Stevenson · Clocks & sleep 2025 · randomized counterbalanced crossover trial · n=34

Under the Covers: The Effect of a Temperature-Controlled Mattress Cover on Sleep and Perceptual Measures in Healthy Adults.

Cited 2 times in the scientific literature.

Level 2 - randomized trial

Individual randomized crossover trial in humans

PubMed 41133665 · doi:10.3390/clockssleep7040055 · record verified 2026-08-31

What was done

In a randomized, counterbalanced crossover trial, 34 healthy adults (20 females, 14 males; age 30 ± 5 years) used a temperature-controlled mattress cover for 14 nights following at least 3 nights of familiarization. Active temperature control was turned on for 7 nights (POD) and off for 7 nights (CON). Objective sleep was assessed using wrist actigraphy, while heart rate (HR), heart rate variability (HRV), and respiratory rate (RR) were recorded using embedded mattress sensors. Subjective sleep quality, thermal comfort, and thermal sensation were captured via daily and weekly questionnaires.

What was found

Linear mixed models demonstrated statistically significant improvements favoring the active temperature condition across all daily perceived outcomes (all p < 0.05), including a large improvement in perceived sleep quality (p = 0.001, d = 0.92). No statistically significant differences were observed between conditions for objective sleep metrics or biometrics (HR, HRV, RR; all p ≥ 0.05).

Why it matters

Thermal regulation of the sleep surface can notably enhance subjective sleep quality and comfort in healthy adults, though these perceived benefits do not immediately correspond to detectable physiological or actigraphy-based changes.

Limits

The study had a small sample size (n = 34) of young, healthy adults, limiting generalizability to populations with sleep disorders. Blinding was likely imperfect because participants can physically perceive temperature changes, introducing potential placebo or expectancy effects. Objective sleep was evaluated with actigraphy rather than gold-standard polysomnography, and the 7-night duration per arm was short.

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