Pillows...how to choose the right one for you

Dr Sarah Konzie, an orthopaedic manual physiotherapist at Physio Plus Clinic in Nairobi, says that the wrong pillow is often the cause of neck, shoulder, and back pain.

“The pillow plays a significant role in spinal comfort during sleep,” she says. “If a pillow does not support the neck properly, it can place the cervical spine in an unnatural position for many hours every night. Over time, this could lead to neck stiffness, shoulder tension, headaches and sometimes upper back pain.”

This means that while many people blame long hours at the desk or poor posture during the day for such pains, the problem may actually begin during the night, on the pillow they rest their head on for seven or eight hours.

From a physiotherapy perspective, a pillow's primary function is to maintain the natural alignment of the spine while the body is at rest.

“It should support the head and neck in a neutral position, allowing the muscles and ligaments around the spine to relax and recover overnight,” she explains.

The problems start when the pillow is either too high or too flat, forcing the neck into awkward angles. This means the support is wrong.

“If the pillow is too high, the neck bends forward excessively, which can strain the cervical joints and muscles,” Dr Konzie says. “If it is too flat, the neck may drop backwards or sideways, leading to muscle tension.”

So what is the correct pillow to use?

The correct pillow height, she says, is not standard. It differs based on how an individual sleeps.

For those who sleep on their backs, the pillow should be of medium height to support the natural curve of the neck, while side sleepers require a thicker pillow to fill the space between the head and the shoulder so that the spine remains straight. On-stomach sleepers, on the other hand, should either use a very thin pillow or none at all to avoid forcing their necks into excessive rotation.

“Sleeping position is very important,” she says. “For spinal alignment, sleeping on your side is generally considered the better position, but if someone sleeps on their back, they can place another pillow under the knees to help reduce the strain on the lower back. Similarly, a small pillow under the stomach can help reduce excessive arching of the lower back for a stomach sleeper.”

Common signs that a pillow may be harming posture include waking up with neck stiffness or shoulder pain, frequent headaches, a constant need to readjust the pillow during the night or noticing the discomfort improves once you get out of bed and start moving around.

Firm isn’t better

And contrary to popular opinion, the orthopaedic physiotherapist says firmer is not always better.

“The best pillow provides support while being comfortable,” she says. “A pillow that is too firm may create pressure points, while one that is too soft may collapse and fail to support the neck. Balance between support and comfort is important.”

Marjorie Watetu, a clinical pharmacist who also runs Peaches Bedding and Beyond, a retail business, agrees.

“The most common mistake people make when choosing what pillow to buy is ignoring their sleeping position,” she says. “Another mistake is choosing one based on popular sentiment and assumptions, yet what works for one person may not work for the other.”

Too high or too low

Sleeping position and pillow height, she says, also affect breathing and snoring. If the pillow is too high or too low, this could obstruct the airways, affecting the flow of air within the body.

Read: How to improve quality of your sleep for effective rest

“If the snoring is in relation to pillows, it tends to be worse in people who sleep on their back because it shifts the chin toward the chest,” she says. “But if the cause of your snoring is not pillow-related, that becomes a medical issue that needs evaluation. Pillow choice can’t really fix that.”

The material of the pillow also plays a role in sleep comfort. For temperature regulation, she recommends natural fibres such as goose down and down feather pillows. [Goose down pillows are filled with the soft, fluffy clusters from the underside of a goose’s feathers, while down feather pillows contain the actual feathers themselves.]

“These allow for more air flow, unlike synthetic fibres which tend to trap more heat,” she says.

“But pillows with these types of fillings tend to be very costly, so if you are not able to afford them, you could at least ensure that your pillowcases are made from either cotton or silk.”

The same concept applies when it comes to choosing pillows when you have allergies. According to her, high-quality natural fibres are generally hypoallergenic, but using a cotton covering also works better than using a pillow whose filling and casing are both made of synthetic material.

“If you suffer from allergies, we also recommend getting a pillow protector,” she advises. “This is because you need to keep your pillows clean, but washing a goose down or down feather pillow will destroy it completely. It is better to have pillow protectors and cases that you can remove and wash at least weekly.”

She also recommends replacing the pillow frequently, especially if you have allergies.

“A good pillow tends to last about two years. With repeated use, it naturally tends to wear out, so you have to replace it. Those with allergies need to do it even more frequently, after about 18 months,” she says. “If it’s not of good quality in the first place, you’d need to do it sooner, which is why a pillow is an investment. You’d rather have a costly one that serves you longer.”

While memory foam and contour pillows are often thought of as newer options, Marjorie says that it might only be because they have come to the Kenya market in recent years, but they actually are not that new.

“The original element of the memory foam came in the 60s through NASA,” she says. “It was used in aircraft cushioning because it was able to absorb pressure and conform to the body’s shape. It was later adapted into the sleep industry to create pillows and mattresses.”

Contour pillows came from the medical world in the 90s, made from memory foam and structured specifically to mimic the natural shape of the head and neck and provide better support. To tell whether a pillow is right for them, Marjorie recommends testing it before buying to gauge comfort.

“Another test you can do at home to see whether your pillow is worn out is to fold it in half or press it down with your hands,” she says. “It should bounce back to its original form. If it remains folded or pressed down, that’s a problem.” Serah Njoroge works at Homelux Lifestyle Kenya, which offers four main types of pillows: normal fibre pillows, latex pillows, memory foam pillows and visco memory foam pillows.

“The fibre pillows are what are found in most Kenyan households and are the most affordable,” she says. “They go for Sh1,500 for two. However, the majority of our clientele usually go for either the memory foam or the cervical latex pillow, which range between Sh2,000 and Sh3,500 for one pillow.”

Doctor’s advice

Most buyers, she says, typically buy pillows following recommendations from doctors to help ease neck pains, breathing difficulties, snoring and other lifestyle-related discomforts.

According to her, the quality of a pillow is reflected in its pricing - the better the quality, the higher the price.

“But if you don’t spend money to get the good stuff,” she says, “You’ll spend money on restoring your health.”

Backing this theory is the rising demand that Serah has witnessed for specialised pillows.

“Even up to late 2024, most people only knew about the normal fibre pillows,” she recalls, “but since 2025, a lot more people have embraced the realisation that these pillows could actually improve not just their rest but also the quality of life. Where we used to sell only about four pillows in a week, now hardly a day goes by without a pillow sale, and some of them are bulk orders.”

The biggest mistake

The biggest mistake she has witnessed in customers buying pillows is going for the cheapest option, which will likely have them buying another set of pillows in four or five months' time.

Most of those who buy the higher-quality options are parents aged 27 years and above, which prompts Serah to urge the younger generation to start investing in their well-being early.

“You don’t have to wait till you’re much older,” she advocates.

To give your pillows a longer life, she encourages cleaning your face every night before bed, wrapping your hair in bonnets and regular washing of the covers.

“Treat them as carefully and intentionally as you do your underpants,” she says.

“And when it’s time to change them, change them. A good horse rider knows when their horse needs a break, and a seasoned driver’s instinct will always tell them when their car needs servicing. Likewise, when you use your pillow every day, you’ll know when it needs an upgrade. Don’t ignore that instinct.”

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