If you suffer from back pain and you're looking for the best mattress, you'll have to navigate through a lot of misinformation. You may have heard that if you have back pain, the best mattress to sleep on is a firm mattress. You may also have read about a Spanish study that found that mattresses with medium firmness improved pain among the 313 study participants—more than a firm mattress—reporting that, "At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed." The truth is that there's no single answer for everyone suffering from back pain.

If you suffer from back pain, here is a good general guideline when choosing a mattress:

• Side sleepers need a softer mattress: A soft mattress will adjust to the side profile of your body, which has more curves than your back or stomach.
• Back sleepers need a firmer mattress: A firm mattress, while it may seem counterintuitive, can support your back better than a soft mattress. Back sleepers can suffer from using a soft mattress that allows their back to sink in, forming a U shape.
• Your weight is a big factor: People under 130 lb tend to need a softer mattress, between 130 lb and 230 lb need a medium-firm mattress, and those over 230 lb need a firm mattress.
• Stomach sleepers need a firm mattress: While this position is not recommended, a firm mattress for back pain can be the best match. However, your mattress firmness can only solve a portion of the issues stomach sleepers encounter.

Those are general guidelines, and it will be different for everybody. The best way to know if you need a softer or firmer mattress is to sleep on different mattresses. You can get an idea by lying on a mattress in a store, but it's not the same as spending a whole night on one.

If you're unable to try out different mattresses, the good news is that 99% of online mattress companies will give you at least 30 days to make sure you're happy with your purchase, and many include 120 and even up to 365 nights of sleeping—totally risk-free.

For our top choices, we selected the mattresses that tend to be more in the middle (medium-firm) to accommodate most sleepers suffering from back pain.

I used to wake up every morning with a tight lower back, and I needed to stretch my hamstrings until my back loosened up. I just assumed this pain was something I would always have to deal with. I once spent a week at the Westin Bonaventure in downtown Los Angeles, and I noticed after a few days that my back wasn't tight on any of the mornings when I woke up. The reason why—the Westin's "Heavenly Bed," which is very soft.

When I got home I ordered a 3" mattress topper. I immediately felt better and had no tightness when I got up. My wife said that her hips and shoulder felt better.

When we moved we decided to buy a new mattress. We went to six different mattress stores and decided to buy one at Relax the Back. The salesman asked if we needed a soft or hard mattress, and we responded: very soft. He told us that the mattress that we wanted had three levels of softness, and he strongly recommended the second softest. He finally convinced us to not get the softest, and we listened.

When we got the new mattress, we both were waking up experiencing a little pain and decided to return the mattress for the softest version. It turned out that the salesman had ordered us the firmest mattress! Once we got the softest mattress, we had no pain.

The great news about our top mattress choices is that the mattress industry is changing, saving consumers lots of money. The old way to buy a mattress went like this: go to a mattress store, lie on several beds, and talk to a salesperson who is fighting for their commission in a very competitive industry. The new way, buying directly from the manufacturer via the internet, has eliminated the middle man. When you buy directly from the manufacturer, the price isn't inflated with all of the additional expenses that you have with a brick and mortar store (salesperson commission, rent, heat, electricity, etc.) According to Tuft and Needle, a mattress from a brick and mortar store that costs $3,500 only costs $300 to make! So the principle "you get what you pay for" doesn't apply when you're comparing a mattress from a brick and mortar store with an online retailer. Now you can buy a mattress from an online retailer for significantly less and get a much higher quality mattress.

All of our top choices are under $1,000. We didn't include any of the ultra-expensive mattresses in this review as they're out of the budget of most shoppers. The mattress industry has changed significantly in the last few years, and the good news is that you can save a lot of money by avoiding the middleman, and you can avoid a lot of misinformation. All of our top choices are sold online.

When my wife and I shopped for our new mattress, we went to six different retailers and were overwhelmed with information. Some of the things we were told contradicted what other salespeople had told us. One salesman even asked us who we had talked to previously, and started going into detail about what a charlatan one of our previous salesmen was! I guess it shouldn't be a surprise to be reminded that each salesperson is incentivized to tell you that their product is the best, whether it's actually best for you or not.

All of our top choices have in-home trial periods so if you don't like the mattress, you can return it risk-free.

If you've never shopped online for a mattress, there are some pros and cons that you should know about. The main pro is that you're probably going to save a significant amount of money. The main con is that you can't try out the mattress in a store, you have to try it out in your house. If you choose a mattress that has a 100-night in-home trial, you'll have the option of returning it.

Another con of shopping online, if you're a reader of reviews, is that sometimes it can be tricky finding honest reviews. Mattress companies will pay people for positive reviews of their products and negative reviews of competitors. If you read a lot of reviews, as we do, sometimes you'll find a high number of mattress reviews written by people that are making a lot of grammar mistakes—that's a clue that it could be a paid review. However, if you go into a store and buy from a salesman, you can't necessarily trust them either! So either way, it pays to do some research.

One option you have is to check out some of the online mattresses in some high-end retailers like West Elm. You may only find a couple of mattresses there that are sold online, and not in all of the West Elm or high-end retailer locations, but it's a possibility that you'll get to check them out without having to order them.

Many mattresses will have a warranty of 10 years or more, but you have to be careful about the "prorated phase," which means that the owner must pay a percentage of the original price to have their mattress replaced or repaired. Make sure you find out how long the non-prorated phase lasts.

Pay attention to indentation depth. Some warranties will use this terminology to differentiate between normal indentations and those that will be covered by the warranty. The range is generally between 1/2"-1.5" Those with back pain will want a warranty that covers at least 1" indentations, and preferably even smaller.

Off-gassing is when a product gives off a chemical smell that comes from the foam, flame retardants, and/or the adhesives. Besides the smell, these volatile organic compounds (VOCs) can include harmful chemicals such as formaldehyde, trichloroethane chlorofluorocarbons, benzene, methylene chloride, toluene, naphthalene, and perfluorocarbons. Some manufacturers claim that exposure to off-gassing isn't harmful, but I personally don't believe this. These manufacturers claim that no studies have shown that memory foam causes cancer. Some people seem to experience issues, while others don't; those with asthma or other respiratory conditions may want to avoid mattresses that off-gas. You will have to decide for yourself whether this is important for you.

We begin every review with an in-depth research phase on both what your body needs in a sleep product (especially in the case of back pain sufferers) and what products are available to meet those needs. We draw from extensive first-hand experience with both traditional coil spring mattresses and modern memory foam or gel mattresses. We conduct interviews with doctors and chiropractors to get an idea of what medical professionals are recommending.

The final part of our research phase is establishing a set of criteria we use to evaluate the mattresses on the market. These criteria keep things unbiased and objective when we make a recommendation.

• Price: Prices of mattresses have come down dramatically over the years but there is still an incredible variation in price, mostly due to branding and the claims of unique benefits.
• Warranty: A solid, long-term warranty is normally good evidence of a quality mattress. Companies that offer 5 or even 10-year warranties stand by their products and are ready and willing to make sure you are happy throughout the life of your mattress.
• Firmness: While there isn't a specific firmness level that works for everyone, we look for mattresses that match popular sleeping positions and user weights. For example, there are mattresses, especially on the softer side, that aren't great for the vast majority of people. This makes it hard to recommend them for anyone other than lightweight sleepers.
• Cooling Ability: Most people want a mattress that prevents them from overheating. Nearly all the mattresses available today claim to help with cooling, we'll help you confirm this.
• Durability: It's especially important that your mattress supports you properly—right away and throughout its life on your bed. We look for mattresses that do not deform significantly over time.
• Customer Service: A quality mattress is an investment and if you have an issue it's important to have a company and customer service team that will help answer your questions, and make sure you're happy with your purchase.
• Length of In-Home Trial: In addition to a long warranty, a long in-home trial is a great indicator of a mattress company's willingness and confidence to make you happy. In-home trials really take away the risk from you as a consumer.

Sometimes your back pain issues are not solved by just getting a new mattress, or even a mattress with a better firmness. Your sleep health is a combination of so many different factors. Here are some tactics you can try:

Side Sleeping Tips

• Use a pillow between your knees. Side sleeping requires one leg to be higher than the other. What ends up happening is that the top leg may rock and pull at your pelvis (straining your lower back) due to the downward slope towards your feet. Adding a pillow between your knees not only takes the weight off your lower leg but it levels the top leg and helps it rest in a more neutral position.
• Use a small thin pillow just above your pelvis. This area is notoriously unsupported, especially for the petite or people with wide hips and a thin waist. If you find this area unsupported then this is a great thing to try as it also helps position your pelvis and legs for good sleep.
• Don't forget about your pillow. Each area within your sleeping position can have an impact on your sleep. Even as a lower back pain sufferer, fixing problems with your pillow and neck position can actually help improve back pain as well. Side sleepers should seek a thicker pillow to fill the often large gap between the shoulder and neck.
• Learn more specifics about side sleeping tips and mattress recommendations by reading my guide on Best Mattresses for Side Sleeping. 

Back Sleeping Tips

• Elevate your legs slightly. While back sleeping is unanimously accepted as the best sleeping position, some people still experience lower back pain, especially on firm mattresses. The main cause of this is your pelvis rocking forward towards your feet, pulling on your lower back. Elevating your legs slightly is very effective at stopping this.
• Try a small lumbar pillow. If elevating your legs doesn't help, you may need to try a small lumbar pillow at the base of your back, especially if you have a firm mattress.
• Make sure your pillow isn't too thick. Back sleepers often make this mistake. Back sleepers should generally find a pillow that allows their forehead and nose to be level with one another. Lowering your head can actually have an impact on your lower back as your weight is slightly more distributed and neutral. If you're looking to learn more about pillow height read my guide on Best Pillows for Back Sleepers.

Stomach Sleeping Tips

Stomach sleeping is not advised by any doctor, chiropractor, or physical therapist, but if you have to sleep on your stomach here are a few ways to minimize the issues related to this sleeping position.

• Add a relatively thick pillow under your hips. Your body weight will significantly compress the pillow, but raising your hips, even a little bit, helps get your lower back in a more natural position.
• Try losing the pillow. The side of your head (when turned 90 degrees) and your chest are almost on the same plane, meaning that when you lie down on your stomach there is almost no need to elevate your head.
• Learn more about stomach sleeping and mattress recommendations by reading my Guide.

Chronic pain—If you're dealing with chronic pain, it's even more important to make sure you're sleeping in a neutral spine position with a pillow and mattress that support you and your sleeping position of choice. It's also important to apply any of the above tips depending on where your pain is located.

Memory foam has air pockets inside—when you lie on it, it compresses the air pockets so there's no air circulation to disperse the heat. Higher body temperature isn't recommended for high-quality sleep. If you already have a memory foam mattress or plan on buying one, you may want to buy a mattress topper that has a cooling effect or purchase a mattress that has a cooling feature.

Spring mattresses are cheaper than memory foam, less durable, transfer motion to another person on the bed, and for two out of the four different types of coil mattresses, aren't recommended for people suffering from back pain.

There are four types of innerspring mattresses, which are the traditional mattresses that have been around for a long time: continuous coils, Bonnell coils, offset coils, and pocket coils. The first two aren't recommended for people with back pain. Offset coils make mattresses very firm, so they could work for back pain sufferers that sleep on their back. Pocket coils, the most expensive type of innerspring mattresses, are not as expensive as memory foam and are the only type that offers the support that someone with back pain would need.

The two benefits of coil mattresses are that they're less expensive and they don't make sleep hot.

Gel mattresses first hit the market in 2011 via Serta's iComfort gel memory foam mattress. They're supposed to be cooler than memory foam and offer the same support. They are incorporated into mattresses as a layer on top or beneath the top layer. The gel can be included as beads inside of the foam, or it's poured into the foam as the foam sets. You'll normally see gel incorporated into memory foam mattresses, but you'll see it in innerspring mattresses and mattress toppers as well. Serta also uses gel in its memory foam pillows.

As far as gel being cooler, there hasn't been extensive testing, but they do seem to be slightly cooler. The liquid in the gel seems to take longer to heat up, but it eventually does heat up. I owned a Tempur-Pedic for 10 years and it would warm up after a while. I bought a memory foam top to make it softer, and that got very hot after a few hours and was definitely hurting the quality of my sleep. My current mattress has a 1" memory gel top layer with memory foam underneath. It still gets warm, so I bought a cooling mattress topper and that keeps it cool.

According to Best Mattress Brand, foam manufacturer Cargill did a study and found that plant-based memory foams sleep 25% cooler than gel memory foam. Amerisleep, one of our top choices, uses plant-based memory foam that has a more open structure, which allows heat to disperse. The plant-based memory foams also produce far fewer VOCs (volatile organic compounds), which can cause health issues.

Latex mattresses are similar to memory foam, although these mattresses are not temperature-activated. They are also more resilient, thus have better "spring back", so the sleeper can avoid the feeling of being "stuck in quicksand", a sensation that some who sleep on memory foam complain about.

Sleeping on your back generally keeps your spine in a neutral position, though it's better when you put a pillow under your knees, which keeps your knees in a better position (just like when you have a massage or acupuncture appointment). It can be problematic for those suffering from sleep apnea, however, as the tongue tends to slide back and block the airway. This position can also make snoring more intense.

Sleeping on your side is the second-best position, and it's better for those who snore and those with sleep apnea. To minimize pressure on your hips and torso, it's best to keep a pillow between your knees and another one in front of your chest to drape your arm over.

Sleeping in the fetal position is better than sleeping on your stomach but can cause issues if you're too balled up, as you're restricting your breathing, and your spine is not in a neutral position, which can put pressure on the vertebrae.

The reality is that most people don't stay in one position all night. Sleepers shift positions during the night, which makes it difficult to keep pillows in the right position (under or between your knees and/or in front of your chest).

If you're looking for more info, Michelle Kenway put together a great back pain video that helps guide people through different sleeping positions.

This is the worst sleep position for your spine. It takes you out of alignment more than sleeping on your side or back, and it puts a lot of pressure on your neck. If you do sleep on your stomach, you can put a pillow under your stomach which will keep your spine in a more neutral position.

Well before I talked to any good chiropractors about my back pain, I learned that sleeping on my stomach was a huge mistake! When I slept this way, I would wake up with incredible tightness in my lower back and it would take me a few hours to be able to move without pain. To stop myself from sleeping on my stomach, I got in the habit of tucking a pillow in right at my stomach, often folded in half, so it would make it almost impossible to go onto my stomach. If I tried to turn over on my stomach while I was asleep, the pillow would keep me from turning all the way over. After a few months, this habit stuck and I never slept on my stomach again.

If a new mattress isn't in your budget, buying a mattress topper for back pain can make your bed softer or firmer. Note that if you purchase a piece of foam that you slip under your bedspread, the foam will compress and become dense. There's no room for air to circulate and allow the heat from your body to disperse, and you get hot. Being hot will reduce the quality of sleep for most people. It is, therefore, a good idea to shop for cooling pads and toppers to make your bed softer.

If your partner or spouse has different firmness requirements to you, there are a few different options:

• Try a mattress that is designed specifically for different positions and sleep weights, like the Leesa.
• Consider investing in a Sleep Number bed or similar that allows you to adjust each side individually.
• Add a mattress topper to make one side firmer or softer as needed.
• To make one side firmer, try putting a piece of plywood between the mattress and the box spring for additional support.
• Order two different twin mattresses of different firmness levels and slide them together.

Sleep researchers have found that you cool down when you sleep, and if your core temperature doesn't drop, the quality of your sleep suffers. The issue with many types of foams is that they compress when you lie on them, and there's nowhere for the heat to escape. So when you first lie down on one of these mattresses, you won't initially feel hot, but after a few hours, you may wake up feeling hot.

Many people don't realize how much more comfortable they could be with a larger mattress. Below we list the sizes of the common and a few uncommon mattresses:

• Crib: 27" x 52". Once your child reaches 35" in height it's a good idea to upgrade the mattress size to a twin or larger.
• Twin: 38" x 75". These mattresses are sometimes referred to as a "single" and are great as a space-saver in a small room, but may not be comfortable for many adults.
• Twin XL: 38" x 80". This mattress is 5" longer than a standard twin and will give taller sleepers more room.
• Full: 53" x 75". Also referred to as a "double," these mattresses are a tight fit for two and are a tight fit for taller sleepers.
• Queen: 60" x 80". The most popular mattress size because it gives many couples the space to sleep comfortably while not taking up too much bedroom space.
• King: 72" x 84". This bed is the widest of the most popular mattresses.
• California King: 72" x 84". This size is 4" longer but 4" narrower than a regular King. These are great for taller people. But if one of the sleepers shifts and moves a lot, the King will give more space as it's wider.
• Emperor or Wyoming King: 84" x 84".
• Caesar: 96" x 87".
• Alaska King: 108" x 108".

The Better Sleep Council recommends replacing your mattress every 7–10 years, but you have to always pay attention to how you feel when you wake up and the quality of your sleep. Of course many things can cause back pain, but an old mattress or a mattress that isn't right for you is a very common contributor to back pain.

Some signs that you need to replace box springs are squeaking or sagging in the center. You can remove the dust cover and look inside. If you see worn or broken wood slats or coils, then you know it's time. Though box springs tend to last longer than mattresses, some people replace their box spring whenever they replace their mattress.

You may also realize that your mattress isn't working for you. Several years ago I spent a week in a hotel and realized on the second day that I wasn't waking up with a tight lower back. The bed I was sleeping on was at the Westin Bonaventure in Los Angeles, and it was called the "Heavenly Bed." The bed was ultra soft. When I got home, I ordered a 4-inch foam layer to put on top of my bed to make it softer, and I was waking up with no pain. My wife said that her hip pain went away. Our mattress was 7 years old, so it was about time to get a new one, but even if I had only just bought my mattress, we would have purchased a new one.

You spend a third of your life sleeping, so it makes sense to put extra time, energy, and money into something that has such a big influence on your back pain and overall health.

• You may have heard that you should flip your mattress every six months, but some mattresses are only designed to be used with one side up. You can, however, rotate your mattress to slow down sagging.
• Don't let kids play on your bed. Though it's fun for them, it will reduce the life of your mattress and your bed frame!
• Use a high-quality bed frame. If your frame is bowing in the center, it reduces the life of your mattress and changes the position you sleep in.
• Get a high-quality mattress cover that's washable and that will protect you from allergens and dust mites.
• Read the care guide for your mattress and follow any recommendations for taking care of your mattress and extending its life.

When you get rid of your old mattress, don't give it away. If it was one of the contributors to your back pain, you don't want anyone else to have the same issue. For tips on the best way to get rid of your mattress, check out our Mattress Disposal and Recycling Guide.