How Does Mattress Affect Sleep

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The Best Mattress for a Better Night’s Sleep

Buying a new mattress? Here are tips for finding the right mattress for you.

You spend about a third of every day in bed. Whether that time is spent blissfully slumbering — or tossing and turning — depends a lot on your mattress.

"A mattress can impact a person’s sleep," says Michael Decker, PhD, RN, associate professor at Georgia State University and spokesman for the American Academy of Sleep Medicine.

One way that your mattress affects your sleep has to do with the network of fine blood vessels, called capillaries, that runs underneath your skin.

"When you lie on any part of your body for an extended period of time, the weight of it reduces the flow of blood through those blood vessels, which deprives the skin of oxygen and nutrients," Decker says. This causes nerve cells and pain sensors in your skin to send a message to your brain for you to roll over. Rolling over restores blood flow to the area, but it also briefly interrupts your sleep.

Ideally, a mattress that reduces the pressure points on your body should give you a better night’s sleep, Decker says. Yet the ideal mattress is different for each person.

Which Mattress Is Right for You?

Finding the right mattress isn’t about searching out the highest-tech brand or spending the most money. "A much more expensive mattress doesn’t necessarily mean it’s better," Decker says. A high price tag is a product of both the materials that go into the mattress, and the marketing that helps sell it.

Instead of focusing on price and brand name, think about what you want in a mattress. "Selecting a mattress is very personal," Decker says. Some people prefer a firmer mattress; others favor a softer style.

Although there isn’t a lot of scientific evidence to prove that one type of mattress will help you sleep better than another, people with certain medical conditions do seem to rest easier on a particular mattress style.

Anyone with back or neck pain should take a Goldilocks approach to mattress buying: not too hard, and not too soft.

"If you’re on too soft [of] a mattress, you’ll start to sink down to the bottom. But on too hard of a mattress you have too much pressure on the sacrum, and on the shoulders, and on the back of the head," says Howard Levy, MD, an Emory University assistant professor of orthopaedics, physical medicine, and rehabilitation.


A medium-firm mattress, or a firm mattress with a softer pillow top, will give your spine that "just-right" balance of support and cushioning.

An adjustable bed can be a good buy if you need to sleep with your head raised. Doctors sometimes recommend elevating the head to help people with COPD breathe easier, or to prevent nighttime heartburn from GERD. These beds can also allow you to adjust your knees and hips to a 90-degree angle, relieving some of the pressure on sore joints, Levy says.

If you have allergies or asthma, you might have considered buying a bed labeled "hypoallergenic."

"There are a lot of claims made by mattress manufacturers that their mattresses are hypoallergenic or don’t support the growth of dust mites, but I don’t know of scientific evidence to support these claims," says Paul V. Williams, MD, a pediatrics professor at the University of Washington School of Medicine and an allergist at Northwest Allergy and Asthma Center in Washington state. Williams says dust mites will live anywhere there’s food — and that food is your dead skin cells.

Instead of investing in an allergy-free mattress, slip on a washable mattress encasing. It will form a barrier that prevents dust mites from getting to you. A mattress encasing cuts allergen growth by robbing dust mites of their food supply, Williams says.

And what about those space-age memory foam mattresses, which can cost thousands of dollars? There is some evidence they can help with back problems and improve sleep, but their advantage over a regular coil mattress is only slight. Where memory foam mattresses can really help you sleep is if you have an active bed partner who is keeping you awake, Decker says. Foam mattresses reduce motion transfer, letting you lie still while your partner tosses and turns.

Test Drive a Mattress Before You Buy

"You wouldn’t buy a car without test driving it," Decker says. So why would you invest hundreds — or even thousands of dollars in a mattress without trying it out first? Take any new mattress you’re considering for a test nap. "People should not be embarrassed to go into a store and lay on a mattress for 20 minutes," Decker says.


For a more realistic test, sleep in the beds at different hotel chains when you travel. If you get an especially good night’s sleep on one of them, ask the desk clerk what brand it is.

When you test out a mattress, make sure it feels comfortable in every position, especially the side you favor for sleeping. The mattress should be supportive where you need it, without putting too much pressure on your body, Levy says.

Time for a New Mattress

If you’ve been having trouble sleeping, the problem might not be your mattress type, but its age. "It’s really important for people to realize that mattresses have a certain lifespan," Decker says.

Keep your mattress too long, and the foam and other materials inside it will start to break down, compromising its ability to support your body.

Decker recommends keeping your mattress for no more than 10 years. After that, it’s time to go mattress shopping again.


Michael Decker, PhD, RN, associate professor, Georgia State University; spokesman, American Academy of Sleep Medicine.

Howard Levy, MD, assistant professor of orthopaedics, physical medicine and rehabilitation, Emory University.

Berghold, K.Spine, April 2008.

Paul V. Williams, MD, FAAAAI, clinical professor of pediatrics,University of Washington School of Medicine; allergist, Northwest Allergy and Asthma Center.

Kovacs, F.Lancet, November 2003.

Halken, S.Journal of Allergy and Clinical Immunology, January 2003.

How Bed Surfaces Affect Your Sleep


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How Bed Surfaces Affect Your Sleep

The feel of your mattress, pillows, sheets, and pajamas affects the quality of your sleep. Your mattress should be comfortable and supportive so that you wake up feeling rested, not achy or stiff.

Contrary to popular belief, it’s not necessarily better to sleep on an extra firm mattress, so use your body as a guide for what feels best through the night. Many sleepers, especially side sleepers, prefer a softer mattress. The same applies to pillows: soft or firm is a matter of preference, but think about replacing pillows when they become lumpy or shapeless. The type and number of pillows you use depends in part on your sleeping position.

Temperature plays a big role in quality sleep. Mattress materials, as well as the fabrics on your bed and your body, deal with heat differently. For example, many people find memory foam comfortable, but some materials can trap heat and make it more difficult to sleep in warmer months. For pajamas and sheets, it may help to choose a breathable cotton fabric so that you don’t overheat. There are newer fabrics available that also have the ability to wick away moisture—especially helpful if you sweat when you sleep.

How Does Anxiety Affect Sleep?

Almost everyone has experienced it. You climb into bed, turn off the lights, and suddenly your brain is running through your day at marathon speed.Did I turn in that report at work? Did I lock the front door? What about those bills due at the end of the week – how am I going to pay those? And that presentation I have to do tomorrow – am I prepared? Remember the last time I embarrassed myself?

It happens to the best of us. Anxiety is a normal, natural response to life stressors. It’s a state of heightened alertness that helps you become more aware of your surroundings and helps you prepare for possible dangers – whether that’s physical safety, like being alone in a dark parking lot, or emotional safety, like preparing yourself for a test or presentation. But when anxiety becomes so intense that it causes problems at work, school, or in your relationships, or if it lasts even after the stressful event or situation is resolved, these might be indicators of a deeper problem.

Anxiety – What exactly is it?

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Yep – anxiety isn’t “just in your head.” Affecting over 40 million people in the US alone, anxiety disorders are the most common mental health diagnoses. The National Institute of Mental Health (NAMI) outlines several different types of anxiety disorders; here are some of the most common:

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by “excessive” worry about everyday events or activities. It’s normal to worry to a certain degree about stressors like work, relationships, and any number of other life situations. “Excessive” usually means that the worry you’re experiencing is so severe that it’s impacting functioning in one or more areas of your life, and continues for more than six months regardless of the circumstances. For example, you might constantly be worrying about your finances, even when your bills are all paid, or worry excessively about your grades in school even if you’ve always been an A student.

Social Anxiety Disorder (SAD)

Social Anxiety Disorder, also sometimes called Social Phobia, is characterized by excessive worry or concern about social events or situations. This isn’t just shyness or discomfort. Again, diagnosis requires that Social Anxiety causes problems in one or more areas of life. The Social Anxiety sufferer usually worries so much about social situations that they avoid them altogether, leave early, or make excuses not to go. This may impact their ability to work, go to school, or maintain relationships with friends, family, or romantic partners. Specifically, they are typically worried about being negatively judged or rejected by others in social situations.

Obsessive-Compulsive Disorder (OCD)

Obsessive Compulsive Disorder is one frequently showcased on TV. But the symptoms are not nearly as amusing to the real-life OCD sufferer. It can be a devastating condition. The difference between OCD and Generalized Anxiety Disorder is that OCD requires two parts: obsessions and compulsions. Obsessions are repeated, intrusive thoughts and fears, images, or urges. Usually, they are about potential harm coming to themselves or loved ones. Compulsions are behaviors that the sufferer feels they must perform in order to relieve the anxiety. This can be both physical tasks like handwashing, or mental tasks, like checking or counting. The obsessions and compulsions can take up hours and hours of the day, severely impacting ability to function in everyday life roles. The OCD sufferer typically knows that their obsessions and compulsions don’t make sense. Yet, they feel powerless to resist the urge to engage in them. There are also different categories of OCD. For some, the obsessions and compulsions focus almost exclusively on their romantic relationship. For others, the theme is contamination – a fear that either they will become sick because of contamination, or that they will accidentally contaminate someone else and cause them to become sick or injured. Hoarding can also be a symptom, though there is also a separate diagnosis for Hoarding Disorder, which can look a little different. Sometimes the diagnosis of OCD can be tricky, because, for those that have only mental compulsions, they may not realize they’re engaging in compulsions at all. It’s not uncommon for these OCD sufferers to be diagnosed initially with Generalized Anxiety Disorder before an experienced clinician recognizes the difference.

Post-Traumatic Stress Disorder (PTSD)

Many people who experience distressing events will have flashbacks, nightmares, or intrusive memories about the event. However, the person with PTSD continues to be anxious and/or depressed about the event for months to years afterward. PTSD frequently goes hand in hand with Panic Disorder, but not always. And, it’s possible to develop PTSD not only from experiencing a trauma first-hand but also from witnessing or even hearing about it.

Panic Disorder (PD)

Panic Disorder is a little different than other anxiety disorders, in that often the panic attacks seem to come “out of the blue.” They occur suddenly, without much if any warning, and often can be detrimental to a person’s life; since they’re nearly impossible to predict, it can impact the ability to work, go to school, and any number of other life tasks. It can also be even more of a financial strain than other forms of anxiety. Often people who experience panic attacks experience a fear that they might be dying, which can seem very real, so they go to the emergency room. The cost of ER trips can really add up. Often, because the experience of having a panic attack is so distressing, the sufferer has a great deal of fear about having another one. Unfortunately, this only makes it more likely that a panic attack will occur.

Symptoms of anxiety disorders are frequently very similar, and many overlaps. It’s also common for a person to be diagnosed with more than one type of anxiety disorder. Some of the most common symptoms of anxiety disorders include:

  • Irritability
  • Muscle tension
  • Memory problems
  • Sleep problems
  • Easily fatigued
  • Feeling “keyed up” or “on edge”
  • Rapid heartbeat
  • Shortness of breath
  • Sweating
  • Trembling or shaking
  • Feeling “out of control,” like you’re “going crazy,” or a sense of “impending doom”
  • Intense fear of situations, environments, or objects that lead to avoidance

Again, it’s important to keep in mind that having one or more of these symptoms doesn’t mean you have an anxiety disorder – most of these symptoms appear in other physical and mental health conditions and are even normal reactions to a number of life events and situations. But if the symptoms become so intense you can’t stand it, or if they begin to cause problems in your life, give your doctor a call.

Anxiety and Sleep – A Vicious Cycle

The link between anxiety and sleep is well-established. You probably already realized that stress and anxiety can lead to sleep deprivation. But research from The Anxiety and Depression Association of America (ADAA) indicates that it can also work the other way around – sleep deprivation can also cause anxiety. This can lead to a vicious cycle where you don’t sleep because you’re anxious, which then makes the anxiety worse, which makes it even harder to sleep. Chronic insomnia can greatly impact mood regulation – when you’re tired, things that might usually roll off your back can seem intolerable, sparking anger, anxiety, or depression, which can also make it more difficult to sleep. But don’t worry – there are a few things you can try at home.

First, make sure you’ve got the right mattress. The Better Sleep Council suggests replacing your mattress every 7 – 10 years. There are a number of factors that go into choosing the right mattress for you – check out our Mattress Buying Guide for more info. If you’ve got the right mattress, and you’re still having trouble sleeping, here are a few things you can try:

  • Deep Breathing and Guided Meditation. There are a TON of apps out there designed to help you calm your mind before bed – some of the most popular are Calm, Insight Timer, Aura, Headspace, and Breethe.
  • Read a Book.This works better for some people than others; the important thing is to swap out screen time, as the blue light from your TV, tablet, phone, and other devices can throw off your circadian rhythm – the timer in your head that says it’s time to sleep or wake up – and decrease the amount of melatonin your brain produces – one of the primary hormones responsible for making you feel tired.
  • Get Out of Bed. If you lay in bed for twenty minutes and still can’t fall asleep, get up and do something else – maybe try one of the activities above, like meditation or reading a book, or listen to music. Lying there awake can lead your brain to associate your sleeping environment with wakefulness – and probably a fair amount of frustration and anxiety, too.
  • Work on that Bedtime Routine. A good bedtime routine looks a little different for everyone; but making sure you go to bed, and wake up, at the same time every day – yes, even weekends – is one of the most important parts of a good bedtime routine.
  • Sleep Hygiene. No, we’re not talking about brushing your teeth – though that’s important too. Sleep hygiene includes a regular bedtime routine, as well as environmental factors – like making sure your room is cool, dark and quiet; avoiding eating & exercise too close to bedtime; using the bedroom just for sleep – not working, watching TV, etc.; avoiding or reducing alcohol and caffeine use; and keeping your eyes off the clock.

When At-Home Strategies Aren’t Working

Anxiety is, of course, only one of several challenges that lead to sleeping problems. Other sleep disorders, mental health disorders such as depression or anxiety disorders, and physical health disorders can cause trouble sleeping – both falling asleep, and staying asleep. Sleep apnea, insomnia, panic attacks, sleepwalking, narcolepsy, and restless leg syndrome are some of the most common. So, if you’re having trouble sleeping, again, it’s important to talk to your doctor or even a sleep specialist. They can help give you an accurate diagnosis and treatment, and medical advice. If an anxiety disorder is a culprit, here are a few of the things they might suggest:

  • Cognitive Behavioral Therapy (CBT).CBT is by far one of the most effective and well-researched behavioral therapies for anxiety and stress disorders – and, by extension, it can also work wonders for sleep. There are several different techniques and therapies that fall under the CBT umbrella, but in general, CBT is used to identify unhealthy patterns of thinking and behavior and substitute healthier, more effective behaviors.

CBT is usually very structured, and often you’ll be assigned “homework” to practice the skills you learn in therapy in your everyday life. It’s often quicker than traditional psychotherapy – aka “talk therapy,” and most insurance companies are often more willing to cover it.

  • Medications. Often, combining mental health therapy with medication leads to even better results than just one or the other alone. There are a TON of different medications that can help with sleep and pros and cons to each. For example,benzodiazepineslike Xanax, Klonopin, and Valium tend to work quickly, with fewer side effects; but they can also be addicting, and your body can get used to them quickly so that you need more and more for it to work. These are usually only prescribed as a short-term fix, and sometimes require a trip to a specialist, like a psychiatrist, as primary care doctors sometimes can’t prescribe them.

Antidepressants, like Prozac, Zoloft, Celexa, and numerous others, can have more side effects in some people, and take longer to work – sometimes 60 – 90 days. On the plus side, they can often be taken long-term, and since they’re not addictive, doctors are more willing to prescribe them – and most primary care doctors and even nurse practitioners can prescribe these.

Beta-blockersoften used to treat high blood pressure, can also sometimes help with anxiety as they help with some of the physical symptoms – rapid heartbeat, shaking/trembling, and blushing.

Your doctor will be able to help you decide which medication is best for you by considering any other medications you’re on, your health history, and other health issues.

Final Thoughts

As you can see, getting a good night’s rest can be trickier than it sounds – especially when anxiety rears its head, or tries to join you in bed. But anxiety disorders and sleep disorders are treatable, and there are so many options you and your doctor can choose from. Sleep is so important to keep yourself both mentally and physically healthy. Don’t let anxiety stand in your way.

How Does Your Mattress Affect Your Sleep And Health?

In ancient times, people used raised beds to protect themselves from insects and snakes. However, every generation tried to improve the quality of the mattress. The beds in ancient Greece were better. Comfort inspired their designs.They knew sleeping places have an aesthetic value.

Today, any mattress design must factor in comfort, sleep quality, and health of the user. Many people still do not understand the value of mattresses in their lives. They take their time before buying a mattress.

We spend approximately a third of our lives sleeping; therefore, you need to understand how mattresses affect your sleep and health.

1. Quality Of Sleep

No one wants to be interrupted when asleep. Quality sleep is sleeping peacefully, perhaps, for six to seven hours nonstop. If you have a quality and comfortable mattress, you are likely to sleep better and longer.

But, imagine having a worn out or a mattress full of lumps because of aging. You will wake up multiple times in the night maybe to change your sleeping positions or move the bed mattress. It is frustrating. The outcome in the morning is waking up still feeling sleepy and not ready to face the day.

The need for quality sleep is one reason most people invest in a quality mattress. However, a mattress is one of those things that we do not buy often, so before buying a new one, you should look for some aspects like comfort, the technology used and last but not the least is the warranty. Such as the SleepDelivered Nectar Mattress which offers a forever warranty! yes, you read it right, however; it sounds unbelievable for a budget-priced mattress. This could be the perfect option for you if you are looking for a high-quality foam mattress. A quality mattress will enhance not only your sleep but also your moods.

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2. Insomnia

The first question your physician is likely to ask when you have sleeping problems or insomnia is about your sleeping place.

Insomnia is the difficulty to sleep or stay asleep for long. Common causes include stress, work schedule, poor sleeping habits, poor eating habits, and mental disorders.

The effects of Insomnia can increase or decrease depending on your sleeping area. The bedroom should be organized and used for two purposes only: Sleep and Sex.

When you have Insomnia, doctors will recommend that you make your bedroom as comfortable as possible. It is not possible to have a lovely bedroom without a comfortable mattress.

3. Stress And Anxiety

Psychologists relate a lot of mental illnesses to sleep inadequacy. Lack of sleep for consecutive days results in anxiety, stress, and possibly depression.

One leading cause of stress and anxiety is a bad mattress. The moment going to bed after a long and tiresome day becomes unattractive, is the moment you must think of changing your bed set.

Continuously using a bad mattress can cause irritation, worry, and poor productivity during the day.

4. Happiness And Relationships

The bedroom is the favorite place for most people to relax and unwind. Cozy and perfect moments in the sleeping room are only possible if the mattress is excellent.

A right mattress helps boost your mood and happiness levels. If you sleep well, you wake up happy, freshened up, and ready to face what the day offers. You also are more alert after a great night.

With a good mattress, there is no reason you cannot enjoy a great night with your other half. Who doesn’t want to be happy in a relationship?

5. Body Pains And Backaches

A right mattress supports the whole body and aligns the spinal cord in a neutral position. Poor sleeping positions and bad mattresses are the primary cause of backaches. For example, imagine if your bed is wooden, and the mattress is worn out. The pressure exerted on the body, and the ribs automatically lead to body pains.

It is also impossible to sleep in a lousy bed when under physical injury or other body pains. A right mattress enhances sleep when you are under strain.

Ideal mattresses to use for pain alleviation are moderately firm and sufficiently thick.

6. Allergies

Sometimes you can itch or sneeze when in your bedroom. Dust mites and bedbugs like to breed in mattresses that in poor condition and with crevices.

Dust mite feces are the main causal factors of allergic reactions. Bedbugs bite a lot and destruct sleep.

Final Thought

Mattresses affect your health and sleep; thus it is recommended to replace them after six years because they tear after six to nine years. But, it depends on quality. Better mattresses last longer and provide better sleeping benefits than cheap ones.

Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders

Victor Ancuelle

a Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Peru

Rodrigo Zamudio

a Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Peru

Andrea Mendiola

a Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Peru

Daniel Guillen

a Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Peru

Pedro J Ortiz

b Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru

c Instituto de Gerontología, Universidad Peruana Cayetano Heredia, Lima, Peru

Tania Tello

b Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru

c Instituto de Gerontología, Universidad Peruana Cayetano Heredia, Lima, Peru

Darwin Vizcarra

a Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Peru

b Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru


We aimed to evaluate the impact in sleep quality and musculoskeletal pain of a Medium-Firm Mattress (MFM), and their relationship with objective sleep parameters in a group of institutionalized elders. The sample size included forty older adults with musculoskeletal pain. We did a clinical assessment at baseline and weekly trough the study period of four weeks. We employed the Pittsburgh Sleep Quality Index (PSQI) and Pain Visual Analog Scale (P-VAS). Additionally a sub-group of good sleepers, selected from PSQI baseline evaluation, were studied with actigraphy and randomized to MFM or High Firm Mattress (HFM), in two consecutive nights.

We found a significant reduction of cervical, dorsal and lumbar pain. PSQI results did not change. The actigraphy evaluation found a significant shorter sleep onset latency with MFM, and a slightly better, but not statistically significant, sleep efficiency. The medium firmness mattress improved musculoskeletal pain and modified the sleep latency.

1. Introduction

Quality of sleep is associated with age-related changes, medical or psychiatric diseases and primary sleep disorders. Aging, itself, modifies the sleep architecture, with disruption of the sleep-wake cycle and increasing arousals and awakenings [1]. The National Sleep Foundation, in the Sleep in America Survey, reported that about 52% of the older adults with major comorbidity reported one or more sleep problems, compared with 36% of the participants reporting no comorbidity [2]. Likewise, several studies found that disturbed sleep is rare in healthy older adults [3].

The sleeping thermal environments, including the mattress and bed equipment (sheets, blankets and pillows), play a role in quality of sleep [4]. One survey estimated that 7% of sleep problems were related to an uncomfortable mattress [5] contributing to poor quality of sleep or physical discomfort. Moreover, several studies indicate that a mattress with ergonomic standards could improve the quality of sleep [6], [7]. Some studies evaluate the association between sleep surface, sleep quality and pain (back and shoulder) [8], [9]. Bader et al. [10] concluded that mattress differences did not significantly affect sleep quality, whereas others consider that those with different firmness or construction can affect quality of sleep [11].

Our aim was to evaluate the impact of a Medium-Firm Mattress (MFM) on sleep quality and musculoskeletal pain in institutionalized elders, and to evaluate in a subgroup of good sleepers the effect in sleep parameters through actigraphy.

2. Materials and methods

We conducted a quasi-experimental study.

2.1. Participants

All the participants were institutionalized older adults (>60 year old), who slept on foam mattresses on an adjustable bed in a public nursing home. In order to find the sample size, we used the formula for studies of contrast hypothesis. We included 40 subjects with musculoskeletal pain who were evaluated by a geriatrician. Evaluation included BMI, polypharmacy, nutritional status and nicturia. Exclusion criteria were: bedridden subjects, moderate to severe dementia, acute illness and subjects who had recent surgery. Additionally, all patients with normal PSQI and without psychotropic medication at baseline were studied for two nights with actigraphy.

2.2. Ethical approval and informed consent

The study protocol was approved by the Institutional Review Board of the Universidad Peruana Cayetano Heredia. Informed consent was obtained prior to initiation of the study.

2.3. Questionnaires and devices

The Pittsburgh Sleep Quality Index (PSQI) is an 18-item self-report questionnaire. The items produce seven component scores which range from 0 (no difficulty) to 3 (severe difficulty): sleep duration, sleep disturbance, sleep latency, daytime dysfunction, habitual sleep efficiency, sleep quality, and use of sleep medications. The sum of these component scores yields a measure of global sleep quality which ranges from 0 to 21. A global PSQI score greater than 5 has a diagnostic sensitivity of 89.6% and specificity of 86.5% in distinguishing good and poor sleepers [12]. We used the Pittsburg Sleep Quality Index validated in Colombia (ICSP) [13].

The Pain Visual Analog Scale (P-VAS) measurement was introduced by Huskisson [14]. It is a continuous scale, 10 cm in length, anchored by 2 verbal descriptors. The P-VAS for musculoskeletal pain contained “no pain” on the far left and “extreme pain” on the far right side of the line.

The Actiwatch 2 (Phillips-Respironics) is a portable device with the size of a large wrist watch, and it consists of a solid state “piezoelectric” accelerometer with a range of 0.5–2 G, bandwidth 0.35–7.5 Hz, Sensitivity of 0.025 G and a sampling rate of 32 Hz. This instrument is validated for different sleep disorders [15], the American Academy of Sleep Medicine (AASM) has concluded that an actigraph can provide objective measures of sleep patterns [16]. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses due its high sensitivity [17].

The Actiwatch 2 database was analyzed using Encore Pro 2 version 2.2 (Patient Management System) software [18], [19]. The database include Bed Time (BT), Get up Time (GT), Sleep Onset Latency (SOL), Wakefulness after Initial Sleep Onset (WASO), Number of Awakenings (NA), Total Sleep Time (TST), Total Time Spent in Bed (TIB), Sleep Efficiency (SE).

2.4. Procedures

All the selected participants that fulfilled the inclusion and exclusion criteria completed the P-VAS and PSQI. The regular mattresses of the 40 participants were changed to Medium Firm Mattress (MFM). Subjects slept in their own beds with their personal linen and pillows without thermal additional modifications. A follow up was done using P-VAS every week, during 4 weeks. Participants completed the PSQI at the end of the 4 weeks evaluation.

In the actigraphy evaluation, the subjects were randomized between MFM and HFM, the transition between MFM and HFM was at random sequences for two consecutive nights.

The P-VAS and PSQI were applied by a blinded evaluator. For the Actigraphy evaluation, participants and the evaluator were blinded about which mattress was used each night. An independent researcher analyzed the outcome and the statistical correlations.

2.5. Mattress

The hardness of each mattress was measured in Newtown with a calibrated durometer. Mattress features are described in Table 1 . Additionally, hardness was rated through a VAS in a healthy group of volunteers. The scale ranged from 1 (hard) to 10 (soft). The MFM was rated as 3–6 in 80% of volunteers.

Table 1

Thickness0.151 m0.155 m
SizeLarge: 2 m; width 0.90 mLarge: 1.96 m Width 0.91 m
FoamFoam 1: viscoelastic polyurethaneFoam: polyurethane
Foam 2: high-resilience polyurethane
DensityFoam 1: 40 kg /m 3Foam: 20.2 kg/m 3
Foam 2: 38 kg/m 3
HardnessFoam 1: 28 NFoam: 75–80 N
Foam 2: 55 N
CoverFabric white colorVinyl light gray
Lateral zippers non eyeletsAnterior zipper with eyelets
Time of useNewNew

MFM=Medium Firm Mattress; HFM=High Firm Mattress

2.6. Statistic analysis

Population Study. PSQI: Pittsburgh Sleep Quality Index.

The mean age of the study population was 78.4±8.7 years old, the mean weight was 69.7±13.5 kg and the Body Mass Index (BMI) was 25.7±3.9 kg/m 2 . The general characteristics are shown in Table 2 .

Table 2

General characteristics of sample study.

Dorsal, lumbar or cervical pain,N(%)38(100)
≥3 comorbidities,N(%)2(5.3)
Psychotropic medication,N(%)14(36.8)
≥3 medications,N(%)12 (31.6)
Nutritional status

The P-VAS showed a significant reduction of cervical, dorsal and lumbar pain since the first week of evaluation and was steeply reduced through the 4 weeks of evaluation ( Table 3 ; Fig. 2 ). However, the percentage of poor sleepers (PSQI>5) did not reach significant reduction after 4 weeks of MFM use, 23 (60.5%) vs 19 (50%),p=0.245.

Variation of cervical, dorsal and lumbar pain. *Week 1 vs Baseline P-VAS **Week 2 vs Baseline P-VAS # Week 3 vs Baseline P-VAS ## Week 4 vs Baseline P-VAS.

Table 3

Table 4

Correlation analysis age, BMI, nicturia, polypharmacy, psychotropic medication and musculoskeletal pain variation.

Psychotropic medication−0.1620.048−0.141

No significant correlation was found in any variables. V-LP=Variation of Lumbar Pain;V-DP=Variation of Dorsal Pain; V-CP=Variation of Cervical Pain.

Among the subgroup of patients with normal PSQI at baseline, studied with actigraphy, a significant shorter SOL with MFM, and a slightly but not statistically significant lower SE with HFM were observed ( Table 5 ).

Table 5

Actigraphy parameters between MFM vs. HFM.

Actigraphy parametersMFMHFMp
BT9:24 pm (±2 h 19 min)8:35 pm (±39.6 min)0.949
GT5:49 am (±55 min)5: 45 am (±1 h 1 min)0.992
SE (%)81.62±6.9173.33±11.920.096
TIB8 h 35 min (±2 h 3 min)9 h 7 min (±1 h 1 min)0.084
TST6 h 52 min (±1 h 59 min)7 h 11 min (±2 h 25 min)0.939
SOL21 min (±17 min)67 min(±67 min)=0.359), dorsal pain (r=0.491; =0.263) and cervical pain(r=−0.577; =0.067) at the week 4.

4. Discussion

We found a significant reduction in musculoskeletal pain in a group of senior institutionalized adults with the use of MFM. This result was independent of age, BMI, nicturia, polypharmacy and the use of psychotropic medication. Although, the only variable that improved in the single night switch from HFM to MFM was SOL, it did not correlate with the observed changes in pain.

Limitations of our study were the absence of a control group, the possible bias induced by a new, and provided at no cost, mattress, that could generate a positive response. Other limitation includes, the Hawthorne effect. This phenomenon also referred as the observer effect, is a type of reactivity in which individuals improve an aspect of their behavior in response to their awareness of being observed [8]. In the same way, the brief evaluation of actigraphy, in the single night switch, for each mattress, could limit further adaptation and the possibility to detect changes that could be observed with a more prolonged use. Other limitations are the selection bias and the short number of participants. In order to reduce these biases we conducted an evaluator blinded study, and we also limited the information about the expected outcome of the study to the participants. The sleeping conditions, which include the support of the mattress, pillows, sheets, blankets and sleep environment, were similar in all the participants and the same every night, which is a strength of our study. In future studies it would be important to determine the impact on sleep quality of each component of the bedding system. These components and the season of the year might influence sleep cycle [20], however we ruled out this effect because of steady weather conditions during the four weeks of the study.

The influence of the hardness of a mattress in sleep quality and low back pain is subject of controversy, Bader et al. [10] found no difference in subjective sleep quality between two mattresses, commercially sold as smooth and hard. In the same way, in the present study there was no change in the sleep quality, measured by PSQI. However, a significant reduction in low back pain with a MFM was observed. Moreover, several studies have concluded that medium-firm sleep surfaces may be the most beneficial for people with chronic low back pain [7], [8], [11], [21]. Although there is scarce evidence and lack of agreement regarding the role of the mattress in musculoskeletal pain, guidelines for prevention of low back pain, state that “there is no robust evidence for or against recommending any specific chair or mattress for prevention in low back pain, though persisting symptoms may be reduced with a medium-firm rather than a hard mattress”, [22]. There is limited evidence about mattress firmness and its effect in neck and dorsal pain. Accordingly to our results we can expect a similar improvement with MFM independently of the region of the spine.

The sleep quality in older adults is associated with several complaints, Eser et al. [23] described that 60.9% of older adults in nursing homes were poor sleepers. Similarly, we observed that our population had a comparable frequency of poor sleepers at baseline (60. 5%).

Furthermore, regarding variations in the PSQI, we did not find a significant reduction. In controversy, Jacobson et al. [21], using visual analog scales (VAS) assessed the participants perception of sleep quality and low back pain before and after setup of a new bedding system, they concluded that a middle firmness mattress increased sleep quality and reduced back discomfort. In contrast to our study, the population selected was younger and had minor musculoskeletal sleep-related pain and compromised sleep, with no clinical history of disturbed sleep [21]. Additionally, the changes in the quality of sleep for our participants could be independent of the mattress firmness, maybe due to the psychometric properties of the PSQI different from VAS; physiological changes and frequent medical comorbidities inherent of the older age group, thus these features may overshadow the benefits of the MFM in the sleep quality.

The sleep surface can contribute to the comfort of sleep [24]. The HFM and MFM have inherent physical differences, which include density and hardness. Both characteristics are important for support and comfort in order to redistribute the body weight and to reduce pressure that may cause muscle discomfort [7]. The main function of the mattress is to support the human body in a way that allows the muscles and intervertebral disks to recover [25], [26].This recovery can be achieved when the shape of the spine is in its natural physiological shape, yet with a slightly flattened lumbar lordosis due to the changed working axis of gravity [27], [28].Therefore, mechanical characteristics of the mattress should be optimized concerning both body contours and weight distribution of the sleeping person [29].Since both of these factors are highly individual, the optimal benefit in actigraphy parameters and pain reduction might be achieved with a tailored mattress, specifically designed for the physical characteristics of the participants. Although this measure might be effective, is likely to be expensive and probably non cost effective in the context of institutionalized elders.

Using various chemical formulations and processing technologies, foam firmness can be controlled during the production process, independent of the density within broad ranges. A high density foam can be produced to have low or high firmness values [30]. Similarly, the cover of the mattress is also relevant. The vinyl cover provides a more allergen-free environment during sleep [31]; however it restricts the airflow through the material, therefore the body heat will not be dispersed inducing perspiration during the night [32]. The mattress we used was a new, medium-firmness, constructed with layers of viscoelastic polyurethane and high-resilience polyurethane foams, without vinyl cover, features that could have contributed to the improvement in musculoskeletal pain.

In our study, P-VAS was steeply reduced over the duration of the study. It has been described that new mattresses require time to deliver full benefit [10], nevertheless there is no agreement of the amount of break-in time. Rosekind [33] suggested 15 nights long and others just 5 or 6 nights long [6]; moreover Scharf et al. [34] consider that only one night could be enough to adapt. Our tested mattress showed a significant result as soon the first evaluation at day 7.

In our study the improvement in musculoskeletal pain did not show a significant correlation with BMI. The literature describe that people who are overweight might be more sensitive to changes in hardness than thinner people [35]. If comfort depends on hardness, subjects with variable BMIs will need mattresses of different hardness to feel equally comfortable. Several other factors such as age, nicturia, polypharmacy and psychotropic medication, some of them with well-known impact in sleep quality had no significant correlation with the improvement in musculoskeletal pain, even though they could still impaired the quality of sleep independently [36], [37], [38], [39].

The single night switch, evaluated with actigraphy was aimed to simulate a real admission to a geriatric inpatient unit. Our study found that the SE, in a harder mattress (HFM), had a tendency to decrease, while the SOL increase with statistically significance with a HFM. Similarly, Krystal et al. [40], in a study with actigraphy, found that a harder mattress was associated with an increased pain perception and worse sleep reports; therefore we could suggest that medium firm mattresses could be best rated.

5. Conclusions

MFM constructed with layers of viscoelastic polyurethane and high-resilience polyurethane foams may have an effect in decreasing cervical, dorsal and lumbar pain in older adults, independently of BMI, age, nicturia, polypharmacy and use of psychotropic medication, since the first week of use.

The medium firmness mattress may reduce the sleep latency since the first night of use, compared with HFM, additional studies of longer duration are recommended.

Further research is highly encouraged to find possible differences in factors affecting sleep quality between older and younger adults.

Conflicts of interest

The authors do not declare any conflicts of interest.


DRIMER provided and installed the mattresses used in the trial without charge; nobody from that company participated in study design or in the collection, analysis, and interpretation of data.


The project was developed through a partnership between Universidad Peruana Cayetano Heredia, and DRIMER, with co-financing from the Fund for Research and Development for Competitiveness (FIDECOM), which is administered by the Fund for Innovation Science and Technology (FINCyT) of the Peruvian Ministry of Production. The grant was awarded through the contract number 103-FINCyT-FIDECOM-PIPEI-2011.

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