Liu Xiaohong, Director Physician of Beijing Geriatric Hospital
A recent study published in the European Stroke Journal has found that using excessively high pillows may increase the risk of stroke. The research involved 106 participants with an average age of 49. Half of the participants were patients treated for spontaneous vertebral artery dissection (a risk factor for stroke) at a comprehensive stroke center in Japan between 2018 and 2023, while the other half comprised a control group with other diseases.
Researchers from the National Cerebral and Cardiovascular Center in Japan and other institutions surveyed the participants about their pillow heights, categorizing them into three groups: less than 12 centimeters, 12 to 15 centimeters (high pillows), and over 15 centimeters (extremely high pillows). The findings revealed that in the patient group, 34% used pillows higher than 12 centimeters, compared to only 15% in the control group. Furthermore, 17% of the patient group used extremely high pillows over 15 centimeters, whereas this figure was just 1.9% in the control group. If a patient used a high pillow, had no prior trauma, and began experiencing symptoms upon waking, the cause of their condition was attributed to the use of a high pillow. Statistical results indicated that approximately 10% of spontaneous vertebral artery dissections are associated with the use of high pillows.
The study indicates that using a high pillow is an independent risk factor for developing spontaneous vertebral artery dissection (sVAD), with the strength of this association being comparable to other established risk factors such as migraines, aortic dilation, and infections. Researchers explain that pillows that are too high cause a greater degree of neck bending during use. This increased neck curvature can lead to vascular injuries when turning over or moving the neck during sleep, potentially resulting in sVAD and subsequently causing a stroke. Fortunately, this is a habit that can be easily changed. It is recommended that people avoid using high pillows to reduce the risk of developing sVAD.
Choosing a pillow that is too low can also have its drawbacks!
A pillow that is too low can cause the head to be excessively tilted backward. This position may lead to mouth breathing, which can result in symptoms such as dry mouth and throat, sore throat, and snoring. Additionally, an improper head position can cause uneven blood supply, leading to nasal mucosa congestion and swelling, affecting breathing and potentially causing eyelid and facial edema. People with asthma, lung disease, or heart conditions need to be especially cautious, as using a pillow that is too low might exacerbate their conditions.
What Makes a Suitable Pillow?
Here are several key points for selecting the right pillow, as introduced by Director Physician Liu Xiaohong:
Height: According to the Qing Dynasty text "Laolao Hengyan" (恒言), it states: "The height should allow one to lie on their side with the head level with the shoulders, ensuring comfort whether lying on the back or side." From a medical perspective, an appropriate pillow should maintain the natural curvature of the cervical spine. A pillow that is too high can lead to a straightening of the cervical curve, while one that is too low can cause reverse curvature.
The specific height of your pillow can be chosen based on your usual sleeping position, with the principle being to keep the cervical spine, thoracic spine, and lumbar spine aligned in a straight line. For those who sleep on their backs, the pillow height should be approximately the size of a clenched fist when lying down. For side sleepers, the pillow height should be roughly equal to the width of one shoulder. Individuals with gastroesophageal reflux disease (GERD) are advised to use a pillow height of 15 to 20 centimeters. Elevating the head higher than the chest creates a height difference between the esophagus and stomach. This uses gravity to help prevent stomach acid from flowing back into the esophagus, thus reducing the likelihood of acid reflux.
Softness and Firmness of Pillows：A pillow that is too hard can lead to excessive pressure on the neck muscles, causing stiffness or even injury. Conversely, a pillow that is too soft does not provide enough support to maintain the natural curvature of the spine. Over time, this can result in discomfort or contribute to the development of cervical issues, negatively impacting sleep quality. Therefore, a pillow with a medium firmness that conforms to the natural curve of the head and neck is ideal. Such a pillow provides appropriate support and helps relax the neck.
Pillow Styles: Flat pillows are relatively easy to manufacture and are commonly found in many households. However, during everyday use, flat pillows often lead to the neck being left unsupported or "suspended," which can cause discomfort and strain. Traditional square Chinese pillows tends to elevate the head quite high, causing the neck to tilt forward unnaturally. Such positioning is not recommended. Yuanbao (Ingot) Shaped Pillows features a design that is lower in the middle and higher at the ends, this type of pillow offers greater comfort compared to other common styles.
Director Physician Liu Xiaohong reminds everyone that pillows are meant to support both the neck and head, so they should not be too small. The width of a pillow should be at least as wide as your shoulders, preferably wider, and it is not advisable to have a pillow width less than 30 centimeters. Additionally, pillows have a lifespan. After more than three years of use, the elasticity of a pillow will deteriorate, making it prone to deformation and unable to support the body's natural physiological curves effectively. Over time, pillows can accumulate large amounts of sweat, sebum, dead skin cells, bacteria, dust mites, and dust, which may contribute to respiratory or skin issues. Therefore, if your pillow shows signs of deformation, has unpleasant odors, or any other issues, it should be replaced promptly.
