Very nice pad.  One of the few that say they’re cotton and actually are.  I’d call it medium, not thick, iand down alternative, which implies lofty, is misleading.  It doesn’t expand when removed from the bag it’s tightly packed into. However the stuffing is  well packed into all it’s 
compartments.  Im happy with it.  I’d rather have a nice, breathable cotton mattress pad and put something underneath it if I needed more padding than have some slippery, hot mass of polyester close to my skin.