Occupational Therapy Sleep Hygiene: Choosing the Right Mattress Firmness & Other Tips for Back Pain

My anecdotal evidence says something similar when I looked up my uncomfortable mattress of five years that may have contributed to back pain to find that it is a firm one.

If you ever walked into a Sleep Number store, it is quite insightful as they have pressure mapping to see the locations on the body where you have the most pressure. I was most uncomfortable starting from the firmest setting (100) and preferred a setting around 25 (softer). However, despite trying out all the mattresses available at Sleep Number, I still had some low backpain – no matter the “sleep number” firmness setting. While a Sleep Number bed may be overpriced to some, it may be a consideration for you and your partner if you both prefer different firmness levels. Ultimately, I decided not to purchase one due to cost vs. comfort benefit.

Mattress Properties and Considerations

• Types – traditional innerspring, hybrid, air, water, memory foam, latex. No one is superior to another. I recommend you try them all.
• Support – have someone check your spinal alignment from the side angle
• Pressure Mapping – visual biofeedback of pressure map, e.g. green-yellow-red of your body on a surface (like how they show you in Sleep Number stores). Unfortunately, the average person does not have access to this tool. Some YouTubers such as Sleepopolis show different pressure maps for people in the light/medium/heavyset sizes, but keep in mind that everyone’s body, including yours – is different. Therefore, pressure relief is different. In an ideal world, you would be able to try out different mattresses and pressure map them all to see if there are any trouble spots.
• Firmness – if you have back pain, research states that you may be more comfortable on a medium-firm than a firm mattress. There is a difference between firm support (not what you want) and firm feel (okay).
• Temperature – cool & hot. Some materials may sleep warmer and/or cooler than others. For example, the Purple mattress supposedly sleeps cooler due to having larger and multiple air pockets under the sleeper.
• Edge Support – do you roll off the edge when sleeping on there due to poor support? If you sit on the edge of bed often, e.g., to put on shoes or pants, you will want good edge support. Test this out.
• Motion Transfer – a property that affects whether you wake your partner up when you roll or get out of bed. Have your eyes closed and test this by having your partner roll or move in bed.
• Adjustable Frames – similar to how hospital beds can raise and lower the head and legs. Maybe a worthwhile investment as this can help alleviate back pain.
• Off-gassing / VOC – does the bed release odors when first deployed (mostly unharmful).
• Materials – For example, eco-friendlier options such as those that are Greenguard certified.

Sleep Positions

• Back – the best position for low back pain. Consider placing pillows under your knees for added comfort.
• Side & Fetal – consider placing pillows between your knees
• Prone (belly)

Purchase Considerations

• Trial Period – the longer the better. Some companies (online) even offer generous 1-year trials.
• Warranty – consider this if purchasing an adjustable frame which will contain a motor. Keep in mind the chance that some newer less-established companies may not “be around” to service your warranty
• Return policy
  • Beware and read the fine print. For example, the frame on Sleep Number beds is nonrefundable.
• Mattress protector – don’t forget to buy one to protect the mattress itself from spills and accidents.
• Watch out for marketing gimmicks, e.g. “orthopedic”, “medically-approved”.

Recommendations

With the current pandemic, it may not be the best idea to go to a mattress store to try out a new mattress. If you still test some out, I will say that many mattress stores are making a good effort with social distancing and using disinfectants.

Alternative: Online sleep trials

Nowadays, many things can be purchased online – even mattresses. Consumers can even buy mattresses termed “bed in a box” which are packed smaller and expand to full size, similar to memory foam. Since online retailers may not have physical presence in a brick and mortar store, they offer many generous sleep trials and free returns and refunds. This also lowers the price as there are no costs for commissions for store associates. If you are environmentally conscious, read reviews on how these companies handle your returned mattress as some may end up in a dump instead of being donated or repurposed.

My List

This is a list of companies that make mattresses that were on my top consideration list.

I was not paid to mention them, but as always, do your own research before buying. Here’s a good place to start:

• Sleep Number – if you have the budget, many people like the adjustable firmness feature. However, many people consider this to be an overpriced air bed.
• Mattress Firm Stores (previously known as Sleep Train) – a good option as you can try out different mattresses in person with reputable brands like Serta, Beautyrest, Tempurpedic. May pay a premium – try negotiating.
• Brooklyn Bedding
• Casper
• GhostBed
• Leesa
• Helix
• Purple – tends to sleep cooler; new type of material that many people like.
• Winkbeds

Conclusion

Consider getting a new mattress if you have been having back pain. One of the most important properties to consider is firmness. Studies have shown that a medium-firm is better than a firm for low back pain. Comfort is mostly subjective so you should trial a mattress for several nights before deciding whether to keep it. Also consider other mattress properties such as edge support, temperature, and motion isolation. Is your mattress getting to be too old? While mattress shopping can seem overwhelming, don’t lose any “sleep” over buying a new mattress – just try before you buy, or trial before you keep!

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