I’m sometimes asked for advice on beds, mattresses and pillows. My standard reply is that it can be beneficial to practise active rest immediately before sleeping and/ or first thing in the morning. The latter can seem counter-intuitive, but our habits of misuse persist through our sleeping hours, and a conscious unwinding of these patterns immediately before starting our day may be just what we need.

In the past, I have steered clear of recommending what to sleep on. However, the BBC radio series Sliced Bread has recently done some evidence-based work on this. Here are its essential findings:

according to a 2021 review, ‘a medium-firm mattress offers more advantages to subjects with non-specific low back pain and reduces the risk of developing low back pain’;
according to a 2015 systematic review: ‘a medium-firm mattress is optimal for promoting sleep comfort, quality and spinal alignment’.

Here’s some additional information from the programme about mattresses and pillows:

There’s no standard measure for measuring spinal curvature when we sleep, and so there’s no really good standardised measure for measuring the firmness of a mattress. However, recent meta-analyses suggest that a medium-firm mattress is ideal. If the mattress is too firm, it doesn’t let your shoulders and neck sink into it, and if it’s too soft you can get problems with your hips and shoulders because they sink too far in.
Mattress types can be divided into two: sprung types (open coil, continuous coil and pocket sprung), and non-sprung types (standard foam, memory foam and latex foam). Hybrid mattresses can be the best of both worlds and have come out top in a lot of consumer tests.
Coil sprung mattresses are less expensive and lighter to move around. However, they wear out more easily, and when you or your partner moves, they are more likely to disturb the other person in the bed. Pocket-sprung mattresses offer independent support: they isolate any movement. The general advice is to go for 1000 springs or more.
Standard (polyurethane) foam mattresses are the cheapest to manufacture. Memory foam is known as a visco-elastic which reacts slowly to weight and body heat, moulding slowly to the shape of the person lying on it. When the person moves, the mattress very slowly recovers to its original shape. Since the mattress becomes indented with your shape, they are ideal for people who don’t need to move much during the night.
Sleep position. Studies suggest that people who habitually sleep on their side are better on a foam mattress, whereas those who are heavier or who sleep on their back or front are better on a sprung mattress.
From a health perspective, you should consider replacing your mattress every seven or eight years.
Buying an ‘orthopaedic mattress’ is not worth it. The term ‘orthopaedic’ is unrestricted and can be used by manufacturers whether the mattress truly is orthopaedic or not.
Pillows. A flatter pillow is recommended if you lie on your front, and a larger pillow is recommended if you lie on your back, in order to maintain the arch in the neck. Placing a pillow between the legs takes the weight off the hips to some degree and can be useful for controlling pain.