A stack of pillows with feathers floating around them. Leaning on the stack of pillows is a guide book on choosing the right pillow.

The Pillow Dilemma: Making the Smart Choice When You Have RA

Last updated: April 2023

Editor's note: This article belongs to a three-part series on getting better sleep with rheumatoid arthritis and other arthritis-related conditions. Check out the first article on choosing the right mattress.

As I mentioned in Part one, people with rheumatoid arthritis can lose sleep nightly due to pain. Painsomnia (sleeplessness caused by chronic discomfort) leads to the release of stress hormones at bedtime, which activates an inflammatory response.1 Poor sleep repeats this cycle, leading to a guarantee of more flares.2

Let’s take a look at how the pillows we choose can impact sleep quality.

Choosing a pillow for RA

It can seem overwhelming when considering all the pillow options out there! Here are some things to consider:3

  • Just like mattresses, pillows for people with arthritis-related conditions should support spinal alignment while providing joint relief.
  • Loft (pillow height) matters. Too high or too low can lead to misalignment and pain.
  • Firmness options run anywhere from soft to medium to firm with calibrations in between. Which is best for you? Only a trial can answer that question.

Pillow types

  • Foam (including memory foam) conforms to your body’s contours.
  • Down pillows are soft, warm, breathable, and support the head and neck. These aren’t the same as feather pillows, which are less soft and don’t retain their shape as well.
  • Latex pillows are resistant to allergens while providing contouring support.
  • Buckwheat pillows never become flat; they retain their shape and are easily adjusted for continued support.
  • Cotton pillows are breathable but less conforming; they flatten and lose firmness quickly.
  • Gel pillows are memory foam pillows infused with layers of cooling gel.
  • Microbead pillows are shapable, breathable, and cooling. They’re commonly used for neck, bolster, and travel pillows.

Pillow shapes

  • The ordinary rectangular pillows comes in standard, super standard, queen, king sizes.
  • Travel pillows are small, portable rectangles or “horseshoes” you tuck around your neck during long trips while sleeping upright.
  • Body pillows measure around 20 x 54 inches as rectangles. They also come in C, J, L, and U shapes at roughly the same size.
  • Wedge pillows incline the upper body, but can be used under the legs.
  • Contour pillows are wave-shaped, with an arch beneath the neck and another supporting the head.
  • Bolster pillows are log-shaped and used to support the neck and back.
  • Sleep apnea pillows come with cut-outs designed to accommodate CPAP gear for side sleepers.

Other considerations for RA pain

Sleep position

Certain positions demand specific lofts and firmness from pillows. Some recommendations include:4

  • Sleep on your back? A pillow with a loft of 4 to 5 inches with a medium to medium-firm firmness may protect spinal alignment while sleeping supine.
  • Side sleepers need a higher loft (5 to 7 inches) because their head and neck are further from the mattress. A medium firmness provides proper cushioning and spinal support.
  • Stomach (prone) sleepers benefit from a thin, firm pillow (a loft of 3 inches or less). Some tummy sleepers use medium loft pillows, resting only their foreheads on them to prevent neck strain.
  • Combination sleepers benefit from adjustable pillows that adapt to their position shifts throughout the night.

Pillows tips

  • Sleeping with an arm under a pillow compresses the neck, shoulder, or arm, blocking circulation, causing the dreaded “dead arm” in the morning.3,4
  • Hugging a pillow (doesn’t that sound lovely?) supports healthy spinal alignment.
  • You can use several different kinds of pillows to achieve support and comfort.

Find what works best for you

If only a one-size-fits-all approach were possible! In reality, personal preference, sleeping position, pain status, and other variables will shape your choices.

Case in point: I have bone spurs all down my cervical spine. I’m also a combination sleeper. My particular pillow configuration:

  • A flatter one under my head
  • A fluffy shapable one between my knees to support my hips and lower back
  • A buckwheat to bolster on either side to support my back when I’m on my side

I also use a memory foam travel pillow under my neck when I’m reading in bed, with a second tucked under my arms to support my book. I put them away when it’s time to sleep.

As a CPAP user, I find this arrangement works fine. I tried a higher loft pillow but it led to neck pain from twisting to accommodate my CPAP gear while side sleeping. I’ve tried a CPAP pillow, but I didn’t like it. I gave it to someone who actually did!

About knee pillows: I trialed a sample of these as a sleep health blogger. They strap around the knees with soft elastic to provide comfort and pressure relief while side sleeping. For me, they worked, but I don’t have knee joint issues.5

Bottom line

So much to consider, but a good pillow—or pillow configuration—is worth the pain relief for anyone with joint problems.

Tune in next time for a review of blankets for people with arthritis-related conditions.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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