Raise the Head of the Bed

Raising the head of the bed does help - it retrains the body sensors and helps reduce symptoms with standing. In the successful trials by Levine and Fu in Texas, their program included focus on fluids, salt, raising the head of the bed and doing the right activities for exercise.1

How it works: If people are repeatedly tilted up, it helps lessen the orthostatic hypotension.1 In the original research, they found that it helped increased how much blood the heart could pump out each time it beat (ctonracted). (The medical term is "cardiac output"). Others think tha tit might also help because it increases the veins tightening up or by retraining the special cells in the neck and aorta (baroreceptors).1

It is also thought that it helps the body hold on to fluids in the blood stream and tissues. When we lie down, the body moves fluid from the vessels and tissues, through the kidneys and then out as urine. That means we start over each day tyring to hold on to fluids to keep the blood pressure/pulse steady so we don't get dizzy when we stand up.


How much should it be raised?

The head of the bed should be raised by 4 to 6 inches or 10 cm.

Some recommend going up to 6 inches, but there is no published guidance on who needs to raise it up to 6 inches. If you think 4 inches is not enough for you and you wonder about going to 6 inches, you can ask us to research it to see what the experts say. (Ask Us)


Is it ok to raise it that high all at once?

Best not to! Of course you can try it and see what happens. You will probably get a headache and feel sick for a couple of days. That's because your body is used to being flat at night - it knows how to get the blood around when you are flat. When you raise it up, it's like standing up part way - all night.

It takes extra work for your heart to get the blood around and back up to the head when the head is raised up. The body needs to have the enough bloodand the heart has to pump more and stronger to get the blood up to your head all night when the head of the bed is raised. It takes time for your body system to adjust to the change.

Recommendation: do it gradually. Increasing by about 1/2 inch a week is pretty easily tolerated. Experiment to see how many times you need to turn it around to raise the head 1/2 inch. On some beds, it takes turning the crank around a full circle, 2 times. When you get to 4 inches off the ground for the head of the bed, you can stop and see how things are going.


How do I do this

There are some 'easy' ideas - to use pillows under your head, to use a wedge under the head of the mattress or, if you have an electric bed, to raise th head of the bed. These are easy but they don't work the best. If you stay in position and don't slide down, they create a "kink" in the body around the wais . If you slide down, your head isn't as high as it needs to be.

To work, the whole body has to be at an angle. The purpose is to require the heart and all the pressure receptors to readjust.

Options that work:
    —If you have a hospital bed, there is usually a crank at the head of the bed. It will raise the legs at the head of the bed.

    —Bed lifts - these are made to raise a bed up off the floor for more storage space. You can use them under the head of bed. Caution - don't start with the whole one - it will be too high too fast and some people get headaches - it's like partly standing up all night! They make them plastic and wood. Two of the plastic lifts could be trimmed so they are only a couple of inches and used to get started.

    —Wooden blocks - the hardware store may also have some ideas. Another option is cutting 2x4s into squares. (Sometimes the hardware store will cut a piece up for you). (You would need a groove in the top to hold the leg of the bed in place. An option - they make protective cups to put under legs of furniture to protect the floor. Find one that has a groove in the bottom and/or has a raised border around it. It can hold the leg of the bed in place. Nail the floor-saver cup into the top of the wood block. You might need to make a number of blocks of short heights so you can increase the height of the bed each week.


The Good News About Compression Garments

  1. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306.  Abstract.  Article PDF.
  2. Ector H, Reybrouck T, Heidbüchel H, Gewillig M, Van de Werf F. Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol 1998; 21:193–196.
  3. van Lieshout JJ, ten Harkel AD, Wieling W. Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res 2000;10:35-42. Abstract

Author: Kay E. Jewell, MD
Page Last Updated: September 18, 2012