The Best Pillows for Sleep Apnea and CPAP Therapy

By Admin

One thing that is often overlooked when discussing sleep apnea and sleep apnea treatment is the type of pillow one should choose. Not all pillows offer the same comfort and support, and more importantly, no pillow is a perfect match for every person. PIllows, like CPAP masks or machines, are designed with particular patient features and preferences in mind, making pillow choice a very subjective and conditional decision. And in some situations, a pillow (or pillows) can be as important as the device itself for sleep health and comfort through the night. According to the Sleep Foundation, people with sleep apnea or other sleep problems should be mindful of these issues and make informed decisions when making a purchase.

Sleep Apnea and PIllows: A Question of Compatibility

Some who use CPAP will find that certain pillows and positions may contribute more to problems such as mask leak or general discomfort during therapy, but they may not know just how much of a difference the right pillow can make. One study found that people often make bad decisions when purchasing a pillow for their sleep needs, resulting in “compromised sleep quality, low pillow comfort, and the presence of waking symptoms.” This pattern was found in over half of the study participants, which, according to the authors, “underscores the difficulty that individuals may have in choosing a pillow and deciding when to change pillows.” To remedy this, sleep professionals like the American Academy of Sleep Medicine (AASM) and the Sleep Foundation recommend an informed decision that takes into account your specific health needs, comfort needs, and sleep position preferences. This means you should consider all aspects of a product before making a purchase, including the materials used, design and technological features such as the type of cushioning, and of course, size and shape.

For those with sleep problems such as sleep apnea, a good pillow can do much more than simply cushion your head. The right design can offer optimal comfort while also reducing the risk of mask leaks or abrasiveness. Some even include indentations to make room for CPAP masks and hoses, and some are more geared toward support or position preferences, keeping the head high or conforming to your features to allow for more leverage. Other modern features can keep materials cool during hot weather, repel moisture, and inhibit mold or dust. Many are also hypoallergenic, and some even have entertainment features such as bluetooth capability or built-in speakers. There are many choices, but you want to keep the most important health priorities in mind. A good way to do this is to make a checklist of those qualities you are looking for before going to make a purchase.

The Pillow Checklist: What to Consider Most, Least, or Not at All

Next time you find yourself making a pillow purchase, write up a checklist that includes the most relevant features and characteristics for your needs. As an example, the following list contains some of the most common recommendations made by sleep health professionals:

Most Frequent Position

According to studies on sleep position and pillow types, your most frequent position is one of the first things you should consider when choosing a pillow. Even the most well-designed pillow will not be compatible with every sleeping position, and this is especially true for people who use CPAP. You want to choose a pillow that is compatible with the sleeping position you most often end up in. And each position can benefit from specific attributes such as height (loft), firmness, and shape or size (which affects alignment).

For back sleeping, also called the supine position, a medium size (or medium loft), roughly 4 to 5 inches up from the bed, is recommended, with a medium or higher firmness level for support.

For side sleeping, a high pillow, or high loft, about 5 to 7 inches from the bed, is recommended, and a medium level firmness is good for average cushioning and support on the ear.

For stomach sleeping, you want a low loft, about 3 inches or even less, bugt a high level of firmness. This keeps the pillow from pushing the head up and misaligning the neck or spine. If you only rest the top of your head on the pillow, a higher loft such as a medium (5-7 inches) may be suitable, but keep in mind that you may shift during the night, so you want to be sure.

Some people are combination sleepers, which means they are generally spending an equal among of time in two or more positions. While this is more difficult to assess, some professionals recommend a conforming pillow such as a memory foam option, or a one-size-fits-all approach that can be customized for needed cushioning and support in all positions.

Loft (Height)

Pillow loft refers to the height or thickness of a pillow when lying flat on the bed. Together, loft and firmness determine where your head will be during sleep, which also affects spinal alignment, breathing, and comfort level. Some pillows have an adjustable loft, allowing you to add or remove material to make adjustments, while others may conform to your shape regardless of position. As mentioned in the sleep positions section above, your sleep habits will determine which loft is best for you, and which height keeps your neck in line with your spine. Some newer pillows may have an option to adjust loft by inserting or removing layers before lying down.

Firmness

The firmness of a pillow is usually on the label or cover of the product. As with loft, you will want to consider your most frequent position, but also your body type and weight, as well as your general comfort preferences, Alignment of the spine, neck, and head should also be considered. Generally, you want to choose a firmness that is compatible with the other features you have chosen.

Support

Studies have confirmed that neck support from a sturdy or ergonomically designed pillow can improve sleep quality. And for those with sleep apnea, support for proper breathing is also an important consideration. Support, by definition, is the measure of how well the pillow holds up to weight and pressure in order to keep the head and neck raised to the right level. Some materials, like foam, polyfoam, and memory foam are known for both support and comfort.

Size and Shape

The shape of a pillow matters because it may or may not be compatible with a user’s sleeping style, body type, or comfort preferences. But you should also consider how well the pillow retains its shape when used. A wedge shape is ideal for head support, while a neck pillow may be needed to keep the neck straight if that is a recurring problem. Also, if a pillow is too big or too small, it may not be comfortable regardless of other features.

CPAP pillows may be very useful for people who use the devices, but always keep the other features in mind as well. If a CPAP pillow has the indentation in the wrong place, for example, it will not accommodate your position or your equipment. This is extremely important for side and stomach sleepers and for any CPAP user who has experienced trouble with mask leak or pressure on the hose.

Materials

Pillows can be made from a lot of different materials, both inside and out, so always check the product descriptions. While it may be difficult to assess in some cases, there are also different levels of quality within each type of materials. Do as much research as you can to find out just what a pillow is made of, and if possible, where the materials originate from. Higher quality materials can make a pillow last longer and perform better all around, so at the very least, make sure that your pillow choice is a quality product.

Another consideration is filling. Traditional fillings like feathers or down are soft and fluffy, but they’re not as supportive as new fillings like foam, polyfoam, or memory foam. Also consider any potential allergies. Many new pillows are hypoallergenic, but not all of them are. If you have allergies, don’t assume a product does not contain those materials. Always check product descriptions or check with the manufacturer. Some pillows are made of latex, for example, which can cause serious skin or breathing problems in people with latex allergies.

Pressure Relief

Pressure relief refers to the ability of a pillow to relieve pressure at certain points of the head and neck. Pressure can be relieved in some areas but created in others, so the overall pressure relief value should be assessed according to the user’s frequent pressure points. For example, a pillow may relieve pressure at the ear for a side sleeper, but create pressure on the neck due to a lack of support. Pressure points are not the easiest thing to estimate before a purchase, but you can base the decision on past experience. Just think of any repeated pressure problems in the past, and take that into account. Luckily, many speciality pillows are designed specifically to relieve pressure in common problem areas like the neck and chin.

Temperature Regulation

Temperature regulation varies between materials, and you may just need to do some research to find out how well a product may stay cool. If sweating or heat at night is a regular problem for you, you may want consider this near the top of your list, especially if it leads to awakenings during the night. Memory foam, for example, tends to warm up due to the amount of surface area contact during sleep, but some contain additional cooling features such as gel infusions within the filling. Gel foams or microfibers, on the other hand, are known to keep cool, so don’t require additional design features for heat retention.

While there are some pillow products that actually include a mini AC unit on the inside, most simply use advanced textile technologies and other design elements to expel heat and keep the internal temperature cool. Using breathable materials such as mesh cotton or nylon is a relatively cheap, simple, and effective way to reduce heat without the need for inserted devices or accessories.

Other Added Features or Accessories

While additional perks like internal speakers or sleep tracking applications may not be the most important aspects of a pillow choice, whatever helps you to sleep well should be considered. While these types of perks can be gained from other devices such as a mobile device or a set of headphones, having them attached to the pillow may give you more of an assentive to use them consistently to your advantage. Just make sure that you consider the most important aspects first. Music or white noise may help, but not so much if you’ve chosen the wrong pillow for your body’s alignment and positioning. Always make your checklist thorough and representative of your most important requirements for healthy sleeping.

Material Types

Cotton Pillows

Cotton is a common fill in traditional pillows, and is often compatible with other bedding materials. Cotton is good for a cheap, simple alternative to some of the higher tech pillows now available. But if you choose a cotton pillow, just make sure the size (loft), shape, and support level fits your needs. One of the great things about cotton is its breathability. This is why a lot of clothes and bedding materials are made of cotton or cotton blends. Even if it isn’t designed with mesh patterns specifically used for cooling factors, it is still a light and breathable material. On the downside, cotton does not conform to the head or neck like some of the other pillow types, and may lose firmness over time. It also tends to absorb moisture, but can usually be machine washed easily for fluffing and longevity.

Note on Thread Count: some people choose a higher thread count assuming it will be a softer, higher-quality product, but keep in mind that a higher thread count means a heavier fabric and less breathability, according to an article from Medical News Today. And higher thread counts can cost a lot more than lower counts, without any clear distinction in terms of softness, durability, or level of support.

Innersprings

Some pillows have layers of Innersprings between layers of other materials such as foam or memory foam. The springs are added for support and sturdiness, but also make the pillow heavier. Innerspring pillows tend to have good airflow as well, but can be costly depending on the technical aspects of their design.

Gels

There are many different types of gels used as fillings or in layers to compliment other filings. Often, gels are used as cooling agents that also provide cushioning and flexibility. The denser gels are more form-fitting, while thinner gels are more for cushioning and pressure relief. Generally, the most popular aspect of gels is their ability to keep cool, which tends to be more effective than any alternatives.

Feather pillows

Feather pillows have been around for centuries, but were more of a luxury in the past. Today, feather pillows are appreciated for their softness and support in a simple design that tends to keep the same shape over time. Feather pillows also tend to contour naturally to pressure, making it cradle the head and retain firmness. Feather-filled pillows are also cheaper than the common alternative of down. One complaint about feather fillings is the tendency for quills to poke through the outer fabric at times, giving users a poke. The feathers usually come from geese, ducks, or other types of water fowl.

Down pillows

A little more expensive than feather pillows, down pillows are made from the softer sections of the bird, oft. Down tends to be softer than feathers but less firm, and provides less support. But with down, there are no quills to worry about, so the softness is consistent throughout. Some pillows may have a mix of feathers and down for a good balance of softness and support, so always read the label and check for filling descriptions.

Down and feathers come from exactly the same place: a goose or a duck. Feathers are the outer covering of the bird; they make it possible for the animal to fly, and they contain quills. Down fibres lie beneath the protective feather covering of the bird. ... Down fibres are light and fluffy, and do not contain any quills.

Down products also have something called fill power, which is a measurement of the down per cubic inch within the filling. Unlike thread count, fill power tends to translate directly to a softer, higher-quality product. A fill power of 600 or higher is considered a luxury item and may cost up to several hundred dollars in some specialty shops.

Down Alternatives

Some pillow fillings are considered alternatives to down because they are made to resemble the same softness and texture of down without the cost or allergenic properties of traditional down products. Down alternatives are usually made of microfiber and other synthetic fibers known as fiberfill, polyester fiberfill, or sometimes polyfill for short. Down alternatives may not be as soft or as consistent as down, but they are often less expensive.

Foam Pillows

Foam is simply an air-containing cushioning, which creates a sponge-like effect. Common foam fillings are made of fiber combinations sometimes referred to as fiberfill, or polyfill when including polyurethane. And it can be either shredded or in block form. In general, the stability and durability of foam fillings depends on the density. The more dense, the more stable and durable. In some cases, lower-density foams can break down quickly with regular use. Regular foam can be relatively inexpensive, but some poly-blends are more costly, depending on what other materials are included.

Memory Foam

Originally developed by Peterson Chemical Technology, memory foam is now in regular use by numerous bedding and pillow manufacturers. Memory foam pillows contour to the shape of the head or anything else placed on them, creating an impression that lasts as long as the pressure remains. It does this by using a form of air-infused foam layering called "viscoelastic" or “low-resilience polyurethane foam (LRPu).” Memory foam is known for its pressure relief, or more specifically, its ability to cancel or minimize motion that would normally transfer from one area of the pillow to another as pressure is applied. This makes the material highly beneficial to CPAP users because of the way it shapes to all the different masks and hoses. Memory foam is also good for those who switch positions frequently, as it conforms to each movement during the night. Some of the downsides to memory foam include cost (a little pricier than some other pillow types), low temperature control (tends to heat up given the amount of contact with the body), and occasional unpleasant scents from chemicals used in the manufacturing process.

Latex

Latex and latex foam are soft, cool, and breathable materials that often provide a good amount of pressure relief as well. Latex also resists mold, mildew, and dampness, and on the surface can repel dust and dirt. Like other foams, latex can be shredded or in block form, and some can even be biodegradable. Generally, natural latex products are of higher quality and more environmentally safe than synthetic versions, but either can be harmful to those with latex allergies, so if that is an issue for you, be very careful about latex ingredients in some pillow fillings.

Buckwheat and Microbeads

Buckwheat hulls are known for their moldability, sometimes considered a natural alternative to highly processed memory foam. Popular in Asia, buckwheat fillings are shaped like small beads and are both durable and biodegradable. Since the beads are small and dense, the filling conforms to shapes and pressure, while still maintaining its firmness at the base. One of the only drawbacks of buckwheat pillows is its noise when moved, as the small hulls rub against one another, but it’s no louder than you might expect from a typical beanbag cushion or chair. Synthetic beads, often called microbeads or polystyrene beads (EPS), are also popular as a filling, and some may be quieter or softer than buckwheat, but likely more expensive as well.

Other Materials

There are many other materials used as fillings for pillows, including many different types of beads, natural fibers such as wool or hemp, water and other liquids, and air. Natural fibers like wool and hemp are preferred for their softness and breathability, but some versions require specialty care and must be dry-cleaned. Liquids and air fillings can be cheap alternatives to the standard cushion, but do not provide much in the way of softness or contouring. To remedy this, some products include a bead fill that is also flipped with liquid or gel. These types of pillows are both squishy and soft, and provide some of the support missing from water and air fillings.

Pillow Types

While you may not find all of the features you want in a single product, many pillows on the current market are designed with your needs in mind as a patient and as a sleeper, so finding one with several accommodating features is not uncommon. Below is a list of some the most common pillow types and their usual product features, but keep in mind that many will have variations available, and in some cases, may be tailored to your specific needs during the ordering process.

Wedge Pillows

Aside from fillings, the next thing you want to consider is shape. Wedge pillows are immediately noticeable due to their flat surfaces slanted upward toward the top. Wedge pillows come in many different sizes and shapes, but all have the wedge design of a slanted top. The slant keeps the head up and neck and back aligned, but it is possible to slip down when moving during sleep. Some wedge pillows use contours to keep the head in place.

When used effectively, wedge pillows can not only provide support for the spine and neck, but also reduce symptoms of snoring, sleep apnea, and acid-reflux or GERD.

Wedge pillows are often made of foam, polyfill, or fiberfill, and thus will have many of the same benefits as those fillings, including firmness, support, and durability. But also keep in mind that low-density foam filling may not last as long or provide the same support.

Wedge Pillow by Perfect Cloud

Contour Pillows

A contour pillow is a pillow that has indentations already on the surface to make room for the head, neck, or facial features. A memory foam pillow, for example, would not be considered a contour pillow because the indentations are not already present in the product before using it. There are many different kinds of contour pillows, and most have concave sections shaped like the head and neck.

Ergonomic Pillows

An ergonomic pillow is a pillow that is specifically designed to support a sleeper’s resting position and spinal alignment. Most ergonomic pillows are contour pillows that fit around the neck and/or head. The ergonomics are meant to provide support but also reduce pressure and possible tension from staying in a position for long periods of time.

Orthopedic Pillows

An orthopedic pillow is a pillow designed for a health or medical effect. Thus, many ergonomic and contoured pillows are considered orthopedic. There are orthopedic pillows for almost every part of the human body, and some have multipurpose designs to support a number of different body parts or bodily systems at the same time. Wedge pillows, for example, are considered orthopedic for some back and neck problems.

Neck Pillows

A common type of orthopedic pillow is the neck pillow. While usually used for upright positions such as traveling, neck pillows often wrap around the neck or support the neck from the back with a convex ergonomic design. One type of neck pillow, the horseshoe pillow, is small and wraps around the neck to keep it upright and straight, keeping it from falling to one side or the other as you nod to sleep in an upright position. Another type, known as a cervical pillow, is a type of contour pillow that is often used for neck or shoulder pain. The cervical pillow normally has a shape that securely holds the head and neck in place, preventing strain. Cervical pillows are also good for stiff necks or frozen shoulders, and may help breathing to reduce snoring and sleep apnoea symptoms.

Contoured Memory Foam Neck Pillow by Tempur-Pedic

Lumbar pillows

Lumbar pillows, like neck pillows, are orthopedic pillows designed for bodily support, but in this case, the back and spine. Lumbar pillows sit directly above the lumbar area (lower back) to provide support and relieve pressure. Sometimes called a spinal support pillow, lumbar pillows sometimes resemble a small wedge pillow and are placed on the back while sitting or lying down. This versatility makes lumbar pillows a good choice for travel.

Bolster Pillows

Bolster pillows are the long roll pillows you see at the end of beds, often on top of the standard bed pillows for extra support. A bolster pillow can be used for both neck and leg support, so makes a good bedside accompaniment. Bolster pillows are also versatile, but due to their long shape, are generally confined to the bedroom environment.

Body Pillows

Body pillows are simply large pillows for the whole body, or for one side of the body: Often long and curved, body pillows are ideal for side sleepers due to their extended support from head to toe. Body pillows can also vary in size and shape, but are normally between 20 and 60 inches long on each side. They can also be shaped like a large horseshoe pillow or curved like the letter J or C. Body pillows are very large, so are usually preferred for larger beds such as a queen or king size. There are also pillows for other specific body parts such as legs or shoulders, which are good for pain in those areas.

Sleep Apnea Pillows

As mentioned in the introduction, some pillows are made specifically for those who have sleep apnea, and those who use CPAP. Some, known as CPAP pillows, are ergonomically designed to fit the CPAP device and hose, usually with sections cut out or contoured on the sides. Others, known as sleep apnea pillows, are similar to wedge pillows with a focus on breathing support. Both of these pillows tend to have high loft to keep the head up and the palate open.

As previously noted, side and stomach sleepers sometimes experience pressure from the mask pushing into the pillow, which can cause both discomfort and air leaks. In those situations, a CPAP pillow is ideal for night time comfort. While anyone with sleep apnea can benefit from standard sleep apnea pillows due to their specialized support and pressure relieving qualities. Studies have also determined that as an alternative to CPAP, some sleep apnea pillows can slightly reduce both snoring and the apnea or hypopnea events for mild to moderate cases.

CPAPMax CPAP Pillow by Contour

Pillow Sizes

While pillows come in many different sizes and shapes, the most common sizes, according to online listings, are those designed to match the standard mattress. While these are the pillows most of us are familiar with, in the case of a larger bed like a king or queen size, you will most likely want compatible size pillows to match. Here are the standard sizes used by most bedding companies:

Standard

A standard pillow is normally close to 20 inches by 26 inches, which is meant to fit the standard size pillow case. Standard size pillows can be used for any mattress or bed type, though a king size bed fits three standard size pillows side by side across the top, so you may want larger pillows for a bed that large.

Super Standard

Super standard pillow sizes are less common than standard ones, but they do exist for some products to offer a size between the standard and queen size options. The super standard pillow is usually about 2 inches longer than a standard pillow on one side, making it 20 by 28 inches. The super standard size should fit snugly in a standard size pillow case, or loosely in a queen size if preferred.

Queen Size

Queen size pillows are longer than standard and super standard on one side, making them 20 by 30 inches. Queen size pillows are meant to fit well on either the standard or the queen size mattress. Queen size pillow cases are needed for this size of pillow.

King Size

King size pillows are quite larger than the standard size, measuring at 20 inches by 36 inches. Since the king size is still 20 inches on one side, they tend to appear long on beds, making them ideal for the king size mattress. Two king size pillows fit side by side on a king size mattress.

Travel Size

Travel pillows are becoming quite popular. A travel size is basically any size smaller than a standard, but often around 12 by 16 inches if rectangular, and 12 to 16 inches across if round. Travel size pillows are good for a number of purposes, including back support when sitting or driving, a seat cushion, a pillow for animals or children, and additional support over the top of another pillow. But keep in mind that travel size pillows are not usually meant to be used as a stand-alone pillow for sleeping.

Note: For specific product recommendations, check the Sleep Foundation website or another sleep professional organization. These recommendations often include pricing guides, product specifications, and other information that can help you to make a decision.