Users generally rank higher comfort for softer pillows ( Hurwitz et al., 2009), though the perception of comfort may change after a period of adaptation ( Gordon, Grimmer-Somers & Trott, 2011). The reliability of the rating obtained using questionnaires or feedback is disputable. People may often choose a pillow based on their immediate perception and comfort, which could be misleading and may lead to choosing an inappropriate pillow size that induces or worsens neck pain ( Erfanian, Tenzif & Guerriero, 2004 Leilnahari et al., 2011 Liu, Lee & Liang, 2011). Optimal pillow height does not correlate with individual anthropometrical dimensions, such as length or width of the head-neck complex ( Erfanian, Tenzif & Guerriero, 2004 Wang et al., 2014). However, selecting the correct pillow height can be difficult. Pillow height affects comfort and sleeping quality, and was identified as one of the critical factors influencing spinal alignment ( Her et al., 2014 Verhaert et al., 2011). (2006) criticized the quality of the studies related to cervical pillows and their insufficient statistical power. On the other hand, it was found that the cervical pillow induced hyper-extension of the neck and was poorly tolerated ( Lavin, Pappagallo & Kuhlemeier, 1997). Some studies demonstrated that the cervical pillow can treat neck pain and should be regarded as a complement to physical therapy ( Bernateck et al., 2008 Erfanian, Hagino & Guerriero, 1998 Persson, 2006). However, evidence regarding the benefits of cervical pillows was controversial and insubstantial ( Shields et al., 2006). It was claimed that this type of cervical pillow design can maintain the spine in a neutral posture and allows the joints and muscles to achieve optimal resting states ( Bernateck et al., 2008 Hannon, 1999 Her et al., 2014). The cervical support pillow, characterized by a B-curve shape, has been proposed as a solution for better support of the cervical spine owing to the pillow prominence under the neck region ( Her et al., 2014). Improper pillow support has adverse effects on the cervical spine, leading to neck pain and cervicogenic headache, which ultimately results in poor quality of sleep ( Gordon, Grimmer-Somers & Trott, 2011 Ohman, 2013).
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It is estimated that neck pain occurs in nearly a quarter of the population, and poor pillow designs represent important factors contributing to this extremely high incidence ( Chiu & Leung, 2006 Hoy et al., 2010).