Should My Mattress be Firm or Soft?

Matress Firmness
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Question: Should My Mattress be Firm or Soft?

If you have chronic neck or back pain, you may know from first-hand experience how this condition can limit things like the number of hours of sleep you get per night, how restful the sleep you do get is, how well you function during your waking hours, and similar sleep-related states of being.

Related: Find a Sleeping Position Your Back Likes

Researchers from Ireland reviewed 17 studies looking at ways in which chronic low back pain affected participants’ ability to get a good night’s rest.

The review, which was published in the Feb 2011 issue of Clinical Journal of Pain, confirmed that chronic low back pain may indeed disturb or otherwise affect the quality of sleep. The researchers also found that back pain may reduce sleep satisfaction, as well as the ability to fall asleep in the first place.

In other words, if you have chronic low back pain, chances are excellent you have a lot stacked against you at bed time.


Mattress Shopping for Those With Bad Backs

If you are anything like me, you’re interested in minimizing the number of obstacles between you and your rest. And if you have a back problem, selecting the right mattress — in other words, matching your mattress choice to your back’s uniquely individual needs for support and comfort — may prove an excellent strategy.

To my mind, shopping carefully for a mattress could even be considered a component of your pain management plan.

However, it’s a process, and to truly be a careful mattress shopper, you need to allot ample time. I, myself, start way in advance (like a year or two), so that I can, with minimal stress and disruption to my usual routine, enable full understanding of the available mattress choices, as well as how each interacts with my spine.

Related: How to Buy a Mattress for a Bad Back

Of the numerous considerations that come with mattress shopping, the question people most frequently want to know is: How hard, or soft, should my mattress be?

I asked Dr. Michael Perry, M.D., Medical Director of the Laser Spine Institute in Tampa, FL, for his recommendations. He advises staying away from either extreme (of hardness or softness) when selecting a mattress. The studies that have been done to date generally find that a medium-firm mattress does the trick with most types of back problems, and Dr. Perry says his clinical experience shows this as well.

Overall, there haven't been many studies in the area of mattress selection for bad backs. Just the same, here are a few research highlights that can further assist you in determining how hard or soft your bed should be, and the type of mattress that may deliver the support and comfort that is right for you. 

Temporary Back Pain from Foam Mattresses- A Survey of 100 Indian Medical Residents

A survey of 100 medical residents conducted in India found that sleeping on 10 centimeter foam mattresses — the kind they have in youth hostels — resulted in a temporary backache. (The backache was not accompanied by nerve symptoms such as sciatica, parasthesia and similar sensations.) In 61% of the participants, this sleep-induced pain was relieved when the residents returned to their own beds, and it came back when they once again slept on the foam.

Related: Radiculopathy Symptoms

Soft, Medium or Hard? A Randomized Controlled Trial that Evaluated All Three

In an effort to confirm whether hard mattresses have a positive effect on symptoms associated with chronic low back pain (as is commonly believed), researchers from The Back Research Center (part of Clinical Locomotion Science, Backcenter Funen, at the University of Southern Denmark in Ringe, Denmark) divided 115 study participants into 3 groups and had them sleep on mattresses of varying degrees of firmness for 1 month.

The “soft” mattress group slept on a water bed (an Akva). Another group slept on a Tempurpedic mattress, which is known for its ability to conform to your body shape, while at the same time providing support. And the “hard” mattress group slept on a futon.

Study participants were interviewed for pain levels on a scale of 1 to 10 (1 represents little to no pain, and 10 represents pain to the max).

Participants were also questioned as to how well they functioned in their daily activities, and the number of hours they slept per night.

Related: Track Your Pain with Pain Charts

The researchers found that, overall, the participants favored the water bed and foam (Tempurpedic) mattresses on the stated measures.

But the difference in scores between these 2 types of mattresses and the hard mattress was small.

When I asked Dr. Perry what his favorite mattress type is, he replied that a Tempurpedic with a dial-in firmness feature would be his top choice. The reason for this, he says, is that if you need more support, you can get it simply by adjusting the dial. “The beauty of Tempurpedic is that you can get support where you need it. You can also get softness where you need it,” he says.

Perry adds that a dial-in water bed also has advantages. More water equals more firmness, he says. “Just remember not to dial in so much water that your mattress bursts,” he quips.

On the flip side (though more seriously), Perry says that if you don’t dial in enough water, your water bed mattress may surround and enclose your body, which can affect your sleep and decrease its quality.

In fact, he says, “some of my patients report they feel smothered in a water bed when they don't dial in enough water firmness." This is because your lungs have less room to expand when, relatively speaking, you sink down into your mattress.

Of course, he says, the cure is to firm it up by in dialing more water. After that, you're ready to realize — in terms of restful repose — the benefits of having invested your time and attention into proper mattress selection.


Bergholdt K, Fabricius RN, Bendix T. Better backs by better beds? Back Research Center, Part of Clinical Locomotion Science, Backcenter Funen, Ringe, Denmark. Spine (Phila Pa 1976). 2008 Apr 1;33(7):703-8.

Jacobson BH, Gemmell HA, Hayes BM, Altena TS. Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. Manipulative Physiol Ther. 2002 Feb;25(2):88-92.

Kelly GA, Blake C, Power CK, O'keeffe D, Fullen BM. The association between chronic low back pain and sleep: a systematic review. Clin J Pain. 2011 Feb;27(2):169-81. doi: 10.1097/AJP.0b013e3181f3bdd5.

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.

Koul PA, Bhat MH, Lone AA, Koul AN, Wahid A. The foam mattress-back syndrome. J Assoc Physicians India. 2000 Sep;48(9):901-2.

Perry, M. MD. Telephone Interview. March 11, 2013.

Jacobson BH, Wallace TJ, Smith DB, Kolb T. Grouped comparisons of sleep quality for new and personal bedding systems. Appl Ergon. 2008 Mar;39(2):247-54. Epub 2007 Jun 26.

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