The objectives of our study were to determine whether sleeping on either a hard, medium or soft mattress and base bed set affected the quality of sleep of patients with low back pain and to assess whether pain-related factors were influenced by the hardness of the bed. Six males and three females between 18 and 30 years of age slept, for two non-consecutive nights, on three mattresses of different firmness; the order of presentation was randomized. Subjective assessments of sleep, mood and back pain were made using visual analogue scales. Backache was reduced and sleep quality improved on the first night on the hard mattress. On the second night, there was an improvement in sleep quality and morning vigilance; in addition a decrease and in the need for sleep discomfort, backache was associated with the hard mattress when compared to the soft mattress. The well-being of our patients therefore improved if they slept on a firmer mattress. We do not know whether the effect is sustained, or has objective correlates.

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