By Robin Wright
The Washington Post
I love my pillows ó the bigger and puffier the better. Iíve always thought of them as the ultimate allies, cradles of comfort outside the womb, the means to melt into peaceful slumber.
And Iíve been so wrong.
I started taking pillows more seriously after two shoulder surgeries on one arm affected my good arm, neck and upper back. The good arm became even more painful than the bad one. Among the myriad issues we explored, my physical therapist and rehabilitation doctor separately brought up pillows and what theyíre really for ó which is getting your wayward body back in line.
Since then, Iíve looked at pillows in a whole new way. The pillow, after all, is the inanimate object with which people arguably spend the most time ó up to a third of their lives. Along the way, Iíve learned answers to questions Iíd never previously thought to ask. Some of them made me shudder.

So how old is your pillow?
One byproduct of my research was learning about the health of the pillow itself.
On her Web site, Mercia Tapping, president of AllergyBuyersClub.com, recalled returning to her parentsí home and finding pillows that were at least 20 years old. iMoldy, smelly and stained,î she writes.
Repositories of body moisture, dead skin and drool, pillows offer irresistible digs to dust mites and fungi. A 2005 medical study of pillows ó said to be the first since 1936 ó found up to 16 species of fungi in a single pillow. Testing both feather and synthetic pillows that ranged from 18 months to 20 years old, University of Manchester researchers found several thousand spores of fungus per gram of used pillow ó a higher count than youíd find on a used toothbrush. A minuteís soak in hydrogen peroxide can kill the toothbrush spores; not so with a pillow.
And the consequences can be serious.
iGiven the time spent sleeping, and the proximity of the pillow to the airway, synthetic and feather pillows could be the primary source of fungi and fungal products. This has important implications for patients with respiratory disease, and especially asthma and sinusitis,î Ashley Woodcock, the University of Manchester research team leader, wrote in the journal Allergy.
A dry steam cleaner can kill fungi, Tapping advises. So can putting a pillow in a plastic bag and freezing the pillow, which can also take care of mites.
 (Good to know, though Iím not sure Iíd want to eat anything that had been in the freezer next to it ó or sleep on a pillow with freeze-dried mites.) Some stores now sell dust mite covers for pillows. Alternatively, wool and natural latex pillows are more mite-resistant.
The average department store pillow lasts about 18 months, Tapping writes in a helpful treatise on pillow health ó the pillowís and the ownerís (www.allergybuyersclub.com/perfect-pillow.html). iIf you fold over your pillow in half and the poor thing just lies there, you have a dead pillow. Time to bury it.î
Alpaca pillows are among the longest-lasting, she says.

Why is a pillow such a big deal? What damage can a pillow do?
iTypically, people like to use two or three pillows under their head, and they end up getting forward head postureî because the head is pushed unnaturally forward, out of alignment with the spine, explained Michael Uttecht, my Georgetown University Hospital physical therapist.
iThe body will adapt to that position and assume it, which leads to a lot of neck tension, shoulder problems, headaches and then loss of range of motion in their neck as well.î
Avoiding pillows altogether is just as bad. You need something to prop up the neck and head so the spine stays aligned.
As people age, they generally tend to develop forward posture ó a kind of shoulder slumping, he explained. The problem has become more severe in computer-centered societies, as people hunch forward over their keyboards all day.
Sleep is the time to let the body heal and realign. But that requires the right pillow.
iIf you see people on the street that look like theyíre looking down, sometimes itís a mechanical problem, sometimes itís neurological, sometimes itís orthopedic. But there are people … (who) sit at their desks with their heads way forward, then go home at night and say pushing their head back hurts. So they stack the pillows, so the head is forward all the time,î explained John Toerge, a Georgetown University Hospital pain specialist.
iIt starts to have consequences of wear and tear,î he added. iOne of the big issues is trying to get to a point where you relax backward or slide backwards or go into an extension moving backwards, so you get into alignment and take care of whatís gone on during the day.î
Otherwise, neck and back pain can only get worse.

So how do you find the right pillow?
In the end, itís personal choice. And the choices are many.
Once crafted from straw, wood and even porcelain, pillows now come in silk, wool, alpaca, latex, cotton, foam and imemory foam,î lyocell (from wood pulp cellulose), air pump-ups and many kinds of down. Some have built-in headphone outlets. Others use super-cleaned materials for sleepers with asthma and allergies.
One major healthy-pillow outlet offers a dizzying selection, including the neck pillow, comfort pillow, husband pillow (complete with two arms and a high back), back body pillow, Magniflex wave pillow, head cradle, Millennium pillow, grand pillow and the all-purpose pillow. It also offers a back wedge, a back leg wedge, a doughnut and the back bed lounger.
Although somewhat alike, its isymphony pillowî differs from the irhapsody pillowî because the former has ia gently arched side that provides head and neck support while the reverse side provides a traditional pillow feel for side sleepers.î The rhapsody is filled with shapeable micro-cushions. But the names donít give consumers many clues about what theyíre getting.
Health professionals offer tips for making tough decisions. The most basic is to try it out. Go to a store and spend 15 to 30 minutes with each product, Uttecht advised. iGet on a bed and see if it really fits. Bring someone along to check if your body is in alignment,î he said.
How you sleep determines a lot. For side sleepers, the nose-to-navel rule is a good guideline. The nose and the navel should be the same height off the bed. The goal is to align the back and head ó and prevent the head from being propped above the spine.
Belly sleepers tend to like the softest pillows, but sleeping on the stomach is bad all around, especially for the neck and body alignment, according to physicians and physical therapists. Uttecht sleeps with a long body pillow just to prevent himself from rolling over and sleeping on his stomach during the night.
Side sleepers tend to prefer the firmest support because they have space to fill under the neck. Back sleepers tend to like medium support, experts say. But back sleepers should be aware of the dangers of the head being propped up out of alignment.
A personís size and weight also make a difference. One size does not fit all.
iPillows are dangerous because people tend to read an advertisement that a pillow will fix their neck,î said Uttecht. iBut no pillow fits every personís body. You have to understand your alignment for it to work appropriately.î

So what did I do?
Researched and ready, I headed to a Healthy Back Store to do my own testing. Self-conscious at first, I got into the swing of it, moving from bed to bed to find one that matched the feel of my mattress, then trying two dozen pillows, taking my time to lie on each and see how I settled into it.
Some pillows the salesperson wouldnít let me try. iTheyíre made for big men,î he said, and Iím a small woman. I liked one of the memory foam pillows and the smallest version of a model with an extra curve that goes under the neck.
Then cost became a consideration. Good pillows can run anywhere from $75 up to $500.
I picked the one that left me with enough left over to buy the dust mite cover, too.