James Leinhardt, looks at why sleep surfaces should be a factor when it comes to looking for care.

The third Thursday of November marks a day of much needed awareness for everyone involved in healthcare; Stop Pressure Ulcer Day. Indeed, anyone working in the sector will have come across this condition before. Costs to the NHS of treating pressure injuries are running at more than £3.8 million every day. 

Pressure injuries are a major complication faced by people who are bed bound or immobile. The pressure that builds on soft tissue causes distortion to the tissues and/or an interruption to the blood supply; this kills or damages skin leading to painful ulcers.

It’s for this reason that when looking for care, you must ask questions about postural management, and whether staff have the expertise to care for a resident’s 24 hour postural needs. This could make all the difference when it comes to preventing pressure injuries.

Preventing pressure injuries

One of the best ways to protect against these injuries is the practice of good posture in bed. There are a vast amount of benefits that can be related to postural care, including:

  • improved sleep quality,
  • better muscle tone and mobility,
  • reduced pain.

However, I’ve all too often seen interventions chosen on the basis of pressure relief only, and specifically the prevention of pressure injuries, rather than the individual holistic needs of the patient.

Whilst a care provider is accountable for pressure sore management and could be fined for failing on this, they are not accountable for postural change and the preservation of body shape. The frustration here is that the majority of pressure injuries are preventable.  


In reality, posture should be used as a preventative measure for combatting pressure injuries. However, there is currently no formal provision for postural management in lying and sitting positions. In addition, therapists often find it difficult to provide suitable equipment. To that end it is vital that care homes do their utmost to choose appropriate patient-focused equipment. And to provide regular turning in bed, and maintain excellent personal care.

Airflow mattresses

Today’s basic prevention and management of pressure injuries is the use of airflow mattresses, which account for 10 per cent of hospital beds. Also known as alternating-pressure mattresses, they contain air pockets which inflate and deflate to supposedly offload pressure on the body. However, research has shown they are not always providing a proper solution to pressure injuries.

Despite air flow mattresses being commonly found in care, no one had carried out research on the effects of sleeping on them until 2019. Now, these clinical studies, and even our own independent research have demonstrated how important sleeping on the right surface is, so surely comfort should be a given rather than an optional extra; whether it’s in healthcare or a domestic setting.

A good night’s sleep

Equally, it is well evidenced how vital sleep is to all of us, and especially the vulnerable. In 2017 neuroscientist Mathew Walker said; ‘Sleep is the single most effective thing we can do to reset our brain and body each day – Mother Nature’s best effort yet to contra death.’ The UK Sleep Council has also published a poll that showed being uncomfortable in bed as the main factor in disturbing sleep.

In 2018 NHS Improvement described pressure injuries as a ‘concerning and avoidable harm’ – if they are treated as the problem, rather than a symptom of poor care, the fight will continue to be lost.  

As the significance of posture, and specifically nighttime positioning increases, the sooner we’ll see it as a priority in care homes, giving us a new weapon in the battle against pressure injuries.

James Leinhardt is founder and CEO at Levitex. An expert in sleep posture, he has spent his career working with NHS Trusts and social care organisations throughout the UK to help improve the lives of patients with debilitating illnesses.