The document provides a systematic review of pillow and mattress designs and their impact on sleep quality, spinal alignment, and pain reduction. Six pillow studies and 24 mattress studies met the inclusion criteria. Key findings include: latex pillows improve sleep quality while feather pillows decrease it; medium-firm mattresses provide the best outcomes for improving sleep quality and reducing back pain; and individualized sleep systems help improve spinal alignment and sleep quality. Limitations include limited literature on pillows and no gold standard for subjective measurements. The purpose was to guide health care professionals on best pillow and mattress recommendations.

1. Philip Fess, Darcy James, John Murphy,
Joe Myers, Michelle Rooney, Jason
Taylor, Lisa Torii
EFFECT OF MATTRESSES AND
PILLOW DESIGNS ON
PROMOTING SLEEP QUALITY,
SPINAL ALIGNMENT, AND PAIN
REDUCTION IN ADULTS:
SYSTEMATIC REVIEWS OF
CONTROLLED TRIALS

2.  Eight hours of sleep is recommended per night
 Average American receives 6.8 hours per night
 75% of Americans report sleep difficulties
 Estimated 100 million individuals will report sleep difficulties by 2050
 Main causes of sleep disturbances:
 Sleep surface
 Musculoskeletal pain
 33% of population report neck pain
 30% of population report back pain
INTRODUCTION
Jacobson, 2009; Jacobson, 2010; Rogerson, Gatchel, &
Bierner, 2010

3. Mattress
& Pillow
designs
Sleep
disturbances
Associated
back and/or
neck pain
Unsupported
claims from
manufacturers
Lack of
current
research

4.  Provide a systematic reviews of the literature regarding designs
of pillows and mattresses in relation to:
 Pain Reduction
 Promoting sleep quality
 Spinal alignment
 Guide health professionals in recommendations of sleep surfaces
PURPOSE

5. METHODOLOGY
Pillow
&
Mattress
Inclusion
Criteria
Databases
Search
Strategy
Results
Data
Extraction

6. SEARCH STRATEGY
• Pillow/Mattress and Ergonomics
• Pillow/Mattress and Pain
• Pillow/Mattress and Spine
• Pillow/Mattress and Alignment

7. RESULTS AND SCREENING CRITERIA
Pillow Mattress
Results
16
Articles
6
Articles
62
Articles
24
Articles
•2 Independent Raters
•3rd Party
•Data Extraction Form
•PEDro Rating
•Summaries

8. PILLOW RESULTS AND
DISCUSSION
6 ARTICLES

9. Author
(year)
PEDro Study Design Category Number of
Patients
Present Condition Outcome Conclusion
1. 6 Comparative,
single subject
study
Pain Reduction 30 Asymptomatic Pain and pillow
height
Pillow should have cervical and
shoulder support. Pillow height is
directly positively proportional
influences pillow comfort.
2. 6 Random-
allocation block-
design trial
Sleep quality 106 Asymptomatic Cervical Stiffness
and
Headaches
Latex pillows are recommended to
help control waking headache and
scapular/arm pain while feather
trial pillow produces the highest
frequency of waking symptoms
amongst the participants.
3. 6 Randomized-
block design
Cervical Spine
Alignment
95 Asymptomatic Spinal alignment The feather pillow demonstrated
the least amount of segmental
stability at all levels.
4. 5 Random allocated
block
Pain reduction and
Sleep quality
99 Asymptomatic Waking Cervical pain.
Pillow comfort and
sleep quality
Rubber pillows performed the best with
regards to waking cervical pain, sleep
quality and pillow comfort. Feather and
Foam contour perform the worst with
these respects.
5. 5 Controlled
comparative
Sleep quality 7 Asymptomatic Sleep quality and skin
temperature
Sleep quality improved with cooling of the
occipital region.
6. 4 cross-sectional study Pain reduction 106 Asymptomatic Cervical pain, pillow
comfort and sleep
quality
Latex pillow rated the highest while the
feather pillow rated the lowest with
regards to sleep quality and pillow
comfort.
Spine Alignment Pain Reduction Sleep Quality

10. PAIN REDUCTION

11.  Liu, S., Lee, Y., Liang, J. (2011)
 A comparative study
 30 participants
 Four different pillow designs
 Standard, cradle, cervical, shoulder
 Conclusion
 Pillow number four was most comfortable
SHAPE DESIGN OF AN OPTIMAL COMFORTABLE PILLOW
BASED ON THE ANALYTICAL HIERARCHY PROCESS
METHOD (6)

12.  Gordon, S., Grimmer-Somers, K., & Trott, P. (2009)
 Random – allocation block design
 99 participants
 Different pillow materials
 Polyester, foam-regular, foam-contour, latex, feather
 Conclusion
 Latex pillow reduced the pain most
PILLOW USE: THE BEHAVIOUR OF CERVICAL PAIN, SLEEP
QUALITY, AND PILLOW COMFORT IN SIDE SLEEPERS (5)

13.  Gordon, S., Grimmer-Somers, K., & Trott, P. (2010)
 Own pillow and five trial pillows
 Polyester, foam-contour, foam-regular, feather, latex
 Field trial
 106 participants
 Conclusion
 Feather and foam contour pillows produce more waking pain
 Latex pillows produced less waking pain
YOUR PILLOW MAY NOT GUARANTEE A GOOD NIGHT’S
SLEEP OR SYMPTOM-FREE WAKING (6)

14. SLEEP QUALITY

15.  Gordon, S., Grimmer-Somers, K., & Trott, P. (2009)
 Random allocated block design
 99 participants
 Tested five different pillows on sleep quality
 Polyester, foam regular, foam contour, feather, latex
 Conclusion
 Latex pillows provided best sleep quality
 Feather pillows provided worst sleep quality
PILLOW USE: THE BEHAVIOUR OF CERVICAL
PAIN, SLEEP QUALITY, AND PILLOW COMFORT IN
SIDE SLEEPERS (5)

16.  Setokawa, H., Hayashi, M., & Hori, T. (2007)
 Effect of body temperature
 Controlled comparative study
 7 participants
 Water pillow temperatures
 Room temperature 26°C
 Ice temperature 16°C
 Conclusion
 Sleep quality improved with cooling occipital region
FACILITATING EFFECT OF COOLING THE
OCCIPITAL REGION ON NOCTURNAL SLEEP (5)

17. SPINAL ALIGNMENT

18.  Gordon, S., Grimmer-Somers, K. & Trott, P. (2011).
 Randomized-block design
 95 participants
 Pillow type and segmental stability
 Polyester, foam regular, foam contour, latex, feather
 Conclusion
 Feather pillow provided least stability
A RANDOMIZED, COMPARATIVE TRIAL: DOES
PILLOW TYPE ALTER CERVICO-THORACIC
SPINAL POSTURE WHEN SIDE LYING? (6)

19.  To decrease pain, pillows should have multiple dimensions
 (Liu et al., 2011)
 Latex pillows increase sleep quality
 (Gordon et al., 2009; 2010)
 Feather pillows decrease sleep quality and increase pain
 (Gordon et al., 2009; 2010)
 Cooling the occipital region promotes sleep
 (Setokawa et al., 2007)
 Feather pillows produce the least amount of segmental stability
 (Gordon et al., 2011)
PILLOW CONCLUSIONS

20. MATTRESS RESULTS
AND DISCUSSION
24 ARTICLES

21. PAIN REDUCTION
10 ARTICLES

22. Author (year) PEDro Score Study Design Number of
Patients
Present Condition Outcome Conclusion
1. 10 Randomized,
blinded,
controlled trial
313 Greater than/equal
to three months
chronic back pain
while lying in bed
or on rising.
Pain reduction The medium-firm mattresses was
more likely to improve degree of
disability than patients who used the
firm mattresses.
Patients with chronic back pain will
benefit more from a medium firm
mattress than a firm mattress.
2. 8 Randomized
Controlled Trial
12 Asymptomatic Pain reduction No significant statistical differences
between the two mattresses in
regards to any of the outcome
measures; however, the pressure
relief-mattress reduced the number
of high pressure points.
3 7 Randomized
single-blinded
clinical trial
160 Symptomatic Pain reduction When compared to the hard
mattress, the waterbed and foam
mattresses had a more positive
influence on back pain and ADL
performance.
4. 5 Controlled Trial 22 Symptomatic Pain reduction Significant decrease in back pain,
back stiffness, and shoulder pain as
well as an increase in sleep quality
and comfort with the prescribed
sleep surface.

23.  Kovacs, F. M. et al., (2003)
 Randomized-blind control trial
 313 participants
 Intervention
 155 allocated to medium-firm mattress
 158 allocated to firm mattress
 Outcome Measure
 Visual Analog Scale (VAS)
 Roland Morris questionnaire
 Conclusion
 Medium-firm mattress reduced degree of disability
EFFECT OF FIRMNESS OF MATTRESS ON CHRONIC NON -
SPECIFIC LOW BACK PAIN: RANDOMIZED DOUBLE -BLIND
CONTROL MULTICENTER TRIAL

24.  Vaughn McCall, W., Boggs, N., & Letton, A. (2012).
 Randomized controlled trial
 12 participants
 Intervention
 Compared conventional mattress and a 7 zone pressure relief mattress
 2 week baseline, 2 week test for each mattress (total of 6 weeks)
 Outcome Measures
 VAS
 Actigraphy and pressure mapping
 Conclusion
 No statistical differences with regards to pain
CHANGES IN SLEEP AND WAKE IN RESPONSE TO
DIFFERENT SLEEPING SURFACES: A PILOT STUDY

25. SLEEP QUALITY
18 ARTICLES

26. Author (year) PEDro Score Study Design Number of
Patients
Present Condition Outcome Conclusion
1 6 Randomized
Control
Trial
10 Asymptomatic Sleep quality No significant difference in sleep
quality between mattress types.. An
adequate mattress should be soft
enough to avoid excess compression
of joints to prevent compression of
neurovascular system
2 6 Non-randomized
controlled trial
23 Asymptomatic Sleep quality Change in mattress pressure had
little physiologic significance,
despite the significant changes in
spinal alignment.
Subjects reported higher comfort
with higher inflation measures.
3 6 Non-randomized
controlled trial
75 Asymptomatic Sleep quality As hardness increases (area under the
load/deflection decreases) the
perception of firmness increases.
As pressure/hardness increases,
subjective comfort increases.
4 6 Experimental 24 Asymptomatic,
patients with
insomnia
Sleep quality Proximal warming improved deep
sleep. and distal improved REM.

27.  Bader, G. G., & Engdal, S. (2000)
 Randomized-controlled trial
 10 participants
 Intervention
 Compared soft and firm mattress
 3 nights on own mattress, 5 nights on each test mattress
 Outcome Measures
 Questions regarding fatigue, discomfort, and pain
 Polysomnography
 Conclusion
 No global mattress design for global population
THE INFLUENCE OF BED-FIRMNESS
ON SLEEP QUALITY

28.  Lahm, R., & Iaizzo, P. A. (2002)
 Non-randomized controlled trial
 23 participants
 Interventions
 Adjustable air bladder (low, medium, high)
 Participants remained lying for 30 minutes
 Outcome Measure
 Subjective comfort pertaining to bed pressure
 EMG, heart rate, blood pressure
 Conclusions
 Subjects reports higher comfort with higher inflation pressures
PHYSIOLOGIC RESPONSES DURING REST ON A
SLEEP SYSTEM AT VARIED DEGREES OF
FIRMNESS IN A NORMAL POPULATION

29. SPINAL ALIGNMENT
4 ARTICLES

30. Author (year) PEDro Score Study Design Number of
Patients
Present Condition Outcome Conclusion
1 8 Controlled Trial 18 Asymptomatic Spine alignment The least amount of pressure was seen
in mattress A (Perfect Contour
Extraordinaire Dorchester by King
Koil and the most pressure was seen
in mattress D(Perfect Sleeper
Southdale by Serta). Mattress D also
demonstrated the least spinal
distortion.
2 5 Controlled Trial 25 Asymptomatic Spine alignment Neither a soft nor firm mattress is
sufficient to support spine alignment.
Too soft of a mattress results in
cervical spine being in a higher
position than the pelvis.
3 5 Quasi-
experimental
10 Asymptomatic Spine alignment Use of inflated lumbar cushion
allowed for more homogenous
distribution of pressure and decreased
pressure in the thoracic and pelvic
regions.
4 5 Multicenter
controlled trial
18 Asymptomatic Spine alignment Most favored mattress by the
subjective ratings was the mattress in
which the spinal curvature in lying
was most similar to that in standing.
Average pressure at the shoulder was
higher in softer beds.
The study found that firmness had to
be extended in order to increase in
patient comfort.

31.  DeVocht, J., Wilder, D., Bandstra, E., & Spratt, K. (2006)
 Randomized controlled trial
 18 participants
 Intervention
 Compared four “top of the line” mattresses in side-lying
 Perfect contour extraordinaire Dorchester
 Beauty rest calibri-firm
 Posture-pedic
 Perfect sleeper
 Outcome Measures
 Postural distortion measured by making spinous processes
 Conclusion
 Perfect Sleeper demonstrated least amount of spinal distortion
BIOMECHANICAL EVALUATION OF
FOUR DIFFERENT MATTRESSES

32.  Leilnahari, K., Fatouraee, N., Khodalotfi, M., Sadeghein, M. A., &
Amin Kashani, Y. (2011)
 Controlled trial
 25 participants
 Intervention
 Compared soft (polyurethane foam), firm, and custom made mattress
 Markers placed on spinous processes C7-L2 and L5
 Outcome Measure
 Spine alignment measured in side-lying
 Two digital cameras captured angle of vertebrae
 Conclusion
 Customized inflatable mattress is conducive to maintain spine alignment
SPINE ALIGNMENT IN MEN DURING LATERAL
SLEEP POSITION: EXPERIMENTAL STUDY AND
MODELING

33.  Medium-firm mattresses provide the best outcomes for improving
sleep quality and reducing back pain
 (Kovacs et al., 2003; Lahm & Iaizzo, 2002)
 Individualized sleep systems help to improve spinal alignment
and sleep quality
 (Bader et al., 2000; Leilnahari et al., 2011)
 Proximal warming can be used to decrease early morning waking
and enhance deep sleep
 (Raymann et al., 2008)
MATTRESS CONCLUSIONS

34.  To enhance sleep quality:
 Rubber (latex) pillows enhance sleep quality
 Cooling the occipital region can enhance sleep
 Medium-firm mattresses provide best outcomes for increased sleep
quality
 To reduce pain:
 Pillows should have multiple dimensions
 Medium-firm mattresses produce the best outcomes for reducing pain
 Proximal warming of mattresses can reduce early morning pain
 To promote spinal alignment:
 No sufficient evidence relating cervical spine stability and pillow
 Individualized mattress systems can enhance spinal alignment
CLINICAL SIGNIFICANCE AND
RECOMMENDATIONS FOR HEALTH CARE
PROFESSIONALS

35.  Limited literature regarding pillows
 Repeated population of subjects amongst studies
 No gold standard for subjective measurements (heterogeneous)
 No universal level of mattress firmness amongst studies
LIMITATIONS

36.  Purpose of study
 Provide a systematic review of current literature of pillows and
mattresses in relation to:
 Improving spinal alignment
 Decreasing pain
 Promoting sleep quality
 Determine best mattress and pillows based on the current literature
 Help guide health care professionals
SUMMARY

37.  Applied Ergonomics Conference
 Accepted for poster presentation
 March 16-19, 2015
 Nashville, Tennessee
FUTURE FOR THE STUDY

38.  Ahmed Radwan
 Thomas Crist
ACKNOWLEDGEMENTS

39. QUESTIONS?

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