They do settle if they stay flat for several days, but a quick fluffing or just resting it on it's side when you aren't sleeping stops that from happening. It has a hypoallergenic cover that comes off to be washed. I washed the whole pillow once and ending up having to take all the foam out and let it air dry for two days. You can also put the whole thing in the dryer for a few minutes to really refluff it. I've had mine for two years and haven't had an issue with it going flat.