Sleeping with head higher than feet

4th Feb 2024 | Dr Boon Lim & Philip Eardley


Sleeping with your head elevated can be very useful way to help minimise daily symptoms of dizziness and lightheadedness associated with low blood pressure over time. To find out why this works please watch the short video below

How exactly should I set my bed up to sleep?

This should be ideally with a brick, wooden block or book underneath either of the feet of the bed (head side)  to allow elevation of the whole of the top half of the body (so you are sleeping with your head higher than your feet). In practice, you should try to elevate the head of the bed as high as you can comfortably sleep without rolling towards your feet (i.e. slipping off the bed). 

It MAY NOT be practical to do this, for example if have a divan bed, without any “legs” to elevate, in which case, don’t be too concerned. Do not let what you cannot do, prevent you from doing what you can! You can  focus on the other aspects of management for orthostatic intolerance / lower blood pressure for example by paying attention to hydration, increasing salt, wearning compression stockings and performing isometric counter pressure exercises

Lessons from Space Flight ... the NASA astronauts orbit experiments!

Click here to link to Nasa full article : (a little technical at times –  but interesting reading nonetheless!)

Think of NASA as the Formula 1 team for human performace! Advancement in science and understanding of human physiology and behaviour can often be inferred from these detailed measurements. In a nutshell, what the study does indicate is with space flight, which is essentially an antigravity environment, where the body’s homeostatic control is altered by the effects of gravity-free environment, we can see that there is a tendency to reduction in plasma volume (which is the overall amount of fluid including blood flowing through your body), as well as impairment in the usual compensatory responses (typically mediated by adrenaline) on standing. The combination of the 2, does lead to astronaut’s who return from space flights often having a very challenging few days after return to Earth in a full gravity environment. 

However these astronaut’s do eventually recovered by getting used to standing again in a gravity environment and the body’s natural ability to respond to this leads to a gradual increase in the plasma volume and reflexes until it comes back to normal function


But I am not in space or zero-gravity environment! So how is this relevant?

These findings from the NASA studies have been replicated in normal subjects, who are asked to lie flat, or typically with the head down lower than the feet for a prolonged period. Studies have shown prolonged bedrest, even in normal subjects, to simulate a low gravity on micro gravity environment, can reduce plasma volume and can impair cardiac reflexes exactly like the findings seen in the NASA-led studies during the space flight program.

If you are somebody who suffers with orthostatic intolerance and tend to spend a significant amount of time in a recumbent or lying down position or indeed a semirecumbent position (perhaps being seated on the sofa with your legs up), and then over time, you would also be “simulating” a lower gravity environment as your body is not subject to the usual “challenges” of having to fight gravity. This may be very challenging on a day-to-day basis but at night, when we sleep, we can use the advantage of a head up, feet down, bed tilt, to “enchance” the effect of gravity on a body and to “train” our bodies to be more used to being in the semi-upright position. 

The physiology of this is highly complex and not within the scope of this article but simple way to think about this is that by sleeping with your head up in your feet down, what you are in fact doing is artificially lowering your blood pressure (hopefully without symptoms as you are sleeping!). Over time, the body’s usual response to a low blood pressure is to elevate the neurohormonal mechanisms (mediated by a combination of your blood vessels, your kidneys, your brain and your heart), which over a longer time (perhaps weeks months), will allow more blood volume to be retained by your body.

For those of you who know about the drug fludrocortisone, think of this long-term strategy of elevating your bed head as having your own endogenous (or self produced) fludrocortisone -your kidneys will eventually up regulate and secrete more of the hormone aldosterone, which serves a very similar function to fludrocortisone but is completely natural and will eventually in time allow your kidneys to reabsorb salt and hold onto water thereby increasing the plasma volume (total amount of fluid circulating in your body), which is essentially what the drug fludrocortisone does

Worth a try! But it's a long game.

Do not expect to suddenly feel extremely well overnight by using this strategy. Often times, when coupled with other conservative treatments including hydration, salt, compression leggings in the daytime, elevating the head of the bed, can, over a period of a few months, lead to a gradual improvement in overall symptoms. If it is convenient for you to do so it certainly worth a try

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