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Thursday Thoughts July 22, 2021


“Tired minds don’t plan well. Sleep first, plan later.”

Walter Reisch

“The amount of sleep required by the average person is five minutes more.”

Wilson Mizener

Have a question? Ask away as part of our Ask Me Anything (AMA)


Sleep Positions and Mattresses.

Question: Hey doc, what is the best sleeping position for my back? While we’re talking about sleep, what about mattresses? Should I get a firm, soft, traditional innerspring, memory foam, latex, or adjustable air type mattress?

Answer: Over the years my general suggestion around sleeping postures has been to avoid stomach sleeping, as this position causes the most stress to the neck and back. I had not seen any evidence that there was a significant difference between side sleeping or back sleeping as far as back or neck pain.  THIS paper looked at the relationships between sleep posture and non-specific spinal symptoms in adults. While the studies were not considered high quality, it looks like side sleeping is best for reducing reported spinal pain and stiffness in the morning. My recommendation is to try to sleep on your side if have pain or if you tend to have pain and stiffness in the morning. Feeling good, have little to no pain or stiffness in the morning and you like sleeping on your back? No need to change a thing!

I found THIS paper interesting. It looked at sleep positions and numbers of position shifts per night in different age groups. The age groups in the study were 3-5, 8-12, 18-24, 35-45 and 65-80 years old. The younger the age, the more frequent position shifts / tossing and turning during the night. The oldest groups changed positions about half as frequently as the youngest groups. The younger the age the more time that was spent in all the various sleeping positions (back, side stomach) whereas with increasing age there was a progressive preference, very marked in the elderly, for right-side positions.

What about mattress firmness? THIS study evaluated the effects of mattress firmness on chronic low back pain. In this study of 313 adults with chronic back pain, a medium firm mattress resulted in less pain in bed, less pain on rising and less daytime back pain than when sleeping on a firm or soft mattress.

HERE is a Mattress Firmness Scale & Guide from Sleep Advisor.

What about mattress types? THIS small study of 30 people with chronic low back pain compared the study participants own innerspring mattress to an adjustable air bed such as THESE beds. The study found that on pain scales, 95% showed pain improvement, and 88% reported better sleep. The average improvements were a 32% pain decrease and a 73% increase in sleep quality. Eighty-five percent preferred the adjustable airbed.

THIS study of 27 participants looked at a medium firm mattress layered with memory foam and latex verses the participants own mattress. The study demonstrated progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly.

My recommendations: First, I recommend a medium firm mattress. I’m not a big fan of a mattress with a built-in pillow top. In my experience they tend to break down faster than the mattress does. If you like it a bit softer, I’d suggest getting a separate mattress topper. The next thing to consider is how much do you want to invest in a mattress? While I referenced studies that did show reported benefits in pain and stiffness with both the adjustable air beds and with memory foam / latex beds, I am not convinced that either style of mattress is significantly more beneficial than a middle of the road (price wise) medium firm innerspring mattress. I have many patients that love their adjustable air beds and many patients that love their memory foam or latex mattress, but these mattresses tend to have a higher price point. Many of the mattress companies will offer a satisfaction guarantee return policy as an enticement to try their brand.

HERE is a 2021 review of popular mattresses by US News & World Report 

HERE is a short (81/2 minute) video from Matthew Walker, Director of UC Berkeley’s Sleep and Neuroimaging Lab on some of the downsides of not getting enough sleep.

Next time I'll touch on pillows...

Jim McDaniel, DC

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