It can have a dramatic effect on the quality of your sleep…

Do you wake up stiff and achy? Don’t be so quick to blame it on your age or arthritis—it just might be due to what you’re sleeping on…

More Than an Afterthought

Plenty of people agonize about buying a mattress—you can easily spend $1,000 or more, and there are all those features to choose from (such as pillow toppers and coil counts).

The truth is, there’s no unbiased research showing that any of these features will reduce pain. The best mattress for you is simply the one that feels best for you.

The features offered in pillows, however, do matter. That’s why pillows should never be selected as an afterthought. How to select a pillow based on where you need support and how you sleep…

Pillows for Neck Pain

I usually advise people to sleep on their sides because it’s a neutral position that’s easy on the back, shoulders and knees.* But side-sleeping leaves a large gap between the downward-facing shoulder and the head. A too-thin pillow will allow your head to dip down, which puts a lot of stress on the neck.

Best pillow for side-sleepers: One that’s thick enough to fill the space between your ear and the mattress. It will support your neck and head and keep them in line with your spine. A firm foam pillow is ideal because the weight of your head won’t compress it very much while you sleep.

Good products: BackJoy SleepSound Pillow, $30. Or you could try a water pillow so you can customize your pillow height. Chiroflow Premium Water Pillow, $60.

Best pillow for back- and stomach-sleepers: A feather pillow. You can shape a feather pillow and make it thicker under the neck for better support and thinner under the head so that it remains flat.

Good product: 700-Fill-Power Sateen White Goose Down Pillow, $360.

If you like the feel of a feather pillow but are allergic, try the LaCrosse Loft-AIRE Pillow Standard 2-Pack. $88..

Another option for neck pain is a thin conventional pillow with a “neck bone” support pillow placed under the neck.

Good product: Original Bones NeckBone Chiropractic Pillow, $14.99.

You can also try a specialized pillow that is thicker at the ends, with a slight cavity in the middle and built-in neck support. These pillows help keep the head at the right height while supporting the neck. In addition, they provide flexibility for people who like to change from back-sleeping (when they would use the thinner middle part of the pillow) to side-sleeping (when the thicker end would be ­appropriate).

Good product: Core Products Tri-Core Pillow Standard Support, $45.

Pillows for Back Pain

For back pain, the usual advice is to sleep on your back on a superfirm mattress. Back-sleeping does give good support, but many people aren’t comfortable in this position, and it tends to increase snoring.

I have found that back pain patients tend to do better when they sleep on their sides. It keeps the spine straight and is generally less stressful than stomach- or back-sleeping.

Stomach-sleeping tends to produce a forward curve in the low back, jamming the joints together and causing pain. Back-sleeping can be better, but if the mattress is too soft, it causes a forward curve in the low back. And if the mattress is too firm, it flattens the low back, which can lead to tight muscles.

Best pillow pick: When sleeping on your back, use a feather pillow that’s “fluffed” to provide more lift under the neck, and flattened out a bit under the head. When sleeping on your side, use a fairly thick and firm foam pillow to support the head and fill the gap between the head and bottom shoulder. See feather pillow and foam pillow recommendations mentioned earlier.

Pillows for Shoulder Pain

It’s a challenge to find a comfortable position when you have shoulder arthritis or a history of shoulder injuries. If you sleep on your stomach, you would have to keep your head turned all night, which could make shoulder pain worse. Of course, sleeping on the “bad” shoulder can be painful as well, but lying with the bad side up is also tricky because the shoulder isn’t supported by a pillow or the mattress.

Best pillow pick: A large body pillow. While on your side, hug the pillow to your chest and rest your top-side arm (with your painful shoulder) on top of it. It will support the shoulder and keep it from “folding” while you sleep.

Good product: Contour L-Shaped Body Pillow. $29.99..

Pillows for Knee Pain

Back-sleeping is ideal when your knees hurt, but as mentioned earlier, few people can comfortably sleep on their backs. And stomach-sleeping is a problem because it overextends the knees. Side-sleeping is less stressful to the knees, but this position can be uncomfortable when the bones of the knees press together.

Best pillow pick: While sleeping on your side, placing a pillow between your knees will prevent them from rubbing against each other and keep your upper hip at a comfortable angle.

Good product: Remedy Contoured Memory Foam Leg Knee Pillow, $44.

You can also put a body pillow between your knees.

Helpful resource

For reviews of additional types of pillows, go to­reviews.html.

*We all have a preferred sleep position, but certain positions are better for various types of pain than others. I have found that patients can adopt a new sleep position if it helps their pain.