Mattresses are now offered in a wide range of styles and materials, each with its own unique benefits and drawbacks. When choosing a new mattress, it is important to consider the following:

  • Level of support. A firmer mattress that provides the spine with additional support is generally preferred, and some studies have noted benefits from the use of a medium-firm mattress. 1 Burton AK, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2:S136-68. And Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491. A mattress that supports the spine along its natural curves and keeps the spine in the same body position as good standing posture can provide relief from certain types of lower back pain.

    See Considerations When Buying a New Mattress

  • Issues related to a hard mattress. While a firm mattress is usually preferred, a mattress that is too hard can cause aches and pains in pressure point areas, such as the hips. Inflammation of the bursa over a person’s hips (greater trochanteric bursitis) is particularly likely to be exacerbated from a mattress that is too firm. People who sleep on their sides—with pressure point areas like the hips and shoulders pressed against the mattress—may also experience discomfort and sleep disruption from a hard mattress.

    See How to Evaluate a Mattress

  • Compatibility with an adjustable bed. An adjustable bed is a base that can be adjusted to various angles. Certain mattresses are not compatible with adjustable beds, so it is important to consider adjustable beds and mattresses in tandem.

    See Considerations Before Buying an Adjustable Bed

  • Pillow-tops provide a softer surface. A pillow-top can help create a softer layer on top of the mattress. Pillow-tops come in a range of softness and thickness, and they are also incorporated into some mattresses. Pillow-tops come in a variety of materials with varying characteristics. For example, pillow-tops may come with a heating component that provides soothing heat therapy; natural wool pillow-tops are relatively expensive, but provide warmth when it's cold and are cooling when it's warm. Egg crate pillow-toppers are less expensive, but they can run on the warm side and tend to wear out quickly.

In general, any mattress and/or pillow-top that results in good sleep, so that the sleeper wakes feeling rested without pain and/or stiffness, is recommended for that person.

Sleeping Position Guidelines

There are no absolute rules when it comes to sleeping positions, but the following general guidelines may be useful:

  • The best sleeping position typically is to lie on the back with a small pillow tucked underneath the back of the knees for support. This position helps to unload the stress on the spine, and supports the natural curvature of the lower back.
  • For people who prefer sleeping on their sides, it is helpful to place a pillow between the knees to reduce stress on the hips and lower spine.
  • For people who sleep best on their stomachs, placing a flat pillow beneath the stomach and hips can minimize stress on the lumbar spine.

See Best Pillows for Different Sleeping Positions


Sleep positions may affect mattress choices. A stomach sleeper may feel more comfortable on a firmer mattress, because a softer mattress may cause the back to arch. Side sleepers, however, may prefer a slightly softer mattress that conforms more to the body.

Dr. Richard Staehler is a physiatrist at the NeuroSpine Center of Wisconsin. He has more than 20 years of experience providing non-surgical treatment for spine pain.

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