Available online at www.sciencedirect.

com

ScienceDirect
Procedia Manufacturing 3 (2015) 4429 – 4435

6th International Conference on Applied Human Factors and Ergonomics (AHFE 2015) and the
Affiliated Conferences, AHFE 2015

Pillow shape design to enhance the sleep quality of middle-aged

groups
Xin-Yu Lin*, Fong-Gong Wu
Department of Industrial Design, National Cheng Kung University, Tainan 70101, Taiwan

Abstract

There are many ways to measure sleep quality, in which sleep disruptive events are included. To improve sleep quality, it is
important to reduce sleep disruptive events such as snoring, apnea, and neck pain resulting to waking symptoms. Few studies
have researched on both reducing snoring and relieving neck pains on pillow design. Thus the purpose of this paper is to
investigate the relationship between pillow shapes and reducing snoring, as well as preventing neck pains, so as to improve sleep
quality. 3 anti-snore pillows and neck-pain-relieving pillows are chosen to be tested for 3 nights on the relationship between the
pillows' shapes and the subjects’ sleep quality. Ten males and females aged between 40 to 60 participated in this experiment. The
sound of snoring was recorded, and the head and neck motions were monitored by a pressure mat during the whole night. This
study used ActiGraph to test the subjects’ objective sleep quality. After subjects woke up, a series of subjective evaluation scale,
including the Pittsburgh Sleep Quality Index, Snore Outcomes Survey and the subjective evaluation scale of neck pain, were
taken to know the subjects’ subjective sleep quality and neck pain condition. Then I formed a morphological chart based on
literature review and used the data got from the pressure mat accompany with a focus group to determine a pillow to enhance the
sleep quality of middle-aged groups. After determining a redesigned pillow, I conducted a 6 nights’ experiment to evaluate the
product. The method is the same as the first stage experiment. In this experiment, we know our design’s pros and cons, and thus
provide us with guidelines to determine a pillow revision. This study investigated the sleep quality of particular users and
redesigned features of a pillow to enhance the sleep quality of middle-aged groups.
© 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
© 2015 The Authors. Published by Elsevier B.V.
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review underresponsibility
Peer-review under responsibilityofof AHFE
AHFE Conference.
Conference

Keywords: Ŕleep quality; Ŕnoring; ŏeck pain; őressure mat; ActiGraph

* Corresponding author. Tel.: +886-910-307726.

E-mail address: xinyulin1990@gmail.com

2351-9789 © 2015 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of AHFE Conference
doi:10.1016/j.promfg.2015.07.476
4430 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435

1. Introduction

Sleep, one of the important activities human beings pursue [1], occupies one third of time in human beings’ life.
Thus the sleep quality indirectly affect our health. The definition of sleep quality on some occasions, “sleep quality”
is used to refer to a series of sleep measures, including total sleep time (TST), total wake time, sleep onset latency
(SOL), degree of fragmentation, sleep efficiency, and sometimes sleep disruptive events such as spontaneous
arousals or apnea [2]. While snoring and body’s aching during night leading to waking symptoms both are the
essential factors severely affect our sleep quality.
Primarily, the American Sleep Association (ASA) defines snoring as "severe respiratory sounds produced in the
upper airways during sleep, without episodes of apnea, hypoventilation, desaturation or arousals and which show no
evidence of insomnia or hypersomnia". Everybody snores more or less. Snoring is not considered as a disease if the
intensity of the noise is less than 40dB and the frequency is constant during sleep. But, snoring is defined as a
disease when the noise is loud, unsteady and labored.
It is reported that adults including about 24% female and 40% male have regular snoring behaviors, while almost
10~12%children have snoring phenomena. In general, snoring have embarrassed people in every family, and
especially it is a troublesome factor to spouse. Snoring becomes more severe as we age, and can lead to daytime
dysfunction and tiredness, resulting in bad consequences such as car accident. The severity of snoring can not be
neglected. About one-half of people who snore loudly have obstructive sleep apnea, what is a disease need to be
taken medical treatment [3]. Large studies have shown that OSA is associated with cerebrovascular and
cardiovascular morbidity and mortality in proportion to severity [4]. It is observed that OSA affect people’s health
tremendously. Thus it is a big issue of sleep to reduce snoring and OSA efficiently.
Besides, cervical pains resulting from muscle tension is a common problem, which increased in the last few
decades [5, 6]. It is reported that 17% subjects have cervical pain at least once a week [7, 8]. Another research
showed that 58% of cervicogenic headache sufferers perceived their headache on waking. The other research
showed that there is 18 persons having morning headache in every 50 obstructive sleep apnea patients [9].
Neck pain has great impact on our life quality, reducing not only our working ability but also sleep quality [10,
11]. It is hard to find a sleep position good to neck, so sleep is often affected by neck pain [12, 13]. On the market,
there are many neck support pillow designs, which are claimed to be effective in relaxing the cervical lordosis [14].
One study showed that neck and arm pain patients should accept physiotherapy and tailored neck support pillow
[15]. Another study showed that these types of contoured pillows are ineffective unless being with active neck
exercise [16]. A good neck support pillow is an important assistive therapy to neck pain [17]. One research indicated
that after using a specially designed pillow that provided neck support, 40 of 52 subjects gave positive feedback
[14]. Moreover, some studies showed that whether one has neck and shoulder pain or not, subjects prefer pillows
with neck support, which improves our sleep quality [17, 18].
Pillow is one of the factors which affect our sleep quality, including snoring and waking symptoms. The main
function of a pillow is to support the cervical spine in a neutral position to prevent more “end-range” cervical spine
posture, which are considered to increase biomechanical stresses on cervical spine structures [16, 19, and 20]. Using
a proper pillow to have support on the head to maintain a natural curvature of the spine during the sleep can get a
high quality sleep, and meanwhile, remarkably reduce pains of neck and shoulder. On the other hand, using
improper pillow may give more stress on the body structure resulting to waking symptoms, such as cervical pain and
stiffness, headache, and arm pain [10]. So a pillow should support the cervical spine at a central position, and
improve sleep quality by maintaining optimal sleep posture.
The present redesigned pillows relieve neck pains by providing neck support, improve the pillow comfort by
providing shoulder support, and assist sleeping in lateral position or sniffing position by providing central neck prop
to reduce snoring.
 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435 4431

Fig. 1. The placement of the experiment.

2. Methods

The first stage of the experiment attempts to investigate the relationship of the shapes of five types of anti-snore
pillow and neck-pain-relieving pillow in market and the effect of relieving neck pain. There are one male and one
female aged between 45~65 participated the experiment. Three different shaped pillows were selected for three
nights respectively, and another three nights for normal pillow.
After every night’s sleep, the subjects fill out the neck pain subjective evaluation scale to understand whether the
subjects have neck pain. And before the first night, the subjects fill out Pittsburgh Sleep Quality Index (PQSI) to let
us know their subjective sleep quality over the whole last month. Besides, the experiment uses ActiGraph to get the
subjects’ objective sleep quality, records the snoring to know the status of snoring, and uses a pressure mat to know
the relationship between neck and head posture and snoring and neck pain. The analyzed data can help us to know
the pillow shape achieving reducing snoring and relieving neck pain.
The second stage of the experiment evaluates our pillow design to enhance the sleep quality of middle-aged
groups. There are five males and five females aged between 45~65 participated the experiment. The redesigned
pillow was selected for three nights, and another three nights for normal pillow.
We records snoring and uses pressure mat to know the status of snoring and neck and head posture. After every
night’s sleep, the subjects fill out the neck pain subjective evaluation scale to understand whether the subjects have
neck pain. And before the first night, the subjects fill out Pittsburgh Sleep Quality Index (PQSI) to let us know their
subjective sleep quality over the whole last month. This experiment helps us to know our design’s pros and cons,
and provides a series of guidelines to get a better pillow shape design.
During each stage of the experiment, the experiment place is in the subject’s house, with their spring mattress and
quilt commonly used by them. The time going to bed is between 10~12 pm, and the time getting up is between 6~8
am. The pressure mat are placed between pillow and head/neck, and the recorder is placed on one side of the head.
The subjects wear ActiGraph on their non-dominant hand.(Fig.1)

3. Results

3.1. Pressure mapping

We got the data from pressure mat, and colored the pillow surface region suffering more pressure.(Fig.2) Then
we overlapped all the colored region into one picture. Finally we got overlapped pictures categorized by gender and
regardless of gender in each of the pillows.(Fig.3 & 4)
For the normal pillow, the female’s result shows that the centers of gravity incline slightly to left side and lower
side; the male’s result shows that the centers of gravity incline slightly to lower side and seriously to left side. And
the result of both female and male shows that the center of gravity incline to left side and slightly to lower side.
4432 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435

For the design of an optimal shape of pillow, the female’s result shows that the centers of gravity are on the
horizontal axis; the male’s result shows that the centers of gravity are on the horizontal axis and left to the vertical
axis. And the result of both female and male shows that the center of gravity are on the horizontal axis and the
regions suffering more pressure distributes symmetrically.

Fig. 2. The corresponding color of the isobar.

Fig. 3. The pressure distribution overlapping (a. normal shape cotton pillow ;b. the design of an optimal shape of pillow).
 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435 4433

Fig. 4. The pressure distribution overlapping (c. SONA pillow; d. the experimental semi-customized cervical pillow).

For the SONA pillow, the female’s result shows that the centers of gravity incline to lower side; the male’s result
shows that the centers of gravity incline to lower side. And the result of both female and male shows that the center
of gravity incline to lower side.
For the experimental semi-customized cervical pillow, the female’s result shows that the centers of gravity
incline to lower side and the regions suffering more pressure are symmetrical and centralized; the male’s result
shows that the centers of gravity incline to lower side and left side. And the result of both female and male shows
that the center of gravity incline to lower side.

3.2. Objective sleep quality

The objective sleep quality is gained through ActiGraph. There are one female and one male go through the
experiment, and we gain the data: TST(total sleep time), light sleep, deep sleep, sleep onset latency, SE(sleep
efficiency), WASO(wake time after sleep onset), number of awakenings. (Tables 1, 2 and 3)
The snoring frequency is lowest in pillow3 in female; is lowest in pillow2 in male.

Table 1. ActiGraphy data over twelve days. (minute)(female).

Normal pillow Pillow 1 Pillow 2 Pillow 3
Day 1 2 3 4 5 6 7 8 9 10 11 12
TST 394 357 425 464 451 429 429 816 379 469 611 481
Light sleep 137 166 172 229 163 89 181 196 174 181 116 236
Deep sleep 257 191 253 235 288 340 248 620 205 288 505 245
Sleep onset latency 20 9 25 23 10 8 20 6 8 10 7 9
4434 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435

Normal pillow Pillow 1 Pillow 2 Pillow 3

SE 0.95 0.98 0.94 0.95 0.98 0.98 0.96 0.99 0.98 0.98 0.99 0.98
WASO 7 0 35 7 0 0 0 0 0 0 10 0
Number of 1 0 6 3 0 0 0 0 0 0 2 0
awakenings

Table 2. ActiGraphy data over twelve days. (minute)(male).

Normal pillow Pillow 1 Pillow 2 Pillow 3
Day 1 2 3 10 11 12 4 5 6 7 8 9
TST 295 431 363 439 295 472 786 426 511 353 374 396
Light sleep 122 153 143 197 107 195 169 197 240 233 204 179
Deep sleep 173 278 221 248 188 277 617 229 271 120 170 217
Sleep onset latency 23 18 10 13 10 15 12 15 19 24 21 15
SE 0.93 0.96 0.97 0.97 0.97 0.97 0.98 0.97 0.96 0.94 0.95 0.96
WASO 0 12 0 2 0 12 0 0 17 0 0 4
Number of 0 2 0 1 0 2 0 0 3 0 0 1
awakenings

Table 3. ActiGraphy averages over twelve days. (minute).

Normal pillow Pillow 1 Pillow 2 Pillow 3
Total sleep time (min) 377.5 425 557.8 447.3
Light sleep duration (min) 148.8 163.3 192.8 191.5
Deep sleep duration (min) 228.8 262.7 365 257.5
Sleep onset (min) 17.5 13.2 13.3 14.3
Time on bed (min) 395 438.2 571.2 461.7
Wake after sleep onset (min) 9 3.5 2.8 2.3
Awakenings 1.5 1 0.5 0.5

Table 4. Snoring frequency. (times/ hrs).

Normal pillow Pillow 1 Pillow 2 Pillow 3
Female 830 860 815 665
Male 538 365 287 379

4. Discussion

The head’s sleep position of female and male shows that there is more right side positions than other positions in
every pillow for males, and it is referred that the male could be a habitual right-side-sleeper. The same as males, the
females got higher frequency in right side position, lowest frequency in supine position, that is to say, pillow2 is
probably effective. However, it is possible that the female is also a habitual right-side-sleeper, because female shows
more right side position than other positions with normal pillow in sleeping, and the frequency in right side sleep is
high generally.
As to snoring frequency, there is the lowest frequency in male with pillow2. And there is the lowest frequency in
female with pillow3. That is to say, though the male is a habitual right-side-sleeper, pillow2 is still probably
effective in enhancing lateral sleeping to reduce snoring.
As to objective sleep quality, average sleep onset latency is lowest in pillow1. And there is fewest number of
awakenings in pillow2 and 3. That is to say, redesigned pillows have better sleep quality data than normal pillows.
 Xin-Yu Lin and Fong-Gong Wu / Procedia Manufacturing 3 (2015) 4429 – 4435 4435

5. Conclusion

Our experiment shows that the redesigned pillows are effective in enhancing the sleep quality. And the pillow
enhancing lateral sleep position with central prop is probably effective. These provide us with guidelines to a pillow
shape design enhance the sleep quality of middle-aged groups.

References

[1] M. Borazio, K. Van Laerhoven, Combining Wearable and Environmental Sensing into an Unobtrusive Tool for Long-Term Sleep Studies.
ACM. 12(1) (2012) 28–30.
[2] A. D. Krystal , J. D. Edinger, Measuring Sleep Quality. Sleep Medicine. 9(1) (2008) 10-17.
[3] National Sleep Foundation. Sleep and Snoring. Retrieved August 13, 2014, from http://sleepfoundation.org/sleep-disorders-problems/other-
sleep-disorders/snoring
[4] H. K. Yaggi, J. Concato, W. N. Kernan, J. H. Lichtman, L.M. Brass, V. Mohsenin, Obstructive Sleep Apnea as a Risk Factor for Stroke and
Death. N Engl J Med. 353(2005)2034–2041.
[5] H.I. Andersson, The Epidemiology of Chronic Pain in Swedish Rural Area. Qual Life Res. 3(1994) 19-26.
[6] G. Bovim, H. Schrader, T. Sand, Neck Pain in the General Population. Spine. 19(1994) 1307-1309.
[7] S.J. Gordon, K.A. Grimmer amd P.Trott, Waking Cervical Pain and Stiffness, Headache, Scapula or Arm Pain: Gender and Age Effects.
Australis Journal of Physiotherapy. 48 (2002) 9-15.
[8] S.J. Gordon, K.A. Grimmer, P. Trott, Sleep Position: Age, Gender, Sleep Quality and Waking Cervico-thoracic Syptoms. The Internet Journal
of Allied Health Sciences and Practice. 5(2) (2007)
[9] C. Guilleminault, J. van den Hoed, M.M. Mittler, in: C Guilleminault, W.C. Dement, Sleep Apnea Syndromes, Alan R Liss, New York.
[10] R. Lavin, M. Pappagallo, K. Kuhlemeier, Cervical Pain: a Comparison of Three Pillows. Archives of Physical Medicine and Rehabilitation.
78 (1997) 193-198.
[11] G.Burns, The Effect of the Purity Health Pillow on Subjects Experiencing Chronic Benign Cervical Pain:a Pilot Study. Journal of Vertebral
Subluxation Research. 3 (1999) 74-77.
[12] T. Roehrs, T.Roth, Sleep and Pain: Interaction of Two Vital Functions. Semin Neurol. 25 ( 2005) 106-116.
[13] C. Gutenbrunner, G. Gundermann, G. Hager, V. Hager, A.Gehrke, Long-term Effect of Clinical Rehabilitation in Patients Suffering from
Chronic Cervicobrachialgia Influence of a Special Pillow. Rehabilitation. 38(3) (1999) 170-176.
[14] L.Persson, Neck Pain and Pillows - a Blinded Study of the Effect of Pillows on Non-specific Neck Pain, Headache and Sleep. Adv
Physiother. 8(3) (2006) 122-127.
[15] M. Bernateck, M. Karst, S. Merkesdal, M.J. Fischer, C, Gutenbrunner. Sustained Effects of Comprehensive Inpatient Rehabilitative
Treatment and Sleeping Neck Support in Patients with Chronic Cervicobrachialgia: A Prospective and Randomized Clinical Trial. Int J
Rehab Res. 31(4) (2008) 342–346.
[16] A, Helewa, C.H. Goldsmith, H.A. Smythe, P. Lee, K. Obright, L. Stitt, Effect of Therapeutic Exercise and Sleeping Neck Support on
Patients with Chronic Neck Pain: a Randomized Clinical Trial. J Rheumatol. 34(1) (2007) 151-158.
[17] Erfanian, Parham, Tenzif, Siamak, Guerriero, C. Rocco, Assessing Effects of a Semi-customized Experimental Cervical Pillow on
Symptomatic Adults with Chronic Neck Pain with and without Headache. The Journal of the Canadian Chiropractic Association.
48(1) (2004) 20-28.
[18] N. Ambrogio, J. Cuttiford, S. Lineker, L. Li, A Comparison of Three Types of Neck Support in Fibromyalgia Patients. Arthritis Care Res.
11(5) (1998) 405-410.
[19] J. McDonnell, Sleep Posture: Its Implications. Br J Phys Med. 9 (1946) 46–52.
[20] R.Jackson, The Cervical Spine, 3rd ed., C. C. Thomas, Springfield Illinois, 1976.