HELLO! asked the experts how long a pillow should last and how to was them to ensure they are not contributing to skin breakouts and a disrupted sleep cycle
Pillow hygiene is probably something we don't tend to give too much thought to but it's about time that we all started to take the cleanliness of oursleeping aidsa lot more seriously. Despite being protected by pillow cases and other additions to dress up our beds and make them look pretty, the actual pillow itself can harbour germs and become problematic for your skin. The lifecycle of a pillow is only one to two years, a shocking timeline that I certainly had no idea about. We're all guilty of fostering pillows for way longer than we should, but why is it so vital that they are changed? I asked the experts on behalf ofHELLO! readers to find out what is so wrong with an old pillow and why they areruining our sleepand our skin.
How often should you replace your pillows
Despite what we know about the importance of regularly changing bed sheets and pillow cases, it's amazing how much we forget about the lifespan and cleanliness of the actual pillow itself. Unfortunately, no matter how much we love our down and feather pillows, experts unanimously recommend swapping out your old pillows for new ones every one to two years. This is to maintain both hygiene but also neck and head support.
Of course, the different fillings found in pillows will affect this recommended timeline. Dr Chris Mosunic recommended to Calm Sleep that:
"Synthetic or polyester pillows tend to wear out faster (often needing replacement after just 12–18 months)
More durable materials like memory foam can last two to three years
Latex can last even three to four years, depending on quality."
Hannah Shore, Head of Sleep Science at Mattress Online, shared her advice with HELLO! on how to test the quality of your pillows. She said: "There are three quick tests you can do to see if your pillow is still giving you the right amount of support:
Folding it in half - If your pillow doesn't expand to its original shape when you fold it in half, you might need a new pillow. This test is made for hollowfibre and synthetic pillows.
Saddlebag test - This test involves you placing your pillow over your extended arm. If it flops over your arm and doesn't hold its shape (like a saddlebag), it's time for a new pillow. Again, this test is more suited for hollowfibre and synthetic pillows.
Press test - Press your hand into your pillow. If it doesn't spring back to its original shape or takes too long to reform, it might be time for a new one. This test is more for foam pillows."
Registered nurse and independent nurse prescriber Georgina Gleen works extensively in anti-ageing and skin health and recommended: "From a clinical point of view your pillow really only has an effective lifespan of around one to two years! Most people are surprised by this. Over time it naturally loses structure which means it stops supporting the head and neck properly. When that happens you'll probably find yourself waking up feeling abit stiff or find yourself having headaches. It can also contribute to poor sleep posture and disturbed sleep that feels very close to insomnia."
A pillow should be washed in the washing machine on a gentle cycle
How to wash pillows
Like most things, every so often, all it needs is a good scrub and your precious pillow is no different. Aside from collecting dust, sweat and skin particles, your pillow may be triggering allergies or contributing to skin problems while you sleep. Georgina explained: "From a skin health perspective, an older pillow presents another problem. Even with washing your pillowcases the pillow beneath will gradually collect things like oils, sweat, dead skin cells and environmental bits."
She continued: "This build up creates a warm, damp environment that bacteria thrive in. For people who struggle with breakouts, congestion or even just unexplained skin irritation, looking at the pillow you're using is something I would recommend. Sleeping on a pillow that has lost volume or has accumulated years of debris means the skin is repeatedly exposed to irritants for hours and hours at a time which can actually undermine the skin barrier."
So, how do we ensure that our pillows aren't breaking out our skin? Start by checking the care label attached to the outside of the pillow. Usually memory foam pillows should never be machine washed, while down or polyester pillows can for the most part. Take off any pillowcases and protective covers, and inspect the pillow for any weak seams that would lead to the filling escaping while in the washing machine. Use a mild liquid detergent and wash on a gentle cycle with warm water, adding an extra rinse if possible to remove all soap residue. Dry thoroughly on a low-heat setting or air-dry in the sun to prevent mould and odours.
Choosing the perfect pillow for your body and sleep position could significantly improve your health
A general rule in life: if something seems too good to be true, it usually is. And in hindsight, the £10 I forked out for an anti-snoring pillow last summer would have been better spent on scratch cards. Still, it seemed like an opportunity too good to miss. A tiny price to pay to give my wife respite and to save me from sleep divorce.
Alas the Silent Night it promised never materialised and I am now frequently banished to the naughty room. The pillow meanwhile is in a landfill somewhere, along with countless others I imagine, purchased by people who were sold a dream. A mass grave full of broken sleep.
James Leinhardt sympathises. He is a sleep posture expert who advises chronically ill patients, athletes and the critically injured on sleep posture and runs Levitex, a mattress and pillow company.
“The industry is unregulated and some companies prey on the vulnerable. If you are in pain and can’t sleep, or your relationship is in trouble because of snoring and you’re then told of a pillow that will solve all your problems, you are an easy target,” he says.
Pillows with supposed magical properties are just the thin edge of the wedge. Walk into any bedding shop or look online for a pillow and the choices are endless. Big, fat, medium, small? Memory foam, natural fibres, micro-fibres, hypo-allergenic? Loft, density, weight? Where do you even start?
Good advice is a good starting point and Leinhardt, who has his own sleep posture consultation room, asks me about my sleeping habits. I explain that I usually begin the night on my side because I know I snore less in this position, but always roll over onto my back, usually because of discomfort. The snoring then begins and ends with the walk of shame in the early hours after my light-sleeper wife has finally managed to banish me.
“So, the ideal solution would be for you to have a pillow that keeps you on your side comfortably,” explains Leinhardt.
One of the main problems is that we tend to approach buying a pillow from the wrong perspective. Instead of asking whether it feels or looks nice, the real trick is to ask what you want it to do.
Positioning
Before you even contemplate buying a pillow, it helps to understand sleep anatomy. The holy grail of sleep is achieving a sustainable neutral spine position, as chartered physiotherapist and sleep expert Sammy Margo, the author of The Good Sleep Guide, explains.
“What we are aspiring to do is to keep the head and neck in the midline position which means a neutral spine position, not kinking your neck off to one side or the other as if you are holding a phone on your shoulder or bending too far forward or backward.”
It’s a pillow’s job to help you get into this position and stay there. Wrong pillow choice has implications.
“One typical example would be someone who sleeps on their back and has too many pillows and wakes up in the morning with headaches because their head is being bent too far forward,” continues Margo.
A good pillow should be comfortable but not at the price of support and not too firm. It should preserve a good sleep posture, and that will depend on the position you go to sleep in, because different sizes and types of pillows are better for different sleepers.
Side sleepers
A side sleeper should choose a pillow that fills the gap and keeps their head in position Credit: Andrew Crowley for the Telegraph
If you are a side sleeper (around 70 per cent of people are), when you lay down your pillow should fill the gap between the tip of your shoulder and the tip of your ear. This supports your head and keeps your spine in that important neutral position.
“For correct sleeping posture, only your head and neck should be placed over your pillow. Do not place your shoulders on the pillow because this will elevate your upper body higher than your lower body,” explains Margo.
If you are a side sleeper, you should choose a pillow that fills the gap and that also keeps your head in position. Many do not.
“If the pillow is too big you will strain your neck and if it’s too small your head will drop into the pillow,” explains Leinhardt.
The average head weighs between 4kg and 6kg (around 9-13lb), so your pillow needs to be dense enough to support that weight throughout the night, so your head doesn’t drop, which strains the neck.
“People who wake with shoulder pain usually do so because their pillow doesn’t support their head during the night,” adds Leinhardt.
Back sleepers
Sleeping on your back has a lot of advantages Credit: Andrew Crowley for the Telegraph
For back sleepers, a pillow should fill the space between the shoulders and the back of the head. This will invariably mean a thinner pillow than that of a side sleeper, as it is a smaller gap to fill.
While fewer people tend to sleep on their backs than on their sides, Margo explains that the position has a lot of advantages.
“It is symmetrical and as you get older you may need surgery and a large percentage of surgery requires you to sleep on your back. Provided you place a pillow under your knees to soften your lower back, it’s a good position to sleep in for a lot of ailments, such as hiatus hernia in elevation,” she explains.
Front sleepers
Front sleepers are 'already lying in a God-awful position,' says Leinhardt Credit: Andrew Crowley for the Telegraph
Leinhardt advises that front sleepers should “never buy a pillow, because you are already lying in a God-awful position”.
When you sleep on your stomach you must turn your head all the way to the left or right and if you have a pillow under your head, it will further extend the neck in an awkward position.
“Logic suggests this is not ideal,” adds Margo. “Your pillow should be relatively flat or removed. This will help keep your spine in line. In this position it is often best to place another relatively flat pillow under your stomach or chest to help natural alignment. If your mattress is soft, you may well need more than one. They will help minimise the strain on your lower back and the degree of twist in your neck.”
Body size
Your body dimensions will affect how effective your pillow is, particularly if you are a side sleeper. Margo recommends that pillow purchasers buy with an awareness of their anatomical dimensions.
“A pillow should fit like a glove,” she says. “Sometimes you can get a slim woman who has a wide neck. Sometimes you can get a big man who has a narrow neck. This affects the distance from your shoulder all the way up your neck. A good gauge is your clothes size and also your neck size. If you have a smaller neck, you might need a bigger pillow.”
Your body dimensions will affect how effective your pillow is Credit: Andrew Crowley for the Telegraph
Material
Pillows come in a baffling range of materials and fillings. Choice is down to individual tastes, budget and needs. The most common fillings are:
Polyester
Some people may suffer allergies and so will best be served by a pillow with a man-made filling, which is mostly made from synthetic polyester. It is cheap and affordable, machine washable but not particularly durable and can clump together over time. There are other more exotic hypo-allergenic fillings including kapok, which is made from the fibre of the seeds of the kapok tree.
Down and feather
Down pillows are stuffed with the soft underfeathers from ducks and geese. They are durable and naturally soft. Down pillows have a luxurious feel and mould to the head and neck. They are often pricey and do not offer as much through-the-night support as more dense material.
Feather pillows are generally more affordable and use bigger feathers. According to Leinhardt: “If you don’t sink in enough, it will be like sleeping on a brick and if you sink in too much it will be like sleeping on a bowl of porridge. Feather and down feel comfortable and are culturally opulent, but they don’t have any form, so they move.
“If what’s under your head is not stable your head will move and if your head moves, your neck muscles have to be active. The principle of a pillow is that it’s meant to take the head out of the equation for the night.”
Down is also not ideal for humid or damp rooms as humidity causes down to lose its loft and its ability to insulate, so the pillow will quickly go flat and become less supportive.
Memory foam
Pressure-relieving and comfortable, memory foam also continues to sink when pressure is applied, so might be comfortable when you fall asleep but may not offer the required amount of support throughout the night. “It’s a bit Marmite and memory foam is quite expensive,” says Margo. “Some neck patients love it, and others say it aggravates their neck. There can also be an issue with smell and heat.”
Cotton
Another common filling, it is usually firmer than polyester, is odourless and is also less of a problem for those with allergies. It is not as durable as other fillings however and can also clump.
Specialist pillows
Anti-snoring
Beware of the claims some pillow manufacturers make, our experts warn. Pillows claiming to be anti-snoring don’t stop snoring per se. They are designed to reposition the head and neck to open the airways, but it is worth noting that 67 per cent of snorers will stop or reduce snoring simply by lying on their side, so it may be more advantageous to find a pillow that optimises sleep in a side sleeping position. If a pillow can keep you on your side, it will probably help reduce snoring.
“For some people they are effective, but so is sewing a tennis ball into the back of your pyjamas to keep you from laying on your back. It comes down to the physiology of snoring and the causes. If you are drunk, you are more likely to snore. So, it’s about understanding what’s causing it and changing the position to adjust to it.”
Cooling
Pillows with cooling technology, specifically marketed at women going through the menopause, should also be approached with caution. The small print will usually state the material is “cool to touch”. But it doesn’t stay cool throughout the night when a warm head and neck are resting on it.
Orthopaedic
The same cynicism should be applied to pillows that claim to be orthopaedic, as the term is often used in an undefinable way. “What does that even mean?” asks Lienhardt. “If a pillow claims to do something, the manufacturer should be able to validate those claims.”
Try before you buy
Given how individual a choice of pillow is, the sagest advice is to try before you commit to buying. And this shouldn’t be a quick squeeze in the bed shop. Try it for as long as possible. Is it still comfortable after five, 10 or even 15 minutes?
Many pillows now come with a trial period. Levitex customers, for example, have a 44-day trial period.
Margo also advises persisting with new pillows. “They can take a while to bed in. Don’t dismiss a pillow straight away,” she says.
What to do if your pillow fails and you get a cricked neck
A cricked neck in the morning can be caused by sleeping position, too many pillows, not the correct type of pillow, or other sleep issues. Gentle stretching and self-massage can help loosen the muscles and ligaments in your neck that have become tight and stiff during the night sleeping. Gently tilt, bend and rotate your neck to loosen your neck muscles and regain full mobility.
Margo advises: “I call these easy neck exercises ‘yes, no, maybes’. Turn your head from side to side five times, look up and down five times and then alternate your ear to shoulder five times.”
In addition, while sitting upright, look straight ahead and hold your left shoulder down with your right hand. Slowly tilt your head to the right while holding your shoulder down. Repeat on the opposite side. Hold each stretch for five seconds and repeat three times on each side.
An ice pack applied to the affected area can also help reduce inflammation while alternate cold and heat can soothe and loosen tight muscles. A hot shower can also help.
For more persistent pain, over-the-counter pain medication such as Voltarol gel should help.
The NHS advises against wearing a neck collar as it’s better to keep your neck moving (unless directed otherwise by a doctor).
Back, front or side? The position you favour has the potential to trigger its own set of health issues, from acid reflux to brain health
How many of us monitor our sleep posture? We have a favourite position; we fall asleep and that’s generally as far as it goes. But sleep position can have profound implications not only for the quality of sleep, but also for long-term health. Indeed, in the worst-case scenarios, a bad sleep posture may be slowly killing you.
Despite the impact sleep posture can have on conditions such as dementia and heart disease, research is limited and tends to focus on aches and pains. But back pain is just one implication of an unsuitable sleep position.
Chartered physiotherapist, sleep expert and author of The Good Sleep Guide, Sammy Margo, explains: “Sleep positions can significantly affect your overall health, comfort, and the quality of your sleep. Each position has its pros and cons and understanding them can help you make adjustments for better sleep and health outcomes.”
Dr Kat Lederle is a sleep scientist and the author of Sleep Sense. She points out that lifestyle factors in the day are usually the cause of postural problems at night.
“What you do in the day generally triggers the pain and discomfort that is felt when you sleep in certain positions. One of the most common contributing factors to this is a sedentary lifestyle, so it is important to move regularly during the day.”
The health risks of your sleep position – and how to mitigate them
Side sleeping
Depending on which side you lie, there are different health implications CREDIT: Andrew Crowley
Side sleeping is the most common position but there are health implications for certain people depending on whether they lie on their left or right side.
It is advised that pregnant women and anyone who suffers from acid reflux or gastroesophageal reflux disease (GERD) or other gut problems sleep on their left side.
“This is because the stomach is lower than your oesophagus,” explains Margo.
People with heart conditions, on the other hand, are advised to try sleeping on their right side to alleviate pressure on the heart. Studies show that when people lie on their left side the position of their heart shifts due to gravity. This causes changes in the heart’s electrical activity. Tissues and structures between the lungs hold the heart in place when you sleep on your right side.
Sleep position may also have an impact on brain health. During sleep the brain’s glymphatic system “washes” waste toxins away from the brain. There is evidence that suggests this process works better when we sleep on our right side.
“That is potentially of interest to people at risk of dementia or Alzheimer’s or any kind of neurodegenerative disease,” says Lederle.
Postural problems can occur with side sleepers depending on body shape, as Margo explains. “Women with hourglass figures sleeping on a soft mattress will sink into a banana shape and that will cause a strain on the spine and hips. While men who side-sleep can tend to get more pain in their shoulders as they get older and their muscles weaken.”
Side sleeping can also cause wrinkles and breast sagging because the skin on the face can get pressed against bedding and gravity can pull breast tissue and stretch skin.
One 2022 study by Beijing Forestry University and Chenzhou Vocational Technical College looked at the relationship between sleeping position and sleep quality. It used flexible wearable sensors to monitor sleep position and turning frequency. It concluded that subjects without sleep disorders who prefer to sleep on their side will sleep better than those who like to sleep on their back and that a higher frequency of turning during sleep will reduce sleep quality.
Another study published in 2021 looked at relationships between sleep posture, back pain and quality of sleep. It reported that positions in which the spine was twisted can cause tissue microdamage and muscle spasms. The study compared common positions such as supine (back sleeping), provocative side lying (where the sleeper twists at the hip with one leg over the other), protected side lying (where the sleeper places a hand between the thighs and crosses the other arm over the chest), and prone (front sleeping).
It concluded that while it is not known if sleep posture is a risk factor for acute onset or recurrent back pain, participants with symptoms and stiffness in the morning spent more of the night in provocative (i.e. twisted at the hip) sleep postures.
To mitigate some of the problems associated with side sleeping Margo recommends using a thick pillow to align the head and neck with your spine and placing a pillow between your knees to support your hips and reduce strain on your lower back.
Back sleeping
Sleep apnoea is the most common health problem associated with back sleeping CREDIT: Andrew Crowley
One of the most common health problems associated with back sleeping is sleep apnoea, a condition whereby the soft tissue at the back of the throat relaxes and collapses the airway causing snoring and interrupted breathing.
Lederle explains: “This has implications for wider health and often goes hand in hand with obesity. It disrupts the continuity and quality of sleep. It can lead to tiredness, which can be a problem for people driving. There are also physical health implications. We know that poor quality sleep raises the risk of diabetes, heart disease and other comorbidities. Sleep apnoea opens the door to all these other conditions.”
One way to try to lessen the problem is to sleep in an elevated position.
However, for those who suffer from back and neck pain, back sleeping is often the best option.
Margo says: “The optimal position for spine alignment is lying on your back with a pillow under the knees to soften the back. This position preserves the natural contours of your spine. It can also minimise wrinkles.”
She also points out that for those who do not suffer from sleep apnoea, back sleeping can be a good position to train yourself into as you get older as back sleepers tend to have less back pain and back sleeping is also required for post-operative patients.
Front sleeping
'Twisting your neck to the side puts strain on your neck,' explains Margo CREDIT: Andrew Crowley
While stomach sleeping may reduce snoring because it can help keep the airways more open than back sleeping, it is the position most likely to lead to increased neck and back pain.
“Twisting your neck to the side puts strain on your neck, and stomach sleeping can also arch your spine,” explains Margo.
“Direct pressure on the face can contribute to wrinkles over time,” she adds.
To help alleviate postural pain front sleepers are advised to use a thin pillow or no pillow at all to keep the neck in a more neutral position and to place a pillow under the pelvis to help keep the lower back supported.
How to change your sleep position
It is normal to move around at night, some people are more active than others and if you move, it is not always indicative of problematic sleep.
If you want to change your regular sleep position, gradually train yourself. For example, if you want to change from a back sleeper to a side sleeper lie on your favoured side for five minutes the first night and then roll onto your back. The following night increase to six minutes, then seven and so on. Start slowly and build up until you get used to the position.
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