Mattresses, even more so than pillows, are subject to personal preferences. When probed about it by patients, I often turn the question around: “If you think back about the different beds where you have slept in the past couple of years, at home and while travelling, what has felt the most comfortable to you?”. Patients sometimes need to be reminded to trust their instincts about what their body is telling them. There is a stoic mentality out there that you need a very firm mattress to support your spine. That is not entirely true. You do need a mattress with a supportive core, and one that does not fail prematurely in the center, but most people feel better with some degree of softness on the outside. The trick is to figure out how much works best for you.
There are a lot of arguments about which mattress material is best, and I don’t plan to add to that. Options range from traditional coil to layers of various materials, to structure foam of synthetic or natural origin. The durability, and often the cost of your mattress will depend upon the quality of the base material and the density of the core, especially the coils. Structure foam options are popular right now, but you need to look closely at the density per square inch on the manufacturer site, since that is highly variable and ultimately determines the firmness. Regardless of the material you chose, I recommend that you get a mattress with relatively little top layer built in and retrofit it with the top layer of your choice. This will give you the option to better customize the mattress and change the top layer halfway through the lifespan of your mattress.
From a general health standpoint, you also want to keep in mind that the newer foam materials tend to gas off a lot, especially with the fire-retardant coatings. If you are more sensitive to chemicals, you should consider the newer wool, natural rubber foam options, which unfortunately come at a steeper price point. At a minimum, you should let your new mattress gas off in a well-ventilated area for 1-2 weeks before use.
The type and thickness of the top layers becomes really crucial for patients with wide shoulders, wide hips, or any ongoing issues to the above two pressure points (shoulder impingement, prior shoulder surgery, prior hip replacement, or chronic bursitis). Less than 2 inches is usually not going to be sufficient.
The life span and support of a mattress depends a fair amount on the base of the mattress. I am not a fan of the standard box springs. They fail faster than the mattress and are mostly responsible for the middle sag of aging mattresses. The traditional European slat system is getting more readily available and cheaper. It provides an excellent combination of support and ventilation. A solid base is also an option, but it tends to limit aeration of the mattress. Flipping the mattress in both directions (180’ and upside down) every couple of months will also extend the life span of a mattress.
As a last note, bed mates sometime have widely different bedding needs and that can be a tricky problem to resolve. One easy option is a mattress with a top layer consisting of two individually controlled inflatable bladders. The other is to install two twin mattresses on a king frame and keep them connected with couple of fitted sheets or mattress protectors. Each side of the bed can be modified with the preferred mattress and top layer, and the transition between the two is usually not a significant barrier.