Choosing the Right Mattress for Spine Health

Choosing the right mattress firmness can make a meaningful difference in how you sleep, especially as we age. For adults over 55, the wrong mattress can contribute to back pain, joint stiffness and disrupted sleep, while the right level of support can help promote proper alignment, ease pressure on the spine and improve overall comfort.

We recently spoke with two orthopedic experts, HOI affiliated orthopedic spine surgeon, Dr. Casey Slattery, and HOI physical therapist, Jennifer Brandon, PT, to discuss mattress firmness, spine health and practical ways to sleep more comfortably.

Q: What orthopedic or spinal conditions in adults over 55 might make a firm mattress a better choice for sleep?

Dr. Slattery: In general, a firmer mattress is a better choice for most spinal conditions. A soft mattress can cause excessive sinking and flattening of the spine while on your back, or a hammock effect on your side. Firm support aids in keeping the spine neutral, helping to offload intervertebral discs which can be a common source of low back pain.

Jennifer Brandon, PT: In general, a firmer mattress is preferable for everyone to promote proper alignment, but especially for those with low back pain from stenosis or herniated discs. For those who are generally deconditioned, a firm mattress provides more stability for getting in and out of bed and using their arms for leverage.

Q: Which orthopedic or spine-related conditions can be made worse by sleeping on a mattress that’s too firm?

Dr. Slattery: A mattress that is too firm can cause pressure point issues. Laying on your side can exacerbate or cause greater trochanteric bursitis for example, often mistaken as sciatica. Firm mattresses can also prevent the shoulders from sinking adequately leading to pain and stiffness.

Jennifer Brandon, PT: An extremely firm mattress may cause discomfort for “achy” arthritic joints. Anyone with fragile skin should be aware of bony prominences and their skin integrity if sleeping on a firm surface.

Q: If someone benefits from a firmer mattress but wants to find ways to get more comfortable, what advice can you offer?

Dr. Slattery: If you suffer from pressure-sensitive conditions, consider a mattress topper. This provides a firm base, but allows cushioning for pressure relief. Consider supportive pillows for more comfort with a firm mattress. Side sleepers can place a pillow between their knees to align their hips and reduce hip and low back strain. Back sleepers can try a pillow under their knees and stomach sleepers can try a thin pillow under the pelvis. Ultimately, it may come down to experimenting with pillows and positioning to increase your sleep quality and improve comfort.

Jennifer Brandon, PT: There are many options to increase one’s comfort when using a firmer mattress such as an adjustable bed. Adding a pillow topper for a little cushion or using a weighted or electric blanket could provide a more calming environment. Try a pillow between your knees when on your side and possibly one behind your low back for support. In addition, hug a pillow in front to optimize your alignment.