How to Evaluate a Mattress

There has been a lot of progress in mattress technology to better support and align the spine.

This article explains mattress types and their suitability for various sleep styles, body types, and personal preferences.

Generally, there are two main aspects to a mattress:

• Support – which comes mainly from the inner core of the mattress and the base.
• Comfort – which is provided by the layers above the core, such as cotton padding or foam, and may be minimal or several inches thick with many variables.

The features, materials, and construction of mattresses vary considerably.  Here is an explanation of the most common types:

• Innerspring mattresses are the most popular type of mattress, as they provide a traditional bounce feel and strong support from coils. The number of coils, along with the strength of the coils, generally determines the level of support. Typically, varying levels of padding are placed on top for comfort preferences. Some innerspring mattresses with an extra layer of padding are marketed as pillow-top mattresses.
• Latex mattresses are constructed from latex material, providing noticeably more bounce and responsiveness than innerspring mattresses. Users of latex mattresses may experience a comfortable sleep that is cooler than that of a memory foam mattress.
• Memory foam mattresses use a firm inner core of memory foam to provide support (with varying levels of cushioning on top). Memory foam provides support that contours to the body and typically lessens pressure points. Because the material adjusts to body temperature, some memory foam mattress users may sleep warm.
• Hybrid mattresses are built with some combination of memory foam or latex layers atop an innerspring mattress. The goal of this combination of materials is to provide a mix of support and softness.
• Air beds typically allow individualized adjustments to the firmness of the bed. The bed, and each side of the bed, has separate chambers of air, which can be increased or decreased and provides the core support. It is important to consider the amount of padding above the air-filled area, which is there for comfort. One potential drawback is the potential for a leak in the air chamber.
• Adjustable beds allow owners to raise or lower certain parts of the bed. Some people experience more comfort sleeping at a slightly inclined position, while others – back sleepers, in particular – enjoy positioning the bed to give support under the knees. Many adjustable beds come with a specific mattress and include the ability to customize mattress firmness and zoned support. Overall, these beds can help address certain back conditions. See Considerations Before Buying an Adjustable Bed

A typical mattress is built in layers:

Mattress springs and coils. The wire used in the coils with a lower gauge number denotes thicker, stiffer wire and a firmer mattress, and vice-versa. A higher concentration of steel coils may indicate a higher quality mattress, but this does not mean that the highest number is best.

Top padding. In addition to the spring coils in a mattress, the padding on top of the mattress can indicate quality. Extensive mattress padding is often more expensive, but many people find it more comfortable and worth the extra cost.  This layer can be made of memory foam, latex, and/or other materials or a combination of materials.

Some people may choose to add this layer separately as a mattress topper, as the top padding can then be changed or independent of the mattress.

Middle padding and insulation. Just below the top layer, there are several layers of padding made of various materials with varying firmness. For example, some materials may provide a layer of firmness in some areas of the mattress rather than others, such as increased firmness in the middle of the mattress.

Mattress foundation.  The mattress foundation or box spring adds another level of support to the mattress. Foundations usually consist of a wooden or metal frame with springs. A plain wooden frame may make mattresses feel harder than a boxspring made with springs. The Better Sleep Council recommends that purchasing a foundation and mattress as a set helps preserve the mattress.

As discussed above, there are many alternatives to traditional spring mattresses, such as mattresses that use an air pump to inflate the mattress to the desired firmness level.

Keep in mind that no single type of mattress or bed works well for everyone, and there is no best kind of mattress for all back problems. Likewise, there is no consensus on an ideal sleep position that applies to everyone. All of this is due to several factors:

• There are many causes of back problems, and the specific cause may respond better to types of mattresses and sleep positions
• Back pain can have numerous contributing and co-occurring factors, so a specific sleeping position may alleviate one contributing factor but exacerbate another. For example, someone with L4-L5 or L5-S1 degenerative disc disease and hip pain will need to consider both issues when selecting a bed.
• Sleeping preferences may be unrelated to the quality and support of a mattress. For example, some people prefer a mattress that keeps cool, so they don’t feel overheated at night.

For anyone with a mattress that is more than 5 to 9 years old, it may well be time to consider getting a new one. Medical research shows that participants switching from their used mattress to a new one usually reported a reduction in back pain and an improvement in sleep quality.¹Jacobson BH, Boolani A, Smith DB. Changes in back pain, sleep quality, and perceived stress after introduction of new bedding systems. J Chiropr Med. 2009;8(1):1-8. doi:10.1016/j.jcm.2008.09.002^,2Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010;42(1):91-97. doi:10.1016/j.apergo.2010.05.004.

On a final note, there is a limit on the amount and quality of medical research detailing the types of mattresses that are best for back pain. It is somewhat challenging to conduct a neutral study because participants know when they get a new mattress, even if they don’t know the exact type. Therefore, there may be somewhat of a placebo effect in mattress testing.

To counteract the lack of directive medical findings, there are extensive reviews of mattresses available online, as well as typical mattress trial periods and guarantees, all of which help when evaluating and choosing a new mattress.