How Hard Should My Mattress Be

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Mattresses are a major part of our lives, but how hard or soft they are can make a big difference for the quality of sleep you’ll get. Let’s look at the pros and cons of each type.

Pros of a Hard Mattress

1. They facilitate a neutral spine position, keeping your body straighter
2. They reduce the pressure on your circulation system, allowing blood to flow better
3. They prevent your lower back from collapsing, which allows you to inhale more oxygen while you’re sleeping
4. They support the use of props like body pillows and pillows between the knees
5. The human body can adapt to sleeping on a hard mattress and begin finding it comfortable

Cons of a Hard Mattress

1. Changing to a hard mattress (from a soft one) can be uncomfortable for several days
2. Studies have suggested that hard mattresses are not a good option for people with certain lower back problems (arthritis, rheumatism, scoliosis, etc.)
3. It can be harder to notice the differences in firmness between harder mattresses, and some may not be quite firm enough
4. Very few locations ever advertise their mattresses as "hard and solid" instead of "soft and plush", perpetuating the problem of people who are harming their bodies by sleeping on the wrong type of mattress
5. Body weight can eventually create indentations

Pros of a Soft Mattress

1. Soft mattresses can reduce back pain and help aging individuals deal with joint pain and problems
2. Slimmer, lighter people can sleep on a medium-firm mattress and enjoy the plushness without sacrificing spinal support
3. Soft mattresses can be a better option for people who sleep on their side, especially in a fetal position
4. Softness can be added through the use of pillow-top systems, allowing for a firm primary mattress with just a bit of softness on top
5. Research is continuing to work on ways to support the body even when softer mattresses are being used

Cons of a Soft Mattress

1. The softness can push a spine out of alignment and reduce the quality of sleep
2. Soft mattresses can be more expensive than their firmer counterparts
3. Two people may disagree on the amount of softness they want in a bed, making it harder to share
4. Soft mattresses tend to grow softer over time and may cease being appropriate after a few years of use
5. Tend to result in below-average buyer satisfaction

In short? You may want to consider a firmer mattress unless your doctor says otherwise.

Firm and Soft Mattresses for Bad Backs

Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle’s Harborview Medical Center.

Soren Hald Collection / Stone

If you’re one of the over 70 million Americans who deals with daily back pain, a lot may be stacked against you at bed time. You likely know first-hand how pain can limit things—like the number of hours of you get per night, how restful the sleep you do get is, how well you function during your waking hours, and how satisfying, overall, sleep is to you.

Your Mattress and You

Sleeping on a mattress that is not right for you, given your individual condition, may be one of your biggest obstacles to rest and repose.

And this may mean you need to go shopping. If that’s the case, what type of mattress should you buy?

To a great extent, mattress choice is a highly personalized one. Likely the most important thing you can do is to match the firmness of your prospective mattress to your spine’s unique needs for support and comfort.

Dr. Michael Perry, M. D., Medical Director of the Laser Spine Institute in Tampa, FL, recommends staying away from either extreme of firmness when selecting a mattress, stating that studies generally find a medium-firm mattress does the trick for most types of back problems.  

A 2003 study published in Lancet confirms this, saying, "a mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain."  

There’s nothing like a good dose of facts, so here’s a quick run down on mattress firmness research as it relates to back pain.

A Survey of Temporary Back Pain From Foam Mattresses

One hundred Indian medical residents who slept on foam mattresses were surveyed about the effects of this on their spines in a 2000 study published in theJournal of the Association of Physicians of India. The mattresses in question were 10 centimeters in thickness—the kind one might find in a youth hostel. The residents experienced temporary backaches from the mattresses, but not the generally more serious type that is also accompanied by nerve symptoms such as sciatica, radiculopathy, or paresthesia (pins and needles.)

The sleep-induced pain was relieved for most of the residents (61%) once they returned to their own beds, and it came back when they again slept on the foam.  

Firm vs Soft

In an effort to confirm that hard mattresses exert a positive effect on the sleep of people with chronic low back pain, as is commonly believed, participants in a study tested bedding with varying degrees of firmness.

The study, a randomized controlled trial, was published in the April 2008 issue of Spine.  

A “soft” mattress group slept on a water bed.

A second group slept on a Tempur-pedic mattress, which is known for its ability to conform to your body shape without sacrificing support.

And the “hard” mattress group slept on a futon.

Overall participants favored the water bed and foam (Tempur-pedic) mattresses the most in terms of pain relief, ability to function and number of hours slept per night. That said, the difference in scores between these two types of mattresses and the hard mattress was small.

"A Tempur-pedic with a dial-in firmness feature would be my top choice," Perry comments. "When you need more support, you can simply press a button and presto! The beauty of Tempur-pedic is that you can get support where you need it. You can also get on-demand softness."

He adds that a dial-in water bed also has advantages, clarifying that more water equals more firmness.

“Just remember not to dial in so much water that your mattress bursts,” he quips.

On the flip side, Perry says that if you don’t dial in enough water, your water bed mattress may surround and enclose your body, which can decrease the quality of your sleep.

In fact, he adds, “some of my patients report they feel smothered when their water bed isn’t firm enough. This is because the lungs have less room to expand when you’re sunken down. Of course, the cure is to firm it up by in dialing more water."

Even in light of this potential drawback, self-inflatable water beds may be the way to go. A 2015 review of studies published inSleep Healthconfirmed all of Dr. Perry’s opinions, concluding that a medium firm mattress with custom inflation capabilities proved the most optimal choice for spinal alignment and sleep comfort.  

Keep in mind that few studies have been conducted on this topic overall. But those that can be found in the medical literature point to achieving the right firmness in your mattress as a key to sound sleep—despite the back pain.

Soft Bed or Hard Bed for Back Pain?

Study Gets Mixed Results, but More Find Soft Bed Slightly Better for Back Pain

April 3, 2008 — If Goldilocks had lower back pain, she’d still prefer the bed that was just right.

It’s one of the most common questions back pain patients ask. Which is better — Daddy Bear’s hard mattress or Mommy Bear’s soft one?

Kim Bergholdt, DC, of Denmark’s Funen Back Center, and colleagues tried to find an answer. They randomly assigned 160 patients with lower back pain to sleep in one of three beds for one month.

When the truck pulled up to the patients’ houses, it delivered either a hard futon, a water bed (Akva brand), or a body-conforming foam mattress (Tempur brand). Akva and Tempur sponsored the study, although Innovation Futon provided the harder beds.

Unfortunately, many of the patients assigned to the water bed never started the study — they did not want to sleep on a water bed. And many of the patients assigned to the futon quit the study before it was over.

The large number of dropouts — and the failure to stratify the patients according to the cause of their back pain — makes the study hard to interpret, says Robert Molinari, MD, associate professor of orthopaedics at the University of Rochester Medical Center.

Among patients who did finish the study, slightly more preferred the water bed or the body-contour mattress over the hard futon. Even so, there were patients who said they felt better after sleeping on the hard bed as well as patients who said they felt worse after sleeping on the softer beds.

That’s no surprise to Molinari.

"We really don’t understand why, but some patients respond better to hard mattresses and some to soft ones," Molinari tells WebMD. "There are very few studies lending support to one mattress over another."

So what does Molinari recommend? Exactly the same method Goldilocks used — trial and error — to find the bed that’s just right.

The Bergholdt study appears in the April 1 issue of the journalSpine.

Sources

Bergholdt, K.Spine, April 1, 2008; vol 33: pp 703-708.

Sarasota & Venice Mattress Stores

Back pain can cause you to lose mobility as you get older. Among other things, it can keep you from being physically active and thus cause weight gain. The right mattress can play a major role in back pain prevention, especially when you consider the fact that most of us spend about a third of our lives in bed. The question then becomes, what type of mattress can help to avoid back pain? Most orthopedic surgeons recommend firm mattresses over soft, but recent studies suggest that this may not be the best option for everyone.

Hard or Soft, Which is Better?

Despite the fact that firm mattresses are widely recommended for those wishing to avoid back pain, there is not much research to support the recommendation. For the most part, firm mattresses are regarded as better because of anecdotes from people who found they had less pain with a board under their mattresses or after sleeping on the floor. Firm mattresses may provide a benefit in that they prevent the spine from moving, which can reduce pain. Many chiropractors have pointed out that the spine is not a straight line and that since hard mattresses do not conform to the body’s curves, they may actually have a negative effect on sleep quality.

It should be noted that a firm mattress may not have the same effect on everyone. For example, the spine of a younger person may tolerate its inflexibility much better than that of an older person.

On the other hand, soft mattresses may not be any better. The fact that they conform to the body’s shape means that they may help with the alignment of joints, but they can also cause you to sink so deeply that your joints twist painfully during sleep. In other words, the lack of support may cause or worsen back pain.

Medium-Firm Mattresses Provide Equalized Support

Back pain is more prevalent as we age and that is where pressure distribution comes in. The term "equalized support” refers to how a person’s weight is distributed on the mattress when they are lying down; a medium firm mattress can help with even weight distribution and thus help you to avoid back pain.

In all cases, test a mattress before you buy. No one type of mattress will suit everyone; your preference is the most important factor when deciding which is right for you.

How to Pick Your Perfect Mattress

Ready for a new mattress? Here’s how to find the one that suits you best.

Getting a good night’s sleep depends on a lot of different factors — comfort, stress level, room temperature – but to get it right, you’ve got to start with the basics and your mattress is the first building block to a restful slumber.

If you’re in the market for a new mattress and have recently taken a stroll down the aisle of a bedding store, you know that there is a dizzying array from which to choose. How do you know which mattress is best for you?

To start, says Arya Nick Shamie, MD, associate professor of orthopedic surgery and neurosurgery at Santa Monica UCLA Medical Center, the mattress needs to support your body in a neutral position, one in which your spine has a nice curvature and your buttocks, heels, shoulders, and head are supported in proper alignment

"If the mattress is too firm, it will push on those main pressure points and take you out of alignment," Shamie tells WebMD. "If it’s too soft, those pressure points won’t be properly supported, so your whole body flops back." Both of these scenarios can lead to an achy morning.

Generally speaking, one type or brand of bed isn’t better than another, says Michael Breus, PhD, a WebMD sleep expert and author ofBeauty Sleep: Look Younger, Lose Weight, and Feel Great Through Better Sleep.But he does find that a firmer bed seems to be better for people with lower back pain.

In fact, researchers in Spain studied people with long-term back pain and found that on a 10-point hard-to-soft scale people who slept on a medium-to-firm mattress (5.6 on the scale) had less back pain than those who slept on a softer mattress.

Is It Time for a New Mattress?

How do you know if the bed you’re sleeping on is the right one?

"If you wake up in the morning and have some low back pain and can stretch and get rid of it in 15 or 30 minutes, that means you’re on an inappropriate mattress for you," Breus says.

The right mattress, on the other hand, is one on which you feel no pressure, almost like you’re floating in air, Breus says.

If you’re looking for a new mattress, experts suggest testing it in the store and laying down on each mattress in the position in which you normally sleep. Breus suggests spending at least 10 to 15 minutes on the bed. And, bring your own pillow! The more you can replicate the way you’ll be sleeping on the mattress once you get it home, the better your chances of picking the right one.

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Innerspring Mattresses

Innerspring mattresses are still by far the most widely used. They support you with coil springs, and in most built today, each coil is individually enclosed. This helps the bed weather years of use and prevents the coils from popping out of the mattress. On top of the coils are a wide variety of materials added for comfort, from pillow to latex to memory foam. It’s all a matter of preference.

Salespeople may try to sell you on the idea that more coils mean more comfort, but that’s not necessarily true, Breus and Shamie say.

"You don’t really need a coil count above 390," Breus says. Beyond that, the difference in feel is so small it would be difficult to notice.

Pros:There are plenty of innerspring mattresses on the market from which to choose. They range in firmness, the fluffiness of the pillow top, and in price to fit nearly every preference and pocket book.

Cons:There’s no direct relationship in most cases between price and comfort, but Shamie suggests steering clear of the cheapest innerspring mattress. If there aren’t enough springs and cushion to offer you proper support, he says, you’ll likely wake up with an aching back.

Conditions:For someone who is very overweight, spring mattresses may offer a firmer support, making them easier to get in and out of, Breus says. Firmer versions are good for people with back pain. But spring-based mattresses can be comfortable for almost anyone.

Memory Foam Mattresses

Memory foam mattresses are growing in popularity. They are made of layers of different densities of foam that respond to weight and temperature, and are known for comfort because they contour to the specific shape of your body. Memory foam toppers are also available.

Pros:By molding to the shape of your body as your weight shifts through the night, memory foam reduces pressure points, and relieves pain. Memory foam also absorbs movement, so if you sleep with a partner, you’re not likely to be disturbed by his tossing and turning.

Cons:One of the biggest complaints with memory foam mattresses is that because these mattresses are temperature sensitive, softening and molding with your body heat, they can make you feel extremely hot during the night. Breus also says memory foam mattresses have been known to emit an unpleasant chemical smell.

Conditions:"If you have a hard time getting comfortable, if you have chronic fatigue, or some type of muscle pain, then a memory foam mattress would work well for you, assuming you don’t have temperature issues," Breus says.

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Latex Mattresses

Latex mattresses are made from either natural or synthetic rubber, and are known for providing a very firm, bouncy support that is uniform throughout the bed.

Pros:"Quite frankly, I think one of the best materials is latex," Breus says. He likes it for being very firm and supportive, but also for providing comfort similar to memory foam. Unlike the memory foam mattresses, however, Breus says latex pushes back, ultimately providing more support.

Cons:If you don’t like the feel of a firm mattress, latex is probably not the right choice for you.

Conditions: Either a latex mattress or latex mattress topper is great for relieving back pain because they offer the best combination of comfort and support, Breus says.

Air Mattresses

We’re not talking about the blow-up mattresses you put your holiday guests on for a few days. Higher-end air beds look like a standard innerspring mattress, but use air-filled chambers instead of coils, and are covered by a foam layer on top.

Shamie notes that air beds have long been used for patients with spinal cord injuries who are lying in bed for a long time. They can be adjusted so they don’t continue to press on the same areas of the body, which helps to avoid skin breakdown in patients who can’t move.

Pros:"Couples who have dramatic differences in their individual preference for comfort and firmness levels might do very well with an air mattress," Breus says. The reason is that the firmness of each side of the bed can be altered. If you like it firmer than your partner, these beds can be adjusted for that.

Like latex and memory foam, you can also find air toppers for your mattress.

Cons:Shamie says people sometimes fail to make their air bed firm enough and wake up with back aches. Less sophisticated air mattresses also pop up on one side when you sit on the opposite end. For that reason Breus says, you want multiple chambers so that doesn’t occur.

Conditions:These beds are particularly useful when sleeping partners have different needs. If one of you has a bad back, one side can be made firmer than the other to provide greater support.

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Adjustable Beds

These beds are able to bend and elevate at varying angles. As a result, the mattress has to be flexible. Different types of mattresses can be used on an adjustable bed – memory foam, latex, or air, for example. Spring mattresses are more difficult to use, however, because the springs don’t handle the bending well.

Pros:For people who have difficulty getting in and out of bed or who like to watch television in bed, Shamie says, adjustables can make life easier by moving you closer to where you need to be.

Conditions:If you suffer from sleep apnea, sleeping flat can make the condition worse by cutting off airways and causing the tongue to fall into the back of the throat, Shamie says. People who experience acid reflux can also benefit by sleeping in a bed that elevates their upper body.

Shamie also suggests adjustable beds for people with hip or back pain who have a hard time moving from a lying position to sitting up or standing.

Sofa Beds

When you have guests staying for a night or two, sofa beds come in handy. The mattresses in these beds tend to be very thin so they are flexible enough to fold and collapse into the couch. It’s a great convenience to have a sofa bed, but you’d be hard-pressed to find someone who raves about their comfort.

Pros:Sofa beds are convenient, especially if you have limited space. But from a health perspective, Shamie and Breus don’t see any advantages.

Cons:A night or two on a sofa bed is OK. But "this is probably the worst kind of bed you can sleep on long-term," Shamie says. The mattresses used in most sofa beds are very thin and the springs quite weak. "It really leads to an uncomfortable situation," Shamie says.

If you’re really tight for space and need a bed that folds up, Shamie says that futons, while not the most supportive, are better for your back than the typical sofa bed.

Conditions:There are no conditions for which a sofa bed will be helpful, according to the experts. But if you have a bad back or hips, these beds will be especially uncomfortable.

Continued

When to Part With Your Old Mattress

Today’s mattresses are made to last a lifetime. But you probably shouldn’t plan on keeping yours for that long. Our bodies change over time, Breus says, so the mattress that was once a joy to sleep on may no longer feel comfortable a few years down the road.

In addition, mattresses collect dust mites, fungus, and other germs that can exacerbate allergies and impact your sleep patterns. After 10 to 15 years, it’s time to think about buying a new bed.

Ultimately, the experts say that the best bed for you is the one that feels most comfortable. And remember, Shamie says, "There’s no mattress that’s going to save your body when you get only five hours of sleep." In order to feel your best, you need to get enough rest… no matter what type of mattress you’re sleeping on.

Sources

Arya Nick Shamie, MD, associate professor of orthopedic surgery and neurosurgery, Santa Monica UCLA Medical Center.

Breus, Michael, PhD, WebMD sleep expert and author ofBeauty Sleep: Look Younger, Lose Weight, and Feel Great Through Better Sleep

Kovacs, FM.The Lancet, November 2003; vol 362: pp 1599-1604.

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