Sleep expert reveals the best type of mattress for back pain

A woman in a brown t-shirt massages her painful lower back in bed
(Image credit: Getty)

Back pain is a nuisance, especially when it impacts your ability to get a full night of quality sleep. Unfortunately, sleeping on the wrong type of mattress can worsen an existing back injury or even create new aches and pains.

If you can't find relief from your back pain when lying in bed, it may be time to consider investing in a new bed. So what is the best mattress for back pain? Firm mattresses are often touted as the catch-all solution for sleepers seeking solace from aching backs, but the real answer is more nuanced. Depending on what your exact issues are, a few of the models in our best mattress ranking might do the trick for you. And if you're in the US and buying a mattress for medical reasons, Medicare may cover some of the costs; see our guide - What types of mattresses are covered by Medicare? - for all the details.

We recently spoke to Dr. Allison Brager, neuroscientist and sleep specialist for Molecule, to get her expert insight into how to pick a mattress that can reduce back pain and help you sleep more comfortably once more.

Are soft or firm mattresses better for back pain?

According to Dr. Brager, most people will find relief with a medium to firm mattress (like those in our best firm mattress guide), while a soft mattress is the least likely to alleviate back pain. However, she stresses that there is no "one size fits all solution" when it comes to selecting the best type of mattress for back pain.

"I don’t want people to think that a firm mattress is the absolute all or nothing solution. A medium-firm mattress is wonderful too," says Dr. Brager, "but everyone is different."

A woman with blonde hair sleeps comfortably on her side

Sleeping on your side provides relief from back pain (Image credit: Shutterstock)

Why your sleep position is important

Your sleeping position (the one you drop off in) is a major consideration when choosing a mattress for back pain. Dr. Brager says it's essential to rest in a position where you are the most comfortable — although her recommendation for most individuals with back pain is side sleeping.

If you wake up with back pain, ask yourself what position you slept in and try something new the next night

Dr Allison Brager

However, if you're prone to changing positions in your sleep (making you a combi sleeper), or you're temporarily resting in a position that provides you with decent pain relief, find a mattress that supports these positions. "For instance, a very soft mattress would be uncomfortable for a stomach sleeping position or back sleeping position, and would very likely cause pain and discomfort.

"Experiment with sleeping positions and be 'body aware',” she says. "If you wake up with back pain, ask yourself what position you slept in and try something new the next night to see if the result is different."

All of the best mattress in a box brands offer trial periods of at least 100 nights, giving you ample time to see whether or a mattress helps with your back pain.

Is your mattress contributing to back pain?

Is your mattress making your existing injury worse, or is it the cause of your back pain woes in the first place? This is a very 'chicken-and-egg' question, but if you're keen to find out if your bed is the culprit behind your aches and pains Dr. Brager shares some telltale signs that it might be time to replace your mattress...

A man sits up in bed holding his painful back

(Image credit: Getty)

"Beyond just the origin of the pain, your entire posterior chain will feel stiff and your back muscles will feel as if they’ve been working out while sleeping," she says. "You can have soreness and stiffness down the spine as well as the hips and just above the hips near your tailbone. Usually, the latter two are a telltale sign it’s time for a new mattress."

Sleeping in a cool environment will reduce the amount of tossing and turning, which torques the back

Dr Allison Brager

A more obvious indicator that your mattress is creating or contributing to back pain is wear-and-tear, particularly sagging. Knowing how often you should replace your mattress will give you an idea of when it's time to shop for something new.

Other ways to alleviate back pain during sleep

In addition to finding a mattress that's the ideal firmness for your body type, and pinpointing a sleeping position that offers the most comfort, Dr. Brager says a cool bedroom will go a long way in providing relief from back pain.

"Sleeping in a cool environment will reduce the amount of nighttime disturbances and tossing and turning, which torques the back as a result. The important thing is to have a mattress built for restorative sleep - one that provides comfort and coolness."  The best cooling mattresses offer a balance of both qualities. 

Beyond finding a mattress that offers adequate support and cooling comfort, also consider the type of pillow you're sleeping on. The best pillows for sleeping are designed to work in harmony with mattresses, providing full-body alignment and all-around comfort so you wake up feeling less stiff and sore.

Three mattresses for easing back pain at night

The DreamCloud Luxury Mattress is a good choice for better back support and pressure relief during sleep

(Image credit: DreamCloud)

1. DreamCloud Luxury Hybrid Mattress

Type: Luxury hybrid
Firmness (1-10):  8
Materials: Cashmere blend, foam, springs
Height: 14 inches
Trial/Warranty: 365 nights/lifetime

For our DreamCloud Mattress review, those on our testing panel with back and hip pain sang the praises of this hybrid memory foam mattress. Our side sleepers found ample pressure relief along their shoulders, hips and legs, while our back sleeper experienced contouring along their lower lumbar. A layer of gel-infused comfort foam coupled with a breathable cashmere-blend top cover lulled even our hottest sleeper to slumberland.

Sleepers with a petite-to-average build may need time to adjust to the DreamCloud as it is quite firm for those body types at first. Fortunately, the brand offers a full year to try it risk-free, with a lifetime warranty to back you up if you opt to keep it. The current DreamCloud mattress sale knocks the starting price of its entry-level bed to $600, with up to $499 of bedding included for free.

The Awara Natural Hybrid mattress is designed to reduce pressure on your back, hips and neck during sleep

(Image credit: Awara Sleep)

2. Awara Natural Luxury Hybrid Mattress

Type: Organic hybrid mattress
Firmness (1-10):  8
Materials: Dunlop latex, foam, innersprings, natural wool, natural cotton
Height: 13 inches
Trial/Warranty: 365 nights/lifetime

Awara makes one of the most affordable organic mattresses on the market. As we mention in our Awara Mattress review, sleepers in any position will find their spine properly aligned and supported thanks to a top layer of adaptive Dunlop latex. The cotton/wool blend cover makes for a cool night's sleep too, and exceptional edge support will allow most individuals to sit comfortably at the edge of the bed without compressing their back. 

As with the DreamCloud above, the Awara is a firmer mattress that lighter bodies may need some time to adjust to. A one-year trial is provided to allow for that, with a limited-lifetime warranty protecting your purchase. The latest Awara drops prices to $699 for a twin, with up to $499 of free bedding bundled in. 

3. Saatva Classic Mattress

The Saatva Classic mattress shown on a light wooden bed frame in a stylish bedroom

(Image credit: Saatva)

Type: Traditional mattress
Firmness (1-10):  3-10
Materials: Foam and innersprings
Height: 11.5 or 14.5 inches
Trial/Warranty: 365 nights/15 years

The Saatva Classic has earned the Congress of Chiropractic State Associations Seal of Approval for back pain relief. It's highly customizable when it comes to firmness and height, so you can better tailor it to your back needs. We tested an 11.5-inch medium-firm version in our Saatva Classic Mattress review and experienced a decrease in back pain, as well as cooler sleep.

You'll get 365 nights to test out the Saatva, although you'll be on the hook for a $99 fee if you decide to exchange or return it. On the flip side, you'll get free white glove delivery (a rarity among mattress brands), where the mattress will be set up for you in your bedroom - ideal if you have back pain and can't move heavy furniture - plus Saatva will remove your old mattress. The new Saatva mattress sale reduces the starting price to $687 for a twin.

Alison Barretta
Freelance reviewer and writer

Freelance writer and editor Alison is an expert mattress tester for Tom's Guide, and hails from Philadelphia, USA. Alison has reviewed a wide range of mattresses, pillows and other sleep accessories for Tom's Guide, putting the latest hybrid, memory foam and cooling mattresses from Casper, Nectar, Awara, Brooklinen and other leading brands through their paces. Alison has been sharing buying advice and retail news for over a decade. When she isn't reviewing mattresses, other home products or hunting for great deals to save you money, Alison can be found teaching/training in martial arts, fawning over skincare, and indulging in her quarantine-borne hobby: cooking.