The benefit of getting a good night’s sleep is one of a few things in the world everyone agrees on. Sadly, getting enough deep sleep can be difficult, especially if you live with a disability. One way to mitigate some of the obstacles to a good night’s sleep is finding the right bed and mattress — one that is comfortable, functional, and goes above and beyond to support your specific health needs.

Many people with mobility disabilities use a standard consumer bed and mattress, and find the ideal setup is a frame that is the optimal height for transfers and a mattress that is the right balance of firmness for independence, but soft enough for comfort and skin protection. Others find that high-end adjustable consumer beds work better or are necessary for their independence or living situation.

Still others find that some combination of a hospital bed frame and specialty mattress is the optimal sleep-system for them. The main advantages hospital bed frames have over adjustable consumer beds is that they offer more adjustments, allowing the user or attendant to quickly and effortlessly change positioning and bed orientation. By lowering and raising the bed height to make transfers easier or angling the head of the bed to help with coughing or breathing, the right hospital bed can enhance independence and address some SCI issues.

The primary reason for choosing a specialty mattress is to protect skin, avoid a pressure ulcer, or help heal a pressure ulcer or skin flap. Additional reasons to choose a specialty mattress include comfort — as the same design that protects skin also provides a comfortable surface for great sleep — and allowing extended periods on bed rest.

Specialty mattresses protect skin integrity with various levels of shear reduction and immersion (sinking into the mattress). The correct amount of immersion also tends to be more comfortable for sleep. But too much immersion can make dressing, turning and transfers a challenge, something the right hospital bed and mattress combination addresses through frame adjustments. Also, many specialty mattress designs incorporate firmer sides for positioning and transfers.

Choices of hospital beds can be daunting. A web search shows there are well over 100 models of hospital bed frames, mattresses and frame/mattress combinations, with prices ranging from $700 to over $30,000. When looking for the optimal sleep system, if possible, try it before purchase to check for comfort and ease of transfers.

A great way to gather information on bed makes and models is to search disability forums like Rutgers University’s CareCure Forums. You can also check out reviews of a model you are interested in at online retail sites like Spinlife.com. For those with compromised skin or a currently healing pressure ulcer, it is wise to consult with a wound care clinician for their opinion of the most appropriate sleep system for your needs. When looking at a specific bed, check to see if there is a return policy in the event the system you choose is uncomfortable or doesn’t meet your needs.

The Benefits of Hospital Bed Frames and Specialty Mattresses

The list of adjustments and benefits for hospital bed frames — depending on the model — can include:

• Raising the Head and Upper Body: Helps with positioning and comfort, enables sitting upright for dressing, and can reduce strain on shoulders. Sitting upright makes it easier to eat and socialize, and can help with digestion and coughing.
• Raising Knees: Helps reduce leg spasticity, shearing and edema.
• Raising and Lowering Bed Height: Enables easier independent transfers, and aids attendant care.
• Raising the Foot-End of the Bed: Helps reduce edema in feet and legs.
• Auto-Transfer: A preset adjustment that lowers or raises the bed to optimal height for chair-to-bed transfers.
• Gravity-Assist Repositioning: Makes attendant repositioning easier.
• Trendelenburg and Reverse Trendelenburg: In the Trendelenburg position, the bed is angled so feet are higher than the head. Trendelenburg can help reduce edema, and reverse Trendelenburg can help with digestion.
• Side Rails: In addition to preventing a fall out of bed, a partial-length siderail (upper end of the bed) can be helpful for turning or provide a stable base for transfers.

Adjustments on a hospital bed can also help you fine-tune your most comfortable sleeping position and/or reposition yourself during the night. If you have decent arm and hand function, adding a trapeze can also help with repositioning.

Specialty mattresses are often more comfortable than their more basic, less expensive counterparts and can be a worthwhile investment whether you want better nightly sleep or are looking at an extended period of bed rest. If you have severely compromised skin or are actively trying to heal a pressure wound or flap surgery, you may need a high-end air management mattress.

Here are ideas and options for bed frames, mattresses, full bed systems and mattress top overlay options that can provide optimal sleep, health and independence:

Examples provided are not intended to be an exhaustive listing of available products. Please note: None of the hospital bed companies contacted for this story would provide a suggested MSRP. Listed and Online prices are approximations based on info available at time of print.

Non-Rehab Consumer Beds

Many consumer beds offer similar functions and benefits to hospital beds and mattresses, including some that combine bed and mattress. Just like choosing a rehab bed or mattress, the key is to find one that has the features you need to protect your skin and maximize your comfort and independence. 

Hospital Bed Frames

Basic Frames 

Basic hospital bed frames offer the primary push-button adjustments needed for sitting upright, dressing, positioning, spasticity reduction and transferring. In general, the more you pay, the more features and automation you get. Most basic hospital bed frames are 36” wide. (A standard twin size bed is 39” wide, and a full-size bed is 54” wide.)

Deluxe Frames

Deluxe bed frames offer more options, customizability and style choices. Additional adjustments usually include Trendelenburg, reverse Trendelenburg, and wider floor-to-bed-height adjustments to help with independent transfers and make it easier for attendants to help with transfers and/or repositioning. Some deluxe frames offer color options and paneling for users who want to avoid the hospital look. Most deluxe models offer wider versions than the 36” width of basic hospital beds, or are expandable.

Hospital/Rehab-Style Mattresses & Overlays 

In addition to comfort, the reason one would choose a hospital or rehab-style mattress is similar to choosing the proper wheelchair cushion. The goal is to get the correct amount of immersion to reduce pressure and shear on sensitive areas. For users with intact, healthy skin, something with multiple levels of foam can provide a good balance of immersion for skin protection and comfort, and enough firmness for dressing and transferring. At the high end are air management systems, which provide immersion that provides maximum protection for compromised skin, often at the cost of mobility. The most expensive mattresses are usually only for people with extremely compromised skin or those healing from a pressure ulcer or skin flap. 

Two items of special note: 

• When trying a new mattress or mattress topper, it is especially important to do regular mirror-skin checks (or smartphone/selfie stick skin check) to look for redness and skin damage. 

• Most hospital/rehab-style mattresses require a strong bed-frame base — either a hospital bed or a base where the mattress support slats are 3 inches apart or less. 

Entry Level 

These mattresses distribute pressure using different layers and densities of multidensity foam. Examples: 

Overlay 

An overlay can be a solid, often more affordable option for people looking for a little extra skin protection or added comfort. For as little as $50, you can add some protection with a 2-3” foam egg crate bed topper, available at online retailers like Amazon. For a little more, Tempur-Pedic makes a 3” overlay made with material that supports and responds to weight, shape and temperature that starts at $259. Keep in mind, an overlay usually adds about 3 inches of transfer height to the top of the mattress that might make chair-to-bed transfers more difficult, depending on your current mattress height.

Low Air Loss 

Low air loss mattresses are the leading-edge protection for people with compromised skin and for helping heal pressure ulcers, recent skin flaps or grafts. They are made up of a series of air chambers and an air pump that create a surface that adjusts to and evenly distributes pressure to help maintain normal blood flow and eliminate pressure points. High-end versions employ microprocessors and computer calculations to monitor and simulate floating in a liquid.  

When checking online prices, be sure the pressure control unit/pump is included in the price. The prices below are for mattress and control unit/pump. 

All-In-One Hospital Beds 

All-in-one hospital beds come with a frame and mattress designed to work together. This is especially helpful with high-end bed and high-protection mattress combinations designed for compromised skin protection and/or healing a pressure ulcer. They offer the ease of one-stop shopping — not having to mix and match bed and mattresses — with the tradeoff of higher cost (see Payment and Sourcing”, below). 

Other Solutions 

Automated Lateral Rotation 

During sleep, nondisabled people turn an average of every 12-minutes. Turning and changing position — or having an attendant reposition you — reduces the risk of pressure sores, and turning from side to side is good for the lungs, and helps open up airways and reduce congestion. The Freedom Bed by ProBed Medical (see “The Bed that Turns You“, November 2019 New Mobility) is a bed that automatically turns you from one side to the other at a range of up to 60 degrees. It has 13 voice-activated functions, including adjustments for side-to-side angle, frequency of turning, and sitting upright. ProBeds are custom-made for each person and incorporate a dry floatation mattress. List: $35,000-$50,000. 

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