Changes in back pain, sleep quality, and perceived stress after introduction of new bedding systems

As trained professionals, we’re all aware of the essential restorative and regenerative powers of a good night’s rest. But do our patients understand the role sleep plays in stress, pain, focus and health? Our consistent goal as healthcare experts and educators is to take what our patients are doing on a daily basis (repetitively for years and years) and tweak their routines, so the decisions and products they surround themselves with will help to move them towards health, instead of away from it. From the coffee they drink to the mattress they spend more than a third of their life on, these choices all collectively add up.

Ask yourself a few questions:

  • Do you talk enough with your patients about how they sleep?
  • Do you ask your patients with back or neck pain, how old their mattress is or when was the last time they flipped it?
  • Do you have patients who consistently get out of bed in pain?
  • Could their mattress be affecting your ability to get them healthy?

We recently came across the study below that made us ask: Could we be missing a major factor in pain and recovery if we have patients sleeping on old, inferior mattresses?

Changes in back pain, sleep quality, and perceived stress after introduction of new bedding systems

Bert H. Jacobson, Ali Boolani and Doug B. Smith



This study compared sleep quality and stress-related symptoms between older beds (5 years or older) and new bedding systems.


A convenience sample of healthy subjects (women = 30; men = 29) with minor musculoskeletal sleep-related pain and compromised sleep, but with no clinical history of disturbed sleep, participated in the study. Subjects recorded back discomfort and sleep quality upon waking for 28 consecutive days in their own beds (baseline) and for 28 consecutive days (post) on a new bedding system using visual analog scales. Following baseline measures, participant’s beds were replaced by new, medium-firm beds, and they again rated their sleep quality and back discomfort. Stress was assessed by a modified stress questionnaire.


Repeated-measures analysis of variance was used to treat sleep quality and efficiency and factored responses of the stress items. Results indicated that the subjects’ personal bedding systems average 9.5 years old and were moderately priced. Significant (P < .01) improvements were found between pre- and post-test mean values in sleep quality and efficiency. Continued improvement was noted for each of the 4-week data gathering period. Stress measures yielded similar positive changes between pre- and post-test mean values.


Based on these data, it was concluded that, in this population, new bedding systems increased sleep quality and reduced back discomfort, factors that may be related to abatement of stress-related symptoms.


Seventy-five percent of Americans report that they have sleep problems a few nights per week or more.1 A projected 70 million people are currently affected by sleep problems, and by the middle of the 21st century, that figure is expected to reach 100 million. It has been estimated that the average individual gets about 6.8 hours of sleep per night, which can equate to symptoms of sleep deprivation and has the potential to relate to a negative quality of life. Sleep is restorative both physiologically and psychologically and aids in healing and repair, whereas sleep deficiency is related to loss of work production, increased sick days, greater absenteeism, loss of productivity, and higher injury rates.

A popular medical dictionary defines insomnia as the inability to sleep or to remain asleep throughout the night. Others have defined insomnia, for the benefit of their study, as problems sleeping for 3 nights or more per week during the past 3 months, in addition to problems with daytime functioning. Feige et al defined insomnia as characterized by low subjective sleep quality. Sleep quality, although poorly defined, is a key feature in insomnia. Poor sleep quality is associated with a continuous activation of the 2 major components of the stress system: the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Furthermore, stress is related to impaired and shortened sleep, sleep fragmentation, and possibly a reduction in sleep stages III and IV. Those who demonstrate higher stress levels have been shown to have significantly lower sleep efficiency. One survey estimated that 65% of Americans are losing sleep because of stress.

Although stress can cause sleep loss, the reverse is also possible. For instance, poor sleep quality can contribute to an increase in perceived stress. Lack of sleep can intensify the degree of stress, and shortened or disturbed sleep causes increases in levels of traditional stress markers and may exacerbate the effects of stress. Both mental and physical processes decline with inadequate sleep. Poor sleep quality is associated with anxiety, depression, and mood disorders. Conversely, adequate sleep improves attitudes, moods, and promotes feelings of self-esteem and competence. Indeed, it has been concluded that lack of sleep is a significant stressor, and chronic sleep problems can themselves become a source of stress. In addition, sufficient sleep improves mood, promote feelings of competence and self-worth, and supports optimal mental and emotional function.

The comfort and support of the sleep surface are related to problems of sleep quality and efficiency. Certain sleep surfaces have resulted in complaints of low back discomfort, pain, or stiffness and shoulder pain. (For further reading, see the link below.)

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