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How to Choose a Mattress

So you need a new mattress — but what should you get?

That’s a great question! I just found myself in the same position. A few years ago I bought an expensive name-brand mattress that felt great in the store… and slowly started to kill me. When I reinjured my back this past summer and it just wouldn’t heal, I began to suspect my mattress. A few weeks ago my suspicions were confirmed when I stayed in a hotel for a few nights, and my back pain got a lot better… until I got home. So it was time for a new mattress!

So many mattress options confront us that it’s no wonder my patients ask me which mattress they should buy. Soft, firm or something in between? Innerspring, memory foam, latex, air or some combination? Pillowtop or customer topper or feather bed? And just how much does a good mattress cost? Just like televisions (or wedding dresses), mattress models start around $500 but the scale goes up to premium models costing more than $5,000! And no one mattress works for everybody: it’s a very personal choice.


Consider Your Sleeping Position

So here’s the skinny: the first and best way to narrow down your options is to consider your sleeping position. There are basically three sleeping positions to help determine what level of mattress firmness you should aim for: the stomach, the side, and the back. Everything else is down to budget and preference.

Stomach sleeping: just stop

Stop it right now! Sleeping on your stomach puts additional strain on your spine, especially at the lower back and neck. But, if you insist on sleeping on your stomach, choose a soft pillow but a firm mattress to support your body.

Back sleeping: fine for most of us

If you have low back problems it may be helpful to elevate your legs from time to time by placing a pillow or a folded towel beneath your knees, but check with your healthcare provider. If you snore or have a cold it may be helpful to elevate your head and shoulders with firmer or additional pillows. Habitual back sleepers are likely going to be better off with a mattress in the range of medium to firm – again, to relieve strain on the spine. If you have respiratory or cardiac issues that require other sleeping positions, consult your medical specialist.

For exercises to help enhance the musculoskeletal system’s mobility and strength, read our post on Active Release Techniques (ART)

Side sleeping: the most optimal for spinal health

Also the most popular sleeping position. I sleep on my side for that matter. People with low back or hip pain may find it comfortable to sleep with a pillow between the knees. People with shoulder pain who like this position will prefer a softer mattress. I’d recommend a firm pillow but a soft to medium mattress for these sleepers, one that will conform to the body’s natural curves and pressure points. A firm mattress will press into the hips and shoulders to create pressure.


The Many Types of Mattresses

After you’ve thought about your sleeping position and desired firmness, another element to consider is the type of mattress and the material it’s made from.

Innerspring Mattresses

The plain old-fashioned mattress. These can range from soft to firm. Most innerspring mattresses these days are pillowtop mattresses, probably so you won’t be able to flip it when it starts to sag forcing you to buy a new one. The classic innerspring is perennially popular, but you can also find hybrids with memory foam or gels.

Memory Foam

A polyurethane foam made from oil. Polyurethane foams have been around for a while, but memory foam was developed by NASA in 1966, eventually released to the public domain, and popularized for mattresses by Tempur-Pedic. Memory foam is exceptionally comfortable because it molds to the body in response to both heat and pressure. Of course, it also traps heat, which some people find uncomfortable, although newer mattresses include gels to dissipate that heat. Memory foams also come in different levels of density, viscosity, and resilience, which can be combined for different effects, so there are a lot of options available — some Tempur-Pedic mattresses have 9 different types of layered memory foam! 

Other issues to be aware of before purchasing a memory foam include off-gassing (when unwrapped they release chemicals for a few weeks), and their energy absorbency, which means they absorb motion which can make it difficult for infants and small children to adjust position if sleeping on them. For this reason, it is not recommended that you put infants down to sleep on memory foam mattresses. 

Companies like Tempur-Pedic and Serta are known for their memory foam mattresses, but smaller companies you’ve never heard of make them too. These mattresses can also vary quite a bit in price. A name brand will cost you quite a bit, while a less well-known brand might cost you less than $1,000.

Latex Mattresses

The bounciest mattress around! Latex is made from rubber trees, a sustainable natural material. They have a really bouncy feel, but they don’t trap heat or smell. They can be layered or blended with other materials like memory foam or gels. All of those factors help make latex mattresses very popular, and it’s nice to know that, according to Sleep Like the Dead, latex mattresses mostly have higher-than-average customer satisfaction ratings. However, these mattresses can be pretty expensive, and because the price point keeps some consumers away, they can be hard to find in showrooms for testing.

Air Mattresses

Adjustable air chambers surrounded by padding. The famous Sleep Number Bed is the most well known of these. The mattress can be inflated to your “perfect “ level of comfort. These mattresses can be good for couples who have different preferences in firmness.


Water chambers on top of a platform base, without additional padding. Water displaces at the heaviest pressure points of your body, relieving pressure but causing you to sag into the mattress. While some people find waterbeds comfortable, I do not recommend them.

Eco-friendly Mattresses

Many people would prefer to find an environmentally friendly mattress. There are many options available, from latex to wool blends, and they can vary quite a bit. Most green options will be found at local vendors, so if that interests you make sure you do a local web search to find vendors in your area.


Mattress Warranties

Many mattresses come with confusing warranties: 7 years, 10 years, 20 years, 10 years with 10 years prorated. Most warranties will list at what point they will consider a mattress “failed.” The standard for this is 1.5 inches of sag. However, many people start to experience aches and pains with as little as .75 inches of sag…so read this information carefully. While many companies claim that their mattresses will last 10 years or more, online reviews often suggest less. And it can be hard to claim on a warranty: you will probably need your purchase paperwork and a measurement of the sag.



When choosing a mattress, start by doing some research on your own like you would for any other major purchase. You can easily begin online. I think you’ll find what I did: a ton of information, some of it confusing, some of it contradictory. I found two articles on how to choose a mattress with completely opposite advice on sleeping positions — both written in an authoritative style (but not with actual professional expertise!). So be aware of the need to evaluate what you read and hear about mattresses.

Consumer Reports provides mattress ratings that may help guide your choice, but always test the mattress before you buy. Many new mattress companies sell directly to the customer online and they have robust money-back guarantees. These newer companies provide great mattresses at a fraction of the cost of more expensive brands.


Buying a mattress

When you’re ready to look in person, take the time to test mattresses. Lie on a mattress in your favorite sleeping position for several minutes. Think about how it feels. Do you feel pressure anywhere? How would lying on it for an hour feel? Think about your neck, shoulder, back, and hips. Think about any injuries you currently have and how it makes you feel. Do you have any chronic issues? Test several mattresses before you choose one. And before buying, check on the return policy. Many companies offer upwards of 120 days to try it out, although beware return shipping and restocking fees.

Also, consider a less well-known brand. While brands like Tempur-Pedic, Serta and Simmons are familiar and reliable, they have also been marked up many times over by the time they reach the showroom where you are seeing them. There are several companies that will sell great mattresses to you directly at a fraction of the cost of a name brand mattress from a furniture or mattress store: Casper, Purple, Nolah, Level Sleep to name a few. However, you might be then taking a risk on a mattress without laying on it first.

Local Charlottesville stores that I’ve had good experiences in:

Essentials by Classic Furniture: Ask for Zeke, and he’ll take good care of you.

Mattress Firm: I worked with the manager. They have a wide array of Tempur-Pedic mattresses. The manager was very kind and very helpful in urging me to pay attention to how a mattress felt.

Well-reviewed online mattress companies:


Tuft & Needle




Level Sleep

I have an update on these online mattresses. I’ve now slept on both a Casper and a Tuft and Needle. I have to say I was really impressed. I thought they were a great “Goldilocks” mattress. Not too firm, and not too soft. To be honest, I wish I had tried one. The last mattress that I got to help with my back cost 3x more than a Casper and I prefer the Casper! I now encourage all my patients to consider one of these online companies because of my own experience, the cost, the excellent online reviews, and the return policy. After a lot of my own research, I wound up purchasing a Nolah which (as a side sleeper) I’ve been very happy with.


Comfort Is Key

Most importantly, think about what is comfortable for your body and for your budget. Bear in mind that you’ll be spending a third of your life on this mattress and it’s probably worth a level of serious consideration and financial commitment. If you aren’t spending that much of your life on the mattress… you don’t sleep enough. Start!

Questions about choosing a mattress? Shoot me an email. If you are having pain and aren’t sure what is causing it, contact us!

About the Author

Dr. Samuel Spillman attained his chiropractic degree in 2008 from Western States Chiropractic College in Portland, Oregon. His undergraduate study was spent at Miami University of Ohio where he earned dual bachelor’s degrees in Interdisciplinary Philosophy and International Studies in 2001.