How should we sleep and do mattresses actually make any difference?

When you look online for a new mattress you get pages and pages of reviews and recommendations.

There are mattresses for back pain, spinal alignment, pressure sores, people who are too hot, people who are too cold, mattresses for arthritis, mattresses for better sleep. There are traditional spring mattresses, pocket spring mattresses, mattresses made from memory foam, gel, latex, natural fibres and then there’s any combination of all of the above!

After thinking about all of that, I need a lie down!! It’s a complete minefield! So where do you start when finding a new mattress and does it even matter?

Let’s get the awkward bit out of the way first……Why am I talking about mattresses when I know nothing about them?

 

I’m certainly no mattress expert, I’m a Physiotherapist and I’m definitely not a bed-sales woman, so I’m not here to tell you all about different mattresses and what they do or don’t do (believe me, it’s been done), but I do get asked A LOT by patients, ‘what type of mattress would you recommend for my back pain’? Usually my answer is something like ‘Mattresses cost a lot of money so let’s try to fix your back before we go changing half of the furniture in your house’! Nevertheless, I’m still interested in whether there is much (non-biased) research behind the benefit of different mattress types and whether they will benefit someone who is suffering with back pain before, during and / or after their pregnancy.

First, let’s look at what we should be looking for in our mattress:

• Support; this is a biggie! Mattress support should help to hold the back, hips and neck in neutral positions throughout the night. The support should also prevent the transfer of movement from one side of the bed to the other, thus helping you maintain your optimum sleeping position.
• Comfort; this is similar to support but what is comfortable to one person may not be comfortable to the next. Comfort can include how much heat the mattress generates and if you are generally a ‘hot or cold’ type- person. In pregnancy we tend to be warmer due to the increased blood supply but obviously this only lasts a certain amount of time. The stiffness of the mattress can contribute to comfort levels as well. You want a mattress that allows for some movement otherwise, when you try to turn in your sleep you will keep waking up, this is more relevant to restless sleepers.
• Pressure relief; this is important if you suffer from any long-term aches or pains. Mattresses that help distribute body weight evenly would be most beneficial in this case. Larger / heavier body areas such as hips, back, buttocks and shoulders tend to sink into mattresses the most. If you suffer with pains in these areas then make sure you look for a mattress that distributes your weight more evenly.
• Another thing to look for (especially if you are a restless sleeper) is; Edge support. It’s likely that you were totally unaware that this was even a thing (like me), but it is. There is often built in added support around the edges of some mattresses to keep mobile sleepers in bed. Spring mattresses would usually come with this as standard, whereas foam wouldn’t.
• Finally, durability; mattresses cost a lot!! You want your mattress to last a long time without failing in any of the aforementioned categories. The saying & ‘buy cheap, buy twice’ rings true here. If you pay for more premium quality materials, then your mattress is likely to last longer. Saying that, not everyone has a spare one to two thousand pounds to spend on a fancy mattress right away, so buying cheap(er) is ok but bear in mind that you will likely have to replace it a little sooner.

Is there an optimum sleep position for us all?

The National Sleep foundation advise that healthy adults need between 7 and 9 hours of sleep per night. This means that we are spending around a third of our lives asleep or resting (usually in a bed, on a mattress of some description).

It is well known that the main job of sleep, in humans and animals, is to allow the body time to restore and repair itself. Your sleep position can either help or hinder that process, depending on how effectively it supports the natural curvatures of your body. Humans are all built differently, some of us have larger spinal curves, some have additional curves, some of us are heavier than others, some of us have bigger hips or bigger shoulders and some are taller and some are smaller, so spinal ‘alignment’ is different for everyone. Having said that, different sleep positions provide different benefits, some of which can help if you’re dealing with issues related to things like back pain, pregnancy or acid reflux.

According to The Sleep Foundation, more than 60% of people sleep on their side. As children, we split our nights by sleeping in all positions equally, but by adulthood, a clear preference for side sleeping emerges. Sleeping on your side promotes healthy spinal alignment and is the sleep position least likely to result in back pain.

What about sleeping when pregnant?

Experts recommend that pregnant women sleep on their side with the knees bent. The side sleeping position relieves the pressure of a growing belly, enabling the heart to pump and blood to flow easily throughout the body. In particular, the left side is recommended because it prevents pressure on the liver and facilitates healthy blood flow to the foetus, uterus, kidneys, and heart. That’s not to say that you must stay on your left side all night, it is simply suggested as a ‘majority’ position.

Any sleep is better than no sleep and often pregnant ladies have hip pain or back pain and struggle to side lie at all. You can use pillows to help train your body into new sleep positions, gradually propping yourself up or decreasing pressure in certain areas, you can also use a pillow between the knees to help any back or hip pains and to help keep that neutral spinal alignment that us Physio’s love so much!! For pregnant ladies who are suffering with gastroesophageal Reflux disease (GERD), it is thought that sleeping on your right side might make this worse. This is due to the increased pressure on your internal organs.

So, we know how we should sleep now but what should we sleep on to help minimise any problems?

A study in 2015 (by Radwan et al) looked at the effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain. This study was a systematic review of published randomised controlled trials, (a systematic review is usually published regardless of the outcome and helps to eliminate bias). Results showed that a mattress which is subjectively identified as ‘medium-firm’ is optimal for promoting sleep comfort, quality, and spinal alignment. It is worth noting here that some of the studies which they assessed were quite old, dating back to year 2000 (meaning that some of the more modern mattresses will not have been included in the review). These results do give us a good idea of what type of ‘firmness’ to look for when searching for mattresses.

We also came across a more recent study by Caggiari et al which was carried out last year (2021). They looked at which mattress types should be chosen to avoid back pain and improve sleep quality. Review of the literature again showed ‘medium-firm’ mattresses offered more advantages to the subjects with low back pain and improved sleep quality but also reduced the risk of developing low back pain in the first place. The authors reported that the beds with ‘active control’ helped to improve ‘column alignment’ in spines and the quality of the subject’s sleep. When reviewing the effects on body temperature, they concluded that use of a high heat capacity mattress (HHCM) caused a reduction in temperature and an increase in slow sleep waves and sleep continuity. In fact, there were several studies that we found in support of the HHCP.

Having reviewed the literature, what would we recommend if you’re thinking of investing in a new mattress?

A medium-firm mattress with good reviews, available on Amazon is THIS one by Silentnight. It is UK manufactured, foam and chemical treatment free, uses pocket spring to individually respond to movement and deliver individual tailored support, it has a ‘soft knit cover’ and is Hypoallergenic.

HERE is another good medium-firm option with amazing reviews. This mattress combines memory foam and spring for a hybrid option.

 

A Quick Summary:

Next time a patient asks me ‘What type of mattress should I get to help my back pain’? My answer will be slightly more detailed….. ‘Have you tried using pillows firstly to correct your sleeping position? If that hasn’t helped then look at getting a medium-firm mattress (if it’s something you’re ready to invest in). But first of all, let’s look at the cause of your back pain and try to fix that’!

There are lots of studies done on mattresses but it is very hard to find any that are completely unbiased as they are often funded / carried out by the manufacturers. The two systematic reviews that we looked at did draw the same conclusion however, that medium-firm mattresses were better for back pain and sleep quality so if you’re going to invest in a new mattress definitely use that as your key search term.

Sleeping on your side is the gold standard of sleep positions, particularly with a pillow between your knees. If you don’t naturally sleep on your side and are waking in pain or with discomfort, then maybe look at sleep position training. Gradually train yourself to sleep on your side, there are lots of other benefits of side sleeping such as decreased snoring, helping sleep apnoea and reducing acid reflux symptoms.

Mattresses are forever changing and evolving, market research conducted by TechNavio identified smart mattresses with sleep tracking, movement detection, and automatic firmness adjustment functions as the next major market driver in the mattress production industry so watch this space for more reviews!

 

Resources:

• Sleeping mattress determinants and evaluation: a biomechanical review and critique (nih.gov)

• Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults

  with or without back pain; systematic review of controlled trials – PubMed (nih.gov)

• What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature

  (springeropen.com)

• Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled,

  multicentre trial – PubMed (nih.gov)