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The Shape of Sleep as a Therapeutic Device:

Solving Cervical Syndromes

  1. Neck problems are common; the lowest part of the cervical spine is the pain source.

  2. The pain is always referred - felt in the wrong place.

  3. Forces in the neck during sleep are the major causative factors; treatment must include reliable support.

  4. The shoulder/jaw problem: Access to the key site in the front of the lower neck for any support requires space between the jaw and lower shoulder.


Neck pain affects at least 8% of adult populations at any point in time, and about 25 % in the course of a year. If you know the site of origin, treatment is not difficult. But we cannot feel any deep structures, including the bones deep in our neck. They are not represented in the cerebral cortex or in consciousness. When these are injured, we feel pain, but cannot identify the structures from which pain arises, or the nature of the injury. The pain is referred, i.e., misinterpreted as arising from perfectly innocent structures, which share the same nerve supply, and are represented in our “mind-body image”.


  • Patients are unaware of the source of their upper body pain.

  • Because there is no local pain, health professionals rarely 
    examine deep structures in the front 
    of the low neck. 


The Shoulder/Jaw Problem

When we sleep on our side, the top shoulder is in a natural position, strutted well to the side with our uniquely human long collar bone. But to adapt to the flat surface of our bed, the lower shoulder rises up and forward towards the cheek. The attached collar bone and muscle also rise, and block access to the lower neck for pillow support.


This is the shoulder/jaw problem. Sleeping face-down or on the back present other difficulties. The unsupported lower neck sags and locks, with tight ligaments and compressed bone. Marked deep tenderness is found in the front of lower neck, with no local symptoms.

A Good Solution

Pillows curved to accommodate the lower shoulder will often provide adequate support and comfort. The neck should be forward, and the neck support ridge angled, tight against the collar bone. The top shoulder should be forward, so that the front of the neck is supported. However, if the 6-7 cervical level (the lowest) is still inadequately supported during sleep, symptoms may remain, with referred pain and characteristic patterns of deep tenderness.


More Complex Solutions to the Shoulder/Jaw Problem

The simple strategies described above work well for most of us. Delivery of reliable support to the lowest levels of the front of the neck may be more difficult for patients with long necks and broad shoulders, or with sturdy shoulders and relatively short necks – the two extremes.


In these, access to the lowest levels of the neck can be obtained by rolling the upper body forward, opening a large space between the jaw and shoulder. This assures smooth support to the lower neck, and to the bones of the upper chest, without uncomfortable pressure on the throat. Breathing is better because the tongue falls forward – a cure for snoring. For most, all of this works best if the lower arm is behind the back. Finish off with a pillow between the bent knees and we have a 3-pillow solution.


To avoid excess pressure on the lower shoulder and arm, it may help to elevate the rib cage and waist with an “arch support” pillow lifting the trunk. Otherwise, you may collapse toward a belly-down position, causing the neck to twist strongly to the side.


When you sleep, you are unconscious, and your postural muscles become paralyzed—that is why your head nods. Provide extra support for the top shoulder and arm and keep both knees well bent to keep the neck in a neutral position.


Some can only sleep on the back. Pillows and collars support the middle of the neck, and may aggravate a problem in the lowest levels. Gentle traction through the neck can be achieved by placing a pillow under the chin, holding it snug with your arms across your chest.



What to expect?

The details are extremely important, and none are intuitively obvious. It is hard to change the habits of a lifetime, so that it may take a few weeks to feel comfortable with neck support. Your position will change during sleep, so you have new habits to learn. Once you are used to neck support, traditional pillows feel totally wrong.


If you are using the pillow to treat a headache, or neck/shoulder/arm pain, the symptoms may persist for some time. The nervous system is sensitized by chronic pain, so that symptoms may continue even if you are doing everything right.


Typically, diagnostic tenderness fades before the referred pain. So if symptoms remain, the situation should be reviewed. Perhaps the tenderness is easing as expected. But it may be that the treatment strategy needs refinement. It was developed from experience with others, and you are different from anyone else.


10 Nov 00 © Hugh Smythe


Different ways of positioning your pillow


Lying on the Side - Angle your pillow


If you lie on your side with your knees up, your head will likely tilt forward, continuing the smoothly flexed line of the spine. You don’t need to keep the pillow square with the bed; in fact, it’s more comfortable to slant it as in picture 1. In this position it will likely match your jawline. 


Also, when lying on the side, the top thigh tends to slide downwards, twisting the low back. To protect or ease your low back (a big source of trouble for millions of people) place a Shape of Sleep or fat traditional pillow between the knees.


If you feel pressure on your lower shoulder (when lying on your side) you can try inserting an old, soft pillow between the chest and waist. The shoulder fits nicely between the two pillows.


Lie towards one end of the pillow


There is no law that says you must lie right in the centre of the pillow. Your arms may be freer to adopt a variety of comfortable positions if you move closer to one end or the other. Try both!


Lying on your back


In this position the neck support ridge compresses into the undercut, giving soft support for the line of the head, neck and trunk.


To read in bed, add other pillows under ‘The Shape of Sleep’


The Shape of Sleep pillow gives marvelous comfort when reading or watching TV in bed. Put one or two of your older pillows underneath; tilt the Shape of Sleep pillow forward until the balance of the neck and head support is just right for comfort. People with medical problems involving lungs, heart, sinuses, or hiatus hernia may be more comfortable in this position for most or all of the night.


In these back positions a soft support of any kind - a second Shape of Sleep or a traditional pillow – under your knees will relax and ease your back.


Neck ridge seem too high?


A small cushion or pad of soft material, or a folded towel placed on the head support section of your Shape of Sleep pillow can increase head support and lessen neck pressure. Add about one-half inch thickness at a time until you achieve the best feeling.

Maximizing Comfort:


Besides having its unique shape, your new pillow has several features which are quite novel and may be unfamiliar. We’ll try to explain these features so that your new pillow can quickly become a familiar part of your life. 


There is no one perfect sleeping position. In fact, it’s important that you be able to shift positions during the night, in order not to place continuous weight on any one part of your body. Your new pillow has the necessary versatility built into it so that it will provide continuous support for whatever position you adopt.

Further Reading:

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