I very much liked this soft pillow. Unfortunately I've not been able to place it in such a way to get adequate air flow. Gave me a tiny ache in low back, which any pilow of such design would do the same.Updated review 12/19/21-So, I bought this pillow and used it for several weeks, all my clients were complaining to me that they just couldn't breathe so I decided to buy a different one by Oakworks they have one with several holes so there is more air flow. If you are using this product for long periods of time with someone face down it may not work for you, but if it's short periods of time it may work. I hope this helps.I'm a massage therapist and I use this pillow when I need clients face down, so they don't hurt there neck looking to one side for too long. Most of my clients have me put a rolled up towel under the edge on top, because they tell me it's a bit hard to breath after about 10 mins. Extra air definitely fixed that problem.Hope this review helpsLove this wacky pillow. Strong but soft, removable cover for washing (haven't washed it yet), hole is right size and has insert for when you're not sleeping face down. The three air tunnels at the bottom of the pillow allow plenty of air in both directions okay. Wedge shape allows neck angle to be to feel better.Downside - Pressure of weight of face is now on edges of your face, which still does not feel 100% natural and takes some getting used to - but only next step up that I have found is a specialized medical device with tens of individually inflatable air pods, and that is hundreds and hundreds of dollars more. This is the best compromise I've found so far.This thing is tiny and meant for tiny adults and children. I have two photos posted. The face hole is about half the size of my face. I have a full size head. But im only 5'7", I'm no giant. The foam is not contoured where your neck sits so you choke if you are not tensed up. Ok for a massage, but completely useless for sleeping because you will be unable to breath.This is the best for massages!My hubby and I love to use for each other.This was a very comfortable wedge pillow because the incline is not uncomfortably high, it’s just right so that it feels like you are sleeping flat. The problem is that on my soft mattress the air holes were covered too much and so I couldn’t breathe. So sad!this may have worked but my face was to big for the hole...it's more for a child's size.I was looking forward to receive this pillow, so that I can sleep comfortably on my stomach. But what a disappointment. I could not breath after sleeping on it for a couple minutes! I have to return it.