It is best to sleep on your back or on your side. Stomach sleeping is hard on both the neck and the lower back. A pillow under the knees helps take pressure off of the lower back. When sleeping on your side, a pillow between the knees will make for more comfortable sleep.
You will need the assistance of someone else to look at you in your normal sleeping position. When viewed from the back while lying on your side, your neck and head should be in a straight line with your spine. When viewed from the side while lying on your back, your hip, shoulder and ear should lie in a straight line. Whatever pillow and mattress combination does this for you and feels comfortable is the one you should use. Don’t forget to reevaluate periodically- pillows compact and compress, as does any topping on your mattress. If you change anything about the bed or pillow- replace the topper, add another comfort layer- recheck your position.
My Current Bed Recommendation
Recently revised after considerable research: A well-designed innerspring mattress will give good support for 10 – 15 years. You need one which is firm enough that your spine does not sag in a U shape, but not so firm that your weight is supported only at shoulder and hip, with the spine between unsupported and sagging. Take a partner when you’re shopping, lie down as you would when sleeping, and have them look at the position- see Sleeping Position above. When you’re getting serious about buying a new bed, be prepared to spend half an hour or so on the ones you’re considering. A brief lie down won’t give you a clear sense of how the bed will work for you. A 60-90 day return policy will keep you from being stuck with a mattress that proves uncomfortable when you get it home.
I would recommend against a pillow-top mattress. Although they feel great initially, the top material wears out much faster than the innersprings, and cannot be replaced. Better to buy a memory foam topper for softness, and replace it when necessary. What you’re looking for is quality, high count springs- the ‘lowest’ model in a manufacturer’s line that has the higher count springs. As you go up the line in a particular spring count, you just get a cushier top.
I used a King Koil Spinal Guard for over 20 years with a separate 2″ memory foam topper. The mattress was designed with the assistance of the International Chiropractors Association, and is relatively inexpensive for a quality mattress. The other major bed manufacturers also make good products. Never buy a used mattress!
I have recently purchased a Novaform “bed in a box” from Costco. We decided to take the risk on a newer form of gel/memory foam mattress, realizing that it may need to be replaced in a shorter timeframe than an innerspring mattress. So far it is quite comfortable and supportive, fitting my criteria for sleeping position, and not exhibiting the downsides of a monolithic memory foam bed like the Tempurpedic. For my opinion on longevity, we’ll have to wait a few years.
Other Types of Beds
A conventional foam bed can give good support, but only for 2 or 3 years, so I can’t recommend them. The monolithic memory foam beds (e.g. Tempurpedic) have been reported to me as being hard to turn over on, and too warm (because you sink in). Some of the new, expensive foam beds are being touted as good for 20 years or more, but I haven’t seen any such studies, nor have they been around long enough to provide the base of experience to confirm that durability.
Air beds, such as the Select Comfort, give good support and have the advantage of being able to vary firmness, even from one side of the bed to the other. The downside is that if you manage to puncture the bed you have nothing to sleep on until you can replace it. Some have also reported issues with the sound of the air pump at night.
I don’t have the money or inclination to try the very expensive ‘alternative’ beds on the market. I wouldn’t spend the money when a reasonably priced innerspring mattress will do the job. I do not recommend waterbeds of any type. See discussion below. For further reading about shopping for beds check out this article.
Foam, fiberfill, down, ‘orthopedic’, memory foam, buckwheat, water- I’ve tried them all. The type of pillow that will work for you depends not on the type of pillow but on the position your head ends up in. I currently use a Brookstone memory foam pillow from Bed Bath and Beyond that I modified to suit myself with a bread knife. I may not be ecstatic about it, but it does the job position wise.
A buckwheat hull pillow has the advantage of being able to change shape during the night as you switch between back and side sleeping, and provides customized support in both positions. This type of pillow takes about a week to get used to, because it’s not “cushy” like your current pillow. They provide great support, though, which can be customized ‘on the fly’ for your needs. Some don’t like the sound of the hulls shifting at night, others it doesn’t bother.
What doesn’t work
Waterbeds keep the body in a “hammock” position which is hard on the spine. They often feel great at first, partially because they’re soft, partially because they’re heated. Get the same effect (and better sleep) with a good innerspring mattress, a topper if you like the softness, and an electric mattress pad if you like the warmth.
Futons do not provide proper support. Avoid them if you can.