
"Say Good Night to Neck Pain." Harvard Health. Harvard Health Publications, 27 Oct. 2015. Web. 16 Aug. 2016.
Shields N, Capper J, Polak T, Taylor N (2006): Are cervical pillows effective in reducing neck pain? New Zealand Journal of Physiotherapy 34(1): 3-9.
Jeon MY, Jeong H, Lee S, Choi W, Park JH, Tak SJ, Choi DH, Yim J. Improving the quality of sleep with an optimal pillow: a randomized, comparative study. Tohoku J Exp Med. 2014;233(3):183-8. PubMed PMID: 25008402
Persson L, Moritz U. Neck support pillows: a comparative study. J Manipulative Physiol Ther. 1998 May;21(4):237-40. PubMed PMID: 9608378.