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The basics of pillow hygiene

Last Modified: June 13, 2022

Family Medicine

A good night’s rest is vital for overall health. We spend 30 percent of our adult lives sleeping, which makes the environment in which we do so important. A critical element of that environment is the pillow we place our head on each night. We asked Srinivasan Devanathan, MD, PPG – Sleep Medicine, to answer our questions about how to select the best option and how often you should be replacing it, so you can rest easy and restoratively.

Why your pillow matters

A proper pillow and mattress are essential for good sleep. A poor sleep environment can result in discomfort, tossing and turning, waking unrefreshed, neck pain, numbness in your arms, waking up worried and scared, etc. Your pillow also impacts the alignment of your back, neck and spine. Malalignment, on top of existing conditions, can make symptoms worse. A good pillow can increase your chances of waking up pain free and eliminate one barrier to a good night’s sleep.

Picking the right pillow

Selecting the appropriate pillow is an individualized process. There is no one-size-fits-all solution, but there are several factors to consider. There are so many materials and degrees of firmness on the market. You want to consider the longevity and quality of the pillow, as well as the length. If you toss and turn, a larger pillow might be a better option, for example. It will take a little time for your body to adjust to a new pillow, so make sure the pillow comes with a trial period, so you can sleep with the pillow for 30 days or so, and see if your body is responding to it positively.


There are so many different options, including down, wool, cotton, memory foam and latex. Down pillows are typically made of goose or duck fiber, with goose being slightly softer than duck. The issue with down pillows is that they contain multiple fillings, including small amounts of dirt from the animals. This can contribute to and worsen symptoms for those with allergies. To address this concern, choose a hypoallergenic down pillow instead, as well as a hypoallergenic cover. They are slightly more expensive, but helpful for those with this condition. Cotton pillows are naturally hypoallergenic.


When it comes to the thickness and firmness of a pillow, there’s a material for every preference. Wool tends to be pretty firm. Cotton is somewhat flat and firm. Down pillows are typically softer and lighter. Memory foam conforms to the body’s shape and heat. The biggest advantage with memory foam is that it supports even distribution of weight across the pillow, which can be beneficial for those with head or neck pain. The one drawback is that some people find memory foam makes them sweat more, but there are newer options that claim to have addressed this issue.

Sleep position

One factor that tends to influence firmness and thickness preference is sleep position. You want an option that keeps your head aligned and spine straight. For example, if you are a side sleeper, you’ll likely be most comfortable with a firm pillow. You might also benefit from a gusset, which is a specific method of filling that increases the thickness and support of the pillow on the sides. Stomach sleepers often report using a thin pillow, or no pillow at all. This can, unfortunately, contribute to strain on the back. Back sleepers traditionally prefer thinner pillows, though this isn’t the recommendation. Because of the weight of the head, the best option is a pillow with more support, and the bottom third of the pillow should have extra thickness, or what’s referred to as a “loft”.

Replacing pillows

Life gets busy, and typically the simplest of self-care tasks fall off of our to-do lists, but it’s important to pay attention to your pillow quality. If you think about the hours you spend with your pillow – 7-8 per night, ideally – and multiply that by weeks and months, it really adds up. As a general rule, the recommendation is to replace your pillow every 18 months-2 years. As time passes, you’ll notice a decline in the comfort and relief you feel when you wake up in the morning.

Natural materials will last longer than synthetic. One way you can test your pillow is to fold it in half. If it stays folded, that’s a dead pillow; A healthy pillow will bounce back and return to its shape. You’ll also want to examine your pillow regularly for stains and unpleasant scents, which would indicate it needs cleaned or replaced. As humans, we shed dead skin cells. This, along with mold and dust mites can increase the weight of the pillow and trigger allergies.


These are general guidelines, and you should always go for what’s most comfortable and yields the best sleep. The amount and quality of your rest impacts how you feel and present yourself. Give yourself the benefit of proper pillow hygiene.


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