Providing relief for patients in the office is one thing—sustaining that relief, though, can be quite a challenge.
Most patients have spent years, if not decades, accumulating bad habits when it comes to posture and movement. And because you can’t follow a patient 24/7, these can be hard to undo.
Fortunately, you can identify specific activities, such as sleep, that turn out to be major contributors to overall health. By guiding patients toward simple solutions, you can encourage healthier habits and make their lives (and yours) easier, even if you can’t be with them all the time.
Sleep is a large part of chiropractic health
If you think about it, it makes sense: Most of us spend a third of the day or more in bed, sleeping. Bad sleep posture not only affects skeletomuscular systems, but encourages sub-optimal postures even during waking hours.
Indeed, there is good evidence that sleep is a critical time when it comes to lumbar stress. Spine posture during sleep has been linked to overall back pain and dysfunction. Even more surprising is the finding that supported postures while lying down also lead to better posture standing. This suggests that correcting and supporting posture during sleep might well lead to better overall posture, and thus less pain and more sustained results from chiropractic intervention.
The causation goes both ways. According to the Centers for Disease Control, roughly 50-70 million adults in the U.S. have some sort of sleep disorder. Many of these are caused or exacerbated by sub-optimal mattresses and sleeping environments that create pressure or encourage bad posture.
And the cycle continues: According to government website healthfinder.gov, sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national healthcare bill each year.
Real science shows: Mattresses might be the main culprit
Mattress companies claim that a lot of research and engineering have gone into their mattress design. Independent studies of mattresses, using proven biomechanical evaluations, are much harder to come by. But they do exist.
One such early study explored the idea that sub-optimal spinal orientation lead to higher levels of sustained muscle activity, which in turn comprises an individual’s ability to relax of initiate sleep. The study found significant differences in alignment of the spine when the underlying mattress was inflated to different pressures. While the study failed to find huge changes in other measures (EEG, heart rate, blood pressure), it made clear that mattress composition and firmness have a direct effect on spinal alignment (which, in turn, can influence posture in other situations).
A later biomechanical study measured pressure distribution patterns and spinal distortion in subjects sleeping on four different “top of the line” mattresses from four different manufacturers. The study found that there was statistically significant differences between the mattresses when it came to distortion at the T1/T3 and the T6/T8 spinal segments.
Weight, too, had a noticeable effect on these measurements.
Finally, a landmark 2006 study published in the Journal of Chiropractic Medicine looked directly at subjective ratings of perceived back pain, stiffness, and sleep quality upon the introduction of new mattresses. Participants in the study reported immediate and sustained benefits after sleeping on a new mattress, whether or not they had previous complaints of back pain.
These studies converge on a few important points. Mattresses, particularly low-quality or sagging mattresses, can put undue stress on the spine, strain muscles, and encourage bad posture and misalignment. More supportive mattress, especially in the medium-to-firm range, can help reduce spinal stress and accompanying reports of pain, as well as improve the quality of sleep.
While some of these benefits take a few weeks to appear, they are statistically significant and hold across age, sex, and weight.
Memory foam is particularly worrisome
Patented in 2004 and gaining mass popularity in 2012, memory foam mattresses have been touted as a way to get more comfortable, more supportive sleep. With several years of consumer history behind it now, those products are facing something of a crisis.
As blogger and industry salesperson Catherine Mostly puts it in her article-cum-industry-confession, “Memory foam was our biggest selling mattress – and the most likely to be returned.” Much of this had to do with how memory foam slept over long periods of time.
The material is partly to blame. Memory foam is known to “sleep hot” – that is, it tends to trap heat instead of dissipate it. As the material warms up, it tends to soften, allowing the body to sink in further and losing its original support and shape. As Mostly, notes, “There is NOTHING that is ‘pushing back up’ to support your back and keep your spine correctly aligned once memory foam turns into cozy, warm mush.”
Mostly recommends a hybrid build to combat this tendency: “Memory foam feels great mixed in with other foam layers on top of a traditional innerspring mattress – and can really make a difference in the luxurious feel between them.”
Hybrid beds also have a better track record when it comes to sustaining their shape and support over time. According to the International Testing Center, hybrids lose only 5% of their resiliency after 8 years, the average recommended lifespan for a mattress. By comparison, memory foam mattresses lose about 16.2 percent of their resiliency, latex foam 22.6 percent, and poly foam a whopping 49 percent. And better resiliency means more sustained posture over time.
Helping your patients choose a mattress
Of course, there is no “one size fits all” when it comes to mattresses. There can be a lot of individual variation when it comes to comfort and desired firmness. Chiropractors should encourage their patients to get a mattress with an extended sleep trial – one that is at least 100 nights – so they can really try the mattress and see how it affects their sleep patterns over an extended period of time.
You should also encourage patients to look outside of traditional mattress stores and brands. While there are many good traditional mattresses, many of the newer bed-in-a-box companies have the advantage that their mattresses are designed “from the ground up” with the latest science in mind. This means that you are likely to find newer materials and more innovative features in the product lines of these younger companies.
And, of course, check in regularly to see how well they are sleeping, and how they feel in the morning. Along with the usual in-office check-ups, this is the most direct way to see if the situation is improving.
Jeff and Mark Quinn, co-founders of Herobed LLC have been in the mattress industry for over 40 years combined. They have spent thousands of hours listening to customers to understand what is most important about their sleep and their mattress, and they drew from that experience to create Herobed. According to their research, most people really don’t understand that a mattress can literally impact your quality of sleep, which impacts your quality of life, so the Quinns came up with Herobed as the solution.