Persistent back pain can seriously affect the quality of life and this includes impaired sleep. A quality mattress could help relieve back pain, facilitating better rest, but with so many options available, choosing the right mattress can be a real challenge.

While many of us believe that sleep is a time when nothing happens, sleep is, in fact, at least from a neurological point of view, a very busy period of time.

Basically, during sleep the body restores itself.

Two behavioral types of sleep are known: slow sleep and paradoxical sleep.

During the slow sleep, a series of functional changes occur, such as:

➢ diminishing in the frequency of respiratory movements with decreased pulmonary ventilation
➢ slowing of the heartbeat
➢ peripheral vasodilation
➢ slight increase in cerebral blood flow
➢ decreased renal blood flow
➢ mild hypothermia etc.

Although slow sleep seems to be shallow, in reality its depth is quite great.

Sleep with fast or paradoxical waves (REM phase - rapid eye movement) alternates with periods of slow sleep. The name is due to the fact that during this period of sleep, people are very agitated, with eye movements and with physiological changes different from those in the slow sleep phase.

In the paradoxical sleep phase the following happen:

➢ reduction of muscle activity, including antigravitational muscles and those in the back of the neck
➢ changes in heart and respiratory rate
➢ slight tendency to increase arterial pressure
➢ peripheral vasoconstriction.

During slow sleep, the muscles are not "paralyzed" as during the paradoxical sleep and we move (we roll from one side to the other, we change the sleep positions). Moreover, a good posture is also important when we sleep because the muscles and ligaments (the tissue that holds the joints together) in the back must relax and recover during sleep.

If the mattress is too firm/hard, it will not properly support the curvatures of the spine, namely, the slight extension from the cervical level (to the neck) and from the lumbar level (the lower back). Research on the mattress suitable for the needs of the back is still limited, but in one study, new mattresses were assigned for 90 days to more than 300 people with low back pain, both medium firmness mattresses and hard/firm mattresses). People in the group with medium firmness mattresses reported minimal or limited back discomfort compared to the group of people who slept on hard/firm mattresses.

If there is already pain and/or inflammation in the back and a very hard mattress is chosen, the back may suffer even more during the movements in the sleep.

Although the feeling of sleeping "like a baby" can be pleasant, the curvatures of the spine are not supported enough (the lumbar part of the back sinks into the mattress instead of being in slight extension, as it is physiological). Basically the muscles will work continuously trying to keep the correct position of the spine. Also, due to the soft surface, movements during sleep will be even more difficult.

In conclusion, in terms of firmness, a mattress with medium firmness is a good option for people suffering from low back pain.

Memory foam technology was originally designed for the sanitary environment. Adapting to the morphology of the body, it helps prevent the formation of skin lesions in the case of bedridden patients for long periods of time. Nowadays, these mattresses are accessible to everyone and are worth opting for, as they adapt perfectly to the shape, weight and body temperature, modeling themselves accordingly. For optimal comfort, however, the memory layer should not exceed 7 cm.

Mattresses have evolved a lot in recent years respecting the benefits of proper alignment of the spine during sleep (proper alignment means that the shoulders and hips sink easily, while the lumbar spine has support). Thus, mattresses that offer this zonal support tend to be the right choice.

The life span of a mattress is 9-10 years, after which it must be replaced.

Even if the mattress is suitable, it is not the only thing that matters when it comes to managing back pain during sleep. The position of the body is important, as well as the pillows used, which must provide a correct lifting of the neck and shoulders.

If a high pillow is used, pain will occur in the cervical spine, because the neck muscles will be in a permanent tension.

If many hours are spent during the day on the phone or computer, during which the head and neck are tilted forward, in order to correct or counteract this position during the day, it is recommended to sleep on your back, with a pillow that supports the curvature of the cervical spine, allowing the head to fall back, to be in slight extension.