Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain Bert H. Jacobson * , Ali Boolani, Guy Dunklee, Angela Shepardson, Hom Acharya 204 Willard Hall, Oklahoma State University, Stillwater, OK 74078, USA article info Article history: Received 24 September 2009 Accepted 15 May 2010 Keywords: Mattress Back Pain Stiffness Sleep quality Position abstract The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions. Subjects consisted of 27 patients (females, n ¼ 14; males, n ¼ 13; age 44.8 yrs Æ SD 14.6, weight 174 lb. ÆSD 39.6, height 68.3 in. Æ SD 3.7) referred by chiropractic physicians for the study. For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds. Subsequently, participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants’ reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks. Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p < 0.01) differences between the first posttest mean and weeks 4 and weeks 8e12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experi- encing poor sleep and physical discomfort decreased significantly. It was concluded that sleep surfaces are related to sleep discomfort and that 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. Ó 2009 Published by Elsevier Ltd. 1. Introduction Sleep is essential to physical, mental and emotional health. For most adults, 7e8 h of sleep per night appears to be the ideal, however, 75% of Americans have sleep problems during a typical week (National Sleep Foundation, 2005). It has been estimated that over 70 million people are currently affected by sleep problems and this number is expected to increase to over 100 million by 2050 (Reiter, 2005). Currently, the average adult gets less than seven hours of sleep per night (National Sleep Foundation, 2005) and such chronic lack of sleep (insomnia) affects quality of life, social interaction and mood (Lee, 2005). Additionally, sleep deficiency results in loss of work production, increased sick days, greater absenteeism, loss of productivity and higher injury rates (Chilcott and Shapiro, 1996; Drake et al., 2004; Ohanyon and Lemoinie, 2004; Godet-Cayre’ et al., 2006; Hillman et al., 2006). Primarily, stress and musculoskeletal discomfort contribute to the lack of sleep. Typical musculoskeletal complaints that interfere with sleeping are lower back pain and shoulder pain. A common belief is that a firm mattress is beneficial for low-back pain, but evidence supporting such claims is lacking. In a survey of orthopedic surgeons 95% believed that a mattress played a part in the management of low back pain and 75% recommended firm or hard mattresses for the relief of back pain (Levy and Hutton, 2000). To compound the problem manufacturers of bedding systems make claims relative to health benefits derived from using selected mattresses. These claims are also are largely unsupported and not based on empirical research. Bader and Engdal (2000) found that some mattress ads depict how the contour of the bed surface conforms to that of the body, but they suggest that there is no evidence that “change in spine curvature is produced while sleeping on hard or soft surfaces”. In contrast, Lahm and Iaizzo (2002) concluded that mattress inflation induces changes in spinal alignment, but with no correlation in EMG activity. A significant relationship between pain and sleep has been noted (Marin et al., 2006), but few studies have compared bedding systems or have attempted to obtain data for accurately recom- mending mattresses for the improvement in sleep quality or reduction in specific musculoskeletal discomfort. While some have suggested that mattress differences do not significantly affect sleep quality (Sullivan, 1993; Scharf et al., 1997; Buysse and Reynolds, 1999), most researchers agree that sleep surfaces are * Corresponding author. Tel.: þ1 405 744 6632; fax: þ1 405 744 7758. E-mail address: Bert.jacobson@okstate.edu (B.H. Jacobson). Contents lists available at ScienceDirect Applied Ergonomics journal homepage: www.elsevier.com/locate/apergo 0003-6870/$ e see front matter Ó 2009 Published by Elsevier Ltd. doi:10.1016/j.apergo.2010.05.004 Applied Ergonomics 42 (2010) 91e97