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  • The influence of the hardness of a mattress

    2018-10-26

    The influence of the hardness of a mattress in sleep quality and low back pain is subject of controversy, Bader et al. [10] found no difference in subjective sleep quality between two mattresses, commercially sold as smooth and hard. In the same way, in the present study there was no change in the sleep quality, measured by PSQI. However, a significant reduction in low back pain with a MFM was observed. Moreover, several studies have concluded that medium-firm sleep surfaces may be the most beneficial for people with chronic low back pain [7,8,11,21]. Although there is scarce evidence and lack of agreement regarding the role of the mattress in musculoskeletal pain, guidelines for prevention of low back pain, state that “there is no robust evidence for or against recommending any specific chair or mattress for prevention in low back pain, though persisting symptoms may be reduced with a medium-firm rather than a hard mattress”, [22]. There is limited evidence about mattress firmness and its effect in neck and dorsal pain. Accordingly to our results we can expect a similar improvement with MFM independently of the region of the spine. The sleep quality in older adults is associated with several complaints, Eser et al. [23] described that 60.9% of older adults in nursing homes were poor sleepers. Similarly, we observed that our population had a comparable frequency of poor sleepers at baseline (60. 5%). Furthermore, regarding variations in the PSQI, we did not find a significant reduction. In controversy, Jacobson et al. [21], using visual analog scales (VAS) assessed the participants perception of sleep quality and low back pain before and after setup of a new bedding system, they concluded that a middle firmness mattress increased sleep quality and reduced back discomfort. In Asiatic acid to our study, the population selected was younger and had minor musculoskeletal sleep-related pain and compromised sleep, with no clinical history of disturbed sleep [21]. Additionally, the changes in the quality of sleep for our participants could be independent of the mattress firmness, maybe due to the psychometric properties of the PSQI different from VAS; physiological changes and frequent medical comorbidities inherent of the older age group, thus these features may overshadow the benefits of the MFM in the sleep quality. The sleep surface can contribute to the comfort of sleep [24]. The HFM and MFM have inherent physical differences, which include density and hardness. Both characteristics are important for support and comfort in order to redistribute the body weight and to reduce pressure that may cause muscle discomfort [7]. The main function of the mattress is to support the human body in a way that allows the muscles and intervertebral disks to recover [25,26].This recovery can be achieved when the shape of the spine is in its natural physiological shape, yet with a slightly flattened lumbar lordosis due to the changed working axis of gravity [27,28].Therefore, mechanical characteristics of the mattress should be optimized concerning both body contours and weight distribution of the sleeping person [29].Since both of these factors are highly individual, the optimal benefit in actigraphy parameters and pain reduction might be achieved with a tailored mattress, specifically designed for the physical characteristics of the participants. Although this measure might be effective, is likely to be expensive and probably non cost effective in the context of institutionalized elders. Using various chemical formulations and processing technologies, foam firmness can be controlled during the production process, independent of the density within broad ranges. A high density foam can be produced to have low or high firmness values [30]. Similarly, the cover of the mattress is also relevant. The vinyl cover provides a more allergen-free environment during sleep [31]; however it restricts the airflow through the material, therefore the body heat will not be dispersed inducing perspiration during the night [32]. The mattress we used was a new, medium-firmness, constructed with layers of viscoelastic polyurethane and high-resilience polyurethane foams, without vinyl cover, features that could have contributed to the improvement in musculoskeletal pain.