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Bed Recommendations

Original Editor - Jonathan Wong Top Contributors - Jonathan Wong

Introduction

The average person spends around one third of their lifetimes asleep.[1] Sleep directly impacts patients' health and mood and life quality.[2] Unfortunately, the prevalence of sleep disorders has shown a steep increase over the years.[3] [4] [5][6] Perhaps particularly relevant to the physiotherapy context is the instrumental role of sleep from a healing standpoint, essential for musculoskeletal injuries.

One way of enhancing sleep quality may lie in mattress choices for patients. Mattress choices can influence lower back pain. Patients with chronic lower-back pain appear to exhibit increased sensitivity to mattresses firmness.[7]A population-based study centered around schoolkids and their parents found strong associations between lower back pain in bed and upon rising with having lower back pain.[8]

Mattress Firmness

There is some evidence that medium firmness mattresses can be effective in reducing lower back pain and improving sleep quality.[9] [10][11] In the literature, mattress firmness has usually been assessed subjectively.[11]

Studies suggest medium firmness mattresses are superior to firm mattresses in reducing lower back pain in the daytime, for lying in bed, and upon rising.[12][13] Medium firm mattresses are also associated with a greater improvement in disability versus firm mattresses.[12] 'Medium firmness' was generally subjectively identified in the research, and one study suggested patients who adjusted and inflated their mattresses themselves had optimal sleep quality.[14]

Temperature Regulation

Some studies have looked at the effect of temperature on sleep quality. Temperature regulation is a key factor for sleep as a reduction in core body temperature triggers sleep, and conversely an increase in temperature promotes wakefulness.[15] It has been recommended that during sleep, skin temperatures should stay within 33.5–35.5 °C, as deviations from this range reduce total duration of sleep and deep sleep, due to an increase in sleep disturbances.[16]Maintaining ideal temperature also positively impacts perceived sleep quality.[17]

Clinical Recommendations

Overall, it appears that medium firmness mattresses may be beneficial in improving lower back pain and improving sleep quality. Temperature regulation, whether with temperature-controlled mattresses or air conditioning systems may also help with sleep quality.

References

  1. ↑ Tonetti LO, Martoni MO, Natale VI. Effects of different mattresses on sleep quality in healthy subjects: an actigraphic study. Biological Rhythm Research. 2011 Apr 1;42(2):89-97.
  2. ↑ Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best practice & research Clinical rheumatology. 2011 Apr 1;25(2):173-83.
  3. ↑ Swanson LM, Arnedt JT, Rosekind MR, Belenky G, Balkin TJ, Drake C. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll. Journal of sleep research. 2011 Sep;20(3):487-94.
  4. ↑ Ahn E, Baek Y, Park JE, Lee S, Jin HJ. Elevated prevalence and treatment of sleep disorders from 2011 to 2020: a nationwide population-based retrospective cohort study in Korea. BMJ Open. 2024 Feb 2;14(2):e075809. doi: 10.1136/bmjopen-2023-075809. PMID: 38309764; PMCID: PMC10840067.
  5. ↑ Karna B, Sankari A, Tatikonda G. Sleep Disorder. [Updated 2023 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560720/
  6. ↑ Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013 May 1;177(9):1006-14. doi: 10.1093/aje/kws342. Epub 2013 Apr 14. PMID: 23589584; PMCID: PMC3639722.
  7. ↑ Enck P, Walten T, Traue HC. Associations between back pain, quality of sleep and quality of mattresses. Double-blind pilot study with hotel guests: Doppelblinde Pilotstudie bei Hotelgästen. Der Schmerz. 1999 Jun;13:205-7.
  8. ↑ Kovacs FM, Gestoso M, del Real MT, López J, Mufraggi N, Méndez JI. Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Pain. 2003 Jun 1;103(3):259-68.
  9. ↑ Jacobson BH, Wallace T, Gemmell H. Subjective rating of perceived back pain, stiffness and sleep quality following introduction of medium-firm bedding systems. Journal of chiropractic medicine. 2006 Dec 1;5(4):128-34.
  10. ↑ Jacobson BH, Wallace TJ, Smith DB, Kolb T. Grouped comparisons of sleep quality for new and personal bedding systems. Applied Ergonomics. 2008 Mar 1;39(2):247-54.
  11. ↑ 11.0 11.1 Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Traumatol. 2021 Dec 8;22(1):51. doi: 10.1186/s10195-021-00616-5. PMID: 34878594; PMCID: PMC8655046.
  12. ↑ 12.0 12.1 Kovacs FM, Abraira V, Peña A, Martín-Rodríguez JG, Sánchez-Vera M, Ferrer E, Ruano D, Guillén P, Gestoso M, Muriel A, Zamora J, Gil del Real MT, Mufraggi N. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003 Nov 15;362(9396):1599-604. doi: 10.1016/S0140-6736(03)14792-7. PMID: 14630439.
  13. ↑ Kovacs FM, Abraira V, Peña A, Martín-Rodríguez JG, Sánchez-Vera M, Ferrer E, Ruano D, Guillén P, Gestoso M, Muriel A, Zamora J, Gil del Real MT, Mufraggi N. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003 Nov 15;362(9396):1599-604. doi: 10.1016/S0140-6736(03)14792-7. PMID: 14630439.
  14. ↑ Radwan A, Fess P, James D, Murphy J, Myers J, Rooney M, Taylor J, Torii A. 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. Sleep Health. 2015 Dec;1(4):257-267. doi: 10.1016/j.sleh.2015.08.001. Epub 2015 Oct 19. PMID: 29073401.
  15. ↑ Murphy PJ, Campbell SS. Nighttime drop in body temperature: a physiological trigger for sleep onset?. Sleep. 1997 Jul 1;20(7):505-11.
  16. ↑ Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. Journal of thermal biology. 2018 Dec 1;78:192-203.
  17. ↑ Cao T, Lian Z, Ma S, Bao J. Thermal comfort and sleep quality under temperature, relative humidity and illuminance in sleep environment. Journal of Building Engineering. 2021 Nov 1;43:102575.
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