At the end of a long day, you change into comfy PJs and head for bed. Maybe now you’ll be able to relax. However, you quickly find that, once again, bedtime just isn’t restful. Whether it’s tossing and turning or back pain that keeps you uncomfortable. morning comes and you’re still tired. The Sleep Foundation estimates that 10-30% of adults battle some type of insomnia.
There are many reasons for difficulty sleeping, one of the most basic is your sleeping surface. Research shows that even for healthy people with no known sleep problems, a mattress can make a difference in how we sleep.
A study published in 2006 evaluated perceived back discomfort and stiffness, sleep quality and comfort, and sleep efficiency (ratio of total sleep time to total time in bed). Participants recorded these elements each morning for 28 days in their own bed. They repeated the process sleeping on a new medium-firm bedding system.
Upon analysis, researchers found that there were “significant differences between pre- and post means in all areas for both high and low sleep quality groups” which increased over time. These improvements were independent of other variables such as age, weight, height, and body mass index, suggesting that the improvements in sleep were a direct result of the sleep system.
These findings align with an earlier study published in 2002 in which researchers examined the connection between mattress inflation pressure and EMG activities, heart rates, blood pressures, subjective comfort levels and spinal alignment data. Again, healthy, back-pain-free subjects were selected for the evaluation. Readings were recorded as participants laid down on their side at three different mattress inflation pressures.
The spinal alignment assessment showed a significant difference in the three inflation pressures studied. Even in these healthy subjects, there were minor changes in EMG activity, heart rate, blood pressure and/or subjective comfort. While the changes were not significant physiologically, this provides a baseline that can be used when evaluating those with acute or chronic pain.
What does this mean for someone who suffers with neck or back pain?
If changing the mattress can improve the sleep of someone who does not already have back pain or sleep issues, can it help those who DO have back pain or sleep issues? The answer from multiple studies is a resounding YES!
A 2010 study evaluated sleep quality and comfort of patients who had been diagnosed with low back pain and stiffness upon waking, and had been referred by their chiropractor for participation. Study subjects recorded back and shoulder discomfort, sleep quality, comfort and primary sleeping position for 21 days while sleeping in their own bed as normal. Following that, their beds were replaced with new medium-firm mattresses, specifically layered with foam and latex according to sleeping position.
Participants slept on the new mattresses while again recording the same elements for 12 weeks. Researchers found “significant differences between pre- and post means for all variables and for back pain.” These improvements were not only from baseline to after the introduction of the new mattresses, but between baseline and 4 weeks, with continued improvement at 8 and even 12 weeks.
The differences were two-fold. First, they had a decrease in the number of days per week that they had poor sleep and physical discomfort. Secondly, for a given day, their pain and discomfort was reduced resulting in higher quality sleep. The researchers concluded that it is “indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position.”
A 2003 study published in the Lancet examined the difference between firm and medium-firm mattresses for people with chronic, non-specific, low back pain. They found that the patients who slept on a medium-firm mattress had better outcomes across the board: less pain in bed, less pain on rising, and less disability that those who slept on the firm mattress. They also experienced less day-time low back pain, than those who slept on the firm mattress. They concluded that sleeping on a medium-firm mattress can improve pain and disability for chronic, non-specific, low-back pain.
Recently, a large Norwegian study was published using data from over 5000 participants in the Norwegian HUNT study who reported chronic LBP at baseline. In this study, researchers wanted to determine the connection between sleeplessness and insomnia symptoms on chronic back pain recovery. They made a few interesting observations:
- Those who frequently experienced sleeplessness had a lower probability of recovering from chronic low back pain as compared to those without sleeplessness.
- Subjects who frequently experienced sleeplessness and also had 5 or more chronic pain sites had even lower recovery rates that those who did not experience sleeplessness or who had only 1-2 chronic pain sites.
Similar to the other studies, researchers concluded that taking steps to improve sleep problems may help improve the long-term prognosis of chronic back pain.
Sleep is an important part of our day. According to the Sleep Foundation, recommendations for the amount of sleep a person needs can range from 7-8 hours for adults, up to 17 hours for newborns.
Why so long? Many bodily processes take place overnight when our body is at rest. A great deal of healing and restoration take place and practically every bodily system is rejuvenated during sleep. It is not only the quantity of sleep, but the quality of sleep that is important.
Therefore it is important to make a concerted effort to practice what the Sleep Foundation calls good “sleep hygiene,” (your bedroom setting and sleep-related habits) in order to give our body the greatest benefit.
We know there are a number of reasons that people have difficulty sleeping. Caffeine consumption, other activities occurring in or near the sleeping area (noises made by people or animals) and stress are just a few. However, multiple research studies have shown that back pain and sleep have a significant impact on each other.
Talk to your chiropractor at your next visit about your sleeping habits and sleep surface. Whether it’s sleep position, dietary changes or getting a new mattress, your chiropractor is knowledgeable about what the body needs to not only sleep enough, but also to sleep well. Your chiropractor can help you determine what steps to take so that you can get your zzzzz’s.
Jacobson 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 Dec;42(1):91-7. doi: 10.1016/j.apergo.2010.05.004. Epub 2010 Jun 26. PMID: 20579971.
Jacobson BH, Wallace T, Gemmell H. Subjective rating of perceived back pain, stiffness and sleep quality following introduction of medium-firm bedding systems. J Chiropr Med. 2006;5(4):128-134. doi:10.1016/S0899-3467(07)60145-1
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. doi: 10.1016/S0140-6736(03)14792-7. PMID: 14630439.
Lahm R, Iaizzo PA. Physiologic responses during rest on a sleep system at varied degrees of firmness in a normal population. Ergonomics. 2002 Sep 15;45(11):798-815. doi: 10.1080/00140130210159968. PMID: 12487692.
Skarpsno ES, Mork PJ, Nilsen TIL, Nordstoga AL. Influence of sleep problems and co-occurring musculoskeletal pain on long-term prognosis of chronic low back pain: the HUNT Study. J Epidemiol Community Health. 2020 Mar;74(3):283-289. doi: 10.1136/jech-2019-212734. Epub 2019 Dec 4. PMID: 31801790.