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The frequency of LBP-disrupted sleep and the fact that LBP is the top presenting complaint in chiropractic offices (2) makes LBP-related sleep questions all too familiar. And as a chiropractor, 3-5 minutes of your day vanish each time a patient asks, “Hey doc, do you have any advice on the best type of mattress?”

How do we know? We asked the ChiroUp provider network and FTCA followers about their mattress education protocols. (3) This blog helps define what mattress do chiropractors recommend. And we’ll also share the sage advice of more than 200 providers to help answer your patient’s five essential mattress-related questions…quickly. Now, let’s dive into the facts about sacks.

1. What Is the Best Type of Mattress?

The elusive answer to this question begins to crystalize after assessing three sources: consumer satisfaction, evidence-based research, and evidence-informed opinion.

Consumer satisfaction

The JD Power 2021 Mattress Satisfaction Report demonstrated similar overall customer satisfaction between all top-selling mattress styles. (4)

Evidence-based research

At least two recent systematic reviews make a case for adjustable air beds.

Results of this systematic review [of 24 qualified articles] show that a mattress that is custom inflated (self-adjusted) is optimal for promoting sleep comfort, quality, and spinal alignment. (5)
Sleep quality [improves] when the rigidity of the air mattress is varied based on the participant’s preference. (6)

Several other studies have endorsed different types of mattresses. And more than one author has confirmed there is no clear-cut research consensus on any superior mattress type:

Literature findings are discordant on the type of mattress that might prevent onset of back pain [and] improved quality of sleep. (1)

Expert opinion: What Types of Mattress Do Most Chiropractors Recommend?

Since existing literature does not provide a definitive evidence-based answer, the ChiroUp team launched a survey on current evidence-informed opinions to that question. (3)

The ChiroUp 2022 Mattress Survey results found that individual chiropractors endorse different “best” mattresses for their patients.

Expert opinion: What Types of Mattress Do Most Chiropractors NOT Recommend?

Conversely, each kind of mattress has chiropractic critics, with waterbeds taking the most heat and airbeds having the fewest detractors.

Net endorsement score

Assessing the chiropractor’s survey responses by subtracting the percent of discouraged (detractors) from the percent of recommended (promoters) generates a net endorsement score for each type of mattress with a possible range of -100 to +100. Not surprisingly, the scores are relatively similar, except for waterbeds which are strongly discouraged by chiropractors.

Bottom line: Most chiropractors agree that no single style of mattress is best for everyone. Factors to consider include body size, sleep position, and significant health conditions.

2. What is the Ideal Mattress Firmness?

Again, patients and evidence-based chiropractors can examine the same three factors: consumer satisfaction, research, and expert opinion.

Consumer preference

A study of more than 1,000 consumers who participated in mattress purchasing decisions revealed consumers fall into four similar-size groups when it comes to optimal mattress firmness: (7)

Research

While many clinicians have historically endorsed the “harder is better” philosophy, recent research found that an excessively firm mattress may not be the best type of bed for everyone.

[On a hard mattress] contact pressure increased significantly, which could cause discomfort and health problems. (8)

Two recent systematic reviews both concluded that a medium to firm mattress is probably the best type of mattress for back pain sufferers:

“Results of this systematic review [of 39 qualified articles] show that a medium-firm mattress promotes comfort, sleep quality and [vertebral column] alignment.” (1)
“Results of this systematic review [of 24 qualified articles] show that a mattress that is subjectively identified as a medium-firm mattress… is optimal for promoting sleep comfort, quality, and spinal alignment.” (5)

Multiple studies have concluded that excessively soft mattresses do not provide adequate lumbar support. And a 2022 study on the relationship between mattress stiffness and neck pain concluded that soft mattresses might not be the best type of mattress for neck pain either.

Compared to a medium or firm mattress, a soft mattress increases cervical lordosis, and leads to 49% higher disc loading. (8)

Expert opinion: What Level of Mattress Firmness Do Most Chiropractors Recommend?

Individualized advice

Many survey participants recognized that individual circumstances often warrant an alternate level of firmness. Here’s their top chiropractic mattress advice:

Choose a firmness that keeps your spine in a neutral position. Have someone snap a picture, then assess how you line up in your habitual sleep position(s).

Back and stomach sleepers typically prefer a firmer mattress, while the best type of mattress for side sleepers may be one with a little more cushioning.
Consider a separately adjustable bed if your sleep partner prefers a different mattress firmness.
When in doubt about the best mattress type for back pain, go with the firmer yet comfortable option. You can always soften a mattress with a topper, but you can never firm up a soft bed.

Bottom line: Patients prefer a wide variety of mattress firmness, from very soft to very firm. Research and expert opinions suggest that a soft mattress is not ideal. A medium to firm mattress is probably the optimal starting point; however individual factors are the ultimate guide to defining what type of mattress is best for back pain and other musculoskeletal conditions.

3. How Often Should You Replace a Mattress?

A consumer research report from the International Sleep Research Association found that most people replace their mattresses between 5-10 years, with a mean replacement age of 9 years. However, 16% wait more than ten years to replace their bed, while a similar number (15%) replace it within the first five years. (9)

Our 2022 ChiroUp Mattress Survey results indicate that nearly 9 out of 10 chiropractors recommend mattress replacement somewhere within a 5-10 year cycle.

The Mattress Stick Test

A dip in the mattress means support is fading. Like athletic shoes, the support is likely inadequate if you notice a visible breakdown.

Bottom line: Most mattresses should be replaced every 5-10 years; however, patient sleep position, weight, and mattress construction all play a role. (Springs and foam may wear out quicker, while air doesn’t break down as easily.)

4. Where Should Patients Buy Their Mattress?

Approximately 17-36 million new mattresses are sold annually in the US. (10,11) The current average mattress cost varies by several factors, primarily construction: (10,12)

Online options

Almost half of mattress consumers (41-45%) are now buying their beds online, and the trend is growing, particularly among younger consumers. (9,10,13) In 2019, CNBC reported that at least 175 bed-in-a-box companies already sold mattresses online. (14) Consumers should weigh the ease of online mattress shopping vs. the ability to test drive several options in person.

Top mattress shopping advice from chiropractors

Here’s what our survey respondents said about choosing a mattress:

You spend one-third of your life on a bed, don’t skimp on that investment.
Conversely, the most expensive is not always the best type of mattress.

When mattress shopping, wear comfortable clothes and lie down on several beds to see which one feels best.
Don’t judge various kinds of mattresses by the first few seconds of comfort. Lay on each for at least 10-15 minutes.
Make sure the vendor offers a trial period of 60-90 days with a reasonable return or exchange policy, especially if you buy online.
Remember that anything new can be uncomfortable at first. Give a new mattress at least a few break-in nights before you abandon it.

Chiropractic Mattress Vendor Affiliate Options

Less than five percent of chiropractors use some type of mattress affiliate referral program. Most of those who do, leverage a personal relationship with a local mattress store; however, a few utilize a formal referral program, including BioPosture ®, Saatva®, Twinkle®, Layla®, or AlignaSleep®.

Bottom line: Our survey revealed that by far, the most frequently mentioned patient advice was “make sure you can return your mattress.”

5. How Do Providers Relay Mattress Answers Quickly?

As noted earlier, our survey found that 80% of DCs spend at least 3-5 minutes each time a patient asks, “So doc, what mattress do chiropractors recommend?” Now ChiroUp subscribers can slim that discussion to about 15 seconds with a response like this:

Great question! I’m part of a team of chiropractors who work together to define the best care and recommendations for you. I will give you some research and advice we compiled to help you choose the best mattress. Please look it over and let me know if you have any questions. 💥💥💥

Here are two ways for subscribers to deliver that information to patients:

Attach the new Mattress Replacement ADL to any Condition Report. And if you have any additional specific mattress advice, don’t forget to customize your ADL for total education automation!
Download or print the following handouts from the search bar of your Forms Library. (Hint: Search for the infographics by name in the search bar)

Automating Clinical Excellence

So, if only three people ask the dreaded mattress question each week, this new education resource saves you approximately 10 hours per year per provider! How many more patient visits will you fit into that bonus 10 hours? Maybe 20, 40, or 60? Multiply that number by your average OV collection, and you’ll quickly realize that this one tiny resource alone will easily cover the investment of a ChiroUp subscription.

Not yet a ChiroUp Subscriber? Start saving more TIME without compromising your CARE.

Free 14-Day Trial - No credit card required | No commitment.

1. Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology. 2021 Dec;22(1):1-24. Link
2. Bertelsman TJ, Steele BC, Gower JG. 2021 ChiroUp Network Dataset: Statistical Reporting of 631,970 Clinical Diagnoses Collected from 2212 Evidence-Based Chiropractic Providers Between July 2019- June 2021. Accessed on 07/30/2021 from Link
3. ChiroUp 2022 Mattress Survey to ChiroUp subscribers and Forward Thinking Chiropractic Alliance followers. October 2022.
4. JD Power 2021 Mattress Satisfaction Report. 11/02/2021. Accessed on 10/22/2022 from Link
5. Radwan A, Fess P, James D, Murphy J, Myers J, Rooney M, Taylor J, Torii A. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep health. 2015 Dec 1;1(4):257-67. Link
6. Yu H, Shin OS, Kim S, Park C. Effect of an inflatable air mattress with variable rigidity on sleep quality. Sensors. 2020 Sep 17;20(18):5317. Link
7. Perry D. BSC Research: Consumer Mattress Buying Behavior, Part 3, All About the Bed. Bed Times. 05/14/2021. Accessed on 10/22/2022 from Link
8. Hong TT, Wang Y, Wong DW, Zhang G, Tan Q, Chen TL, Zhang M. The Influence of Mattress Stiffness on Spinal Curvature and Intervertebral Disc Stress—An Experimental and Computational Study. Biology. 2022 Jul 8;11(7):1030. Link
9. Perry D. BSC Research: More Consumers Moving Online. Bed Times. 01/12/2021. Accessed on 10/22/2022 from Link
10. Hales D. Mattress Sales Statistics (2022) NapLab. 06/09/2022. Accessed on 10/22/2022 from Link
11. Jennifer P. (October 25, 2019). Mattresses Sold Per Week, US. Accessed on 10/21/22 from Link
12. Tuck. Best Airbed Mattresses – Top Picks and Buyer’s Guide. Accessed on 10/30/2022 from Link
13. Consumer Reports. Best Places to Buy a Mattress. 09/02/2022. Accessed 10/21/2022 from Link
14. Wu J. There are now 175 online mattress companies—and you can't tell them apart. CNBC Online. 08/18/2019. Accessed on 10/21/22 from Link

5 Chiropractic Recommendations for the Best Type of Mattress