Chronic back pain and insomnia seem to go together, and much science shows that sleeping poorly increases sensitivity to pain. When you’re caught in that unhappy loop, it’s worth exploring ways to improve your sleep alongside remedies for your back. Could a new mattress help? The answer is yes — sometimes.
If you regularly sleep better in hotels, on the sofa, or in your recliner, it’s time to look for a new mattress. Another sign is morning achiness. Back pain, typically triggered by movement, is often mildest in the morning. If you wake up in pain, you may have been moving too much during the night, or your mattress may not be giving you enough support.
Don’t assume you need a firmer bed; the conventional wisdom that hard beds are better for your back derives from the days when many Americans slept on old, sagging bunks. Doctors would advise people to put a board under the mattress, says Richard Deyo, MD, MPH, a back pain expert at the Oregon Health & Science University. Sinking into a sagging bed strains the muscles.
Your goal is a mattress that stays in contact with your body, supporting the normal curves of your back while yielding just enough. If it presses back against your hip or shoulder, you’ll need to shift, interrupting your sleep. That’s why side- and stomach-sleepers tend to appreciate softer beds. Heavier people, and those who sleep on their backs, need more support. A tall heavy man and a tiny woman probably won’t sleep best on the same surface, so if they’re sharing a bed, ideally, they’d customize each side.
The Better Sleep Council, an industry group, suggests reevaluating a mattress after five to seven years; in an industry-sponsored study, people with mild muscle pain felt better after replacing beds that were 9.5 years old, on average.
Should you decide to go shopping, the Council advises test-driving mattresses in the showroom by taking off your shoes and lying down in various positions, especially your usual sleeping pose. Unfortunately, in a 2011 study from RTI International, a North Carolina-based research firm, researchers concluded that people do worse than chance at picking a mattress that measurably improves their sleep.
The RTI team recruited 128 healthy adults without any major sleep issues and had them sleep on seven mattresses of varying firmness for up to a month each. They wore a device called an Actigraph, a sleep tracker that measured their movements during the night, and they also filled out diaries, recording their perceptions about pain, daytime drowsiness, and other issues.
The researchers used the sleep tracker data to determine which bed gave each subject the calmest night. The diaries backed up these conclusions; people had indeed reported feeling best after they had slept on the best bed. It also turned out that beds can matter a lot: the severity of morning pain and daytime sleepiness were significantly cut in the best bed compared with the second best and the average of the pack.
The researchers also had the subjects try out each of the seven mattresses as they would in a showroom. Only 38 percent chose a mattress that was among the top three from the Actigraph data, less than the number you’d expect by chance.
So if the showroom test doesn’t work, what can shoppers do? Some mattresses pumped with air let you adjust the firmness. Boutique latex mattress firms sell panels that can be stacked to adjust the firmness for each sleeper. You might test drive your mattress at home at different firmness levels.
If beds with adjustable firmness are beyond your price range, your best bet may be a “medium-firm” mattress. The middle path tends to work best, two American studies found. A Spanish research team came to the same conclusion in a study that appeared in the prestigious journal Lancet. This team divided 313 participants with low back pain between firm and medium-firm mattresses and compared the results after 90 days. Those who slept on the medium-firm mattresses had less pain in bed, upon arising, and during the day. In the United States, a medium-firm full-size coil mattress has at least 300 14- or 13-gauge coils.
Beds that adjust to different angles can be helpful, says Terry Cralle, a nurse and spokesperson for the Better Sleep Council. “You can take pressure off your lower back by raising your feet,” she says.
To save a bit, you may be able to get away with keeping your current box spring foundation, as long as the springs are still stiff, writes Consumer Reports. In its survey, about 80 percent of respondents who put a new mattress on top of an old foundation said they were sleeping better.
Some people swear by mattresses made of memory foam that is sensitive to temperature and conforms to the body. Since there is no conclusive scientific evidence that this kind of foam helps back pain, you might try a topper first. Toppers change how a mattress feels but not how it supports you. They can be made of feathers, fiber alternatives to feathers, latex, wool, and varieties of foam, and can help people with ongoing pain problems, Cralle notes.
March 25, 2015
Janet O’Dell, RN