Heads-up sleeping has dramatically improved my daily functioning. I went, in a week and a half, from bedbound to reasonably active–out of bed most of the day, light housework, getting out to social events, etc. Although it sounds like it doesn’t help everyone, it seemed to take away most of my POTS and much of my exhaustion, and to greatly improve my stamina–just as saline infusions do for some people – Throughhiker
Simply raising the head of the bed several inches really helps some people sleep better.
This blog is more about lying down than sleeping; it just so happens that we spend much of our time lying down when we sleep. Some researchers and doctors propose that lying flat for long periods of time, whether sleeping or otherwise, is simply not very good for some people’s brains. In fact, they believe it can cause all sorts of problems.
It all starts with too much blood flowing to the brain. Of course, many people with chronic fatigue syndrome (ME/CFS) lie down to get more blood flow into their brains but if they’re right too much of a good thing might be a bad thing.
Cardiovascular Dysregulation?
Could brain blood pressure regulation be off in ME/CFS/FM as well?
Just as there are systems in the body that help propel blood into the brain when we stand other systems prevent too much blood from hitting the brain when we lie down. If those systems are faulty, spinal fluid can gather in the ventricles increasing intracranial pressure and causing the brain to be bathed in excess fluid. That excess fluid means, ironically, reduced circulation and the flow of oxygen and sugar to our brain cells. .
Studies suggest the cardiovascular regulatory system is ‘off’ in ME/CFS; heart rates are high even during sleep, blood pressure regulation is poor and the response to exercise is impaired. Some researchers think the arteries are dilated and the small blood vessels are contracted. Is it possible that blood pressure regulation in the brain is a bit off as well?
The Space Connection
An Australian anthropologist named Singer reports that zero-gravity situations cause increased brain pressure and that NASA mimics the effects of zero-gravity by having people lie down for long periods of time. NASA’s researchers have contributed many important insights into the problem of deconditioning by having astronauts simply lie down for long periods of time. .
Singer stated these researchers found that brain circulation is optimal at about a 30 percent incline of the head of the bed. His lay research suggested migraines might be able to be relieved or eliminated by heads-up sleeping.
Ultimately they suggested that many conditions associated with increased intracranial pressure might be able to relieved using this technique.
Intracranial Pressure?
Did someone say intracranial pressure? Intracranial pressure (ICP) refers to pressure inside the skull. Dr. Raymond Perrin (DO, Ph.D) believes brain congestion and reduced lymphatic flow play a key role in ME/CFS and doctors report that elevated spinal fluid pressure is common. Just this month a small study suggested increased blood pressure in the brain is present in chronic fatigue syndrome. This preliminary study found that 40% (of 20 people) had moderately high or greater intracranial pressures (>20 cm Hg or greater) during lumbar puncture.
Increased intracranial pressure could cause headaches and head pain.
They proposed these patients have idiopathic intracranial hypertension (IIH), a condition characterized by migraine, headaches, and ‘visual disturbances’ and often found in obese, young women but which can be found in any person at any time. Headaches, dizziness, depression, hyperventilation, joint pain, anxiety, visual disturbances, and fatigue are common.
Increased intercranial pressure can cause sinus, eye, ear, and face pain. Sydney Singer proposed that migraines can be triggered in some people by lying flat for too long. (If you have migraines or headaches you might ask, if you spend a lot of time in bed if they started after that began.)
Singer took his theory to the limit (and probably over it) when he proposed that all manner of brain disorders (migraines, strokes, ADHD, SIDS, sleep apnea, etc.) can be affected by this problem.
Research
Researchers have also studied the effects of head-up. A small study suggested that a 10% incline in the upper part of the bed resulted in reduced problems with orthostatic intolerance and…blood volume after 4 months in people with orthostatic intolerance. (Heart rate and blood pressure did not change.) Happily, the hard-to-treat cases – the most severely orthostatically challenged people – exhibited the most improvement.
Using both fludrocortizone and head-up sleeping increased orthostatically challenged patients’ ability to stand without symptoms from 3-10 minutes as well as their blood pressure. One week of heads-up sleeping (18″) in young healthy adults or near adults resulted in reduced dizziness, reduced drops in blood pressure during standing, reduced ‘peripheral resistance’ (blood vessel contractions), and nightime peeing. Standing cardiac output was increased.
Head Up Sleeping – the How To’s
Ways to Raise Your Head While Sleeping
- Use more pillows
- Use a foam wedge
- Place blocks or risers under the legs of the bed at the head of the bed
- Use an adjustable bed.
Degree of elevation
- 10-30 degrees. Starting off at 10 degrees is fine and you should experiment
Others
Since tight neck muscles and neck injuries can impair drainage of the blood from the brain, massage or spinal adjustments can help.
Improvements can take from a couple of weeks to set in…
Any more ideas on how to improve sleep or your ability to stand without symptoms? Please let us know in the comments below.
- (Thanks to Throughhiker for the idea for the blog. Check out her blog here…)
Very interesting article, thanks a lot! Will definitely give it a try.
Good..Let us know how it goes. Good luck with it.
Thanks! 😉
I actually looked this up after taking a rolled up carpet and sticky under the head of my bed..
I would say that the rolled up carpet is probably making my bed at about a 30 degree angle give or take. interesting that 30° is supposed to be helpful, as opposed to 45 or even 90 degrees.
Is there a link somewhere with this study?
Thanks for following up on this, Cort! I learned so much from your explanations of the science behind it. I hope this helps others improve their orthostatic tolerance, as it did for me.
I guess putting the whole bed anti-Trendelenburg would be best, but I think my bed would not hold it. So I will try with only the head up.
I will ask the Dutch cardiologist Visser in the series ‘Science to patients’ about this. He measures the blood flow to the brain of ME patients. Lying down, sitting en standing. Wonder what he thinks of this!
Thanks Esme, I’d love to hear what he has to say…Looking forward to seeing Visser in the new series. 🙂
So, is it enough just to elevate the head and not the whole body? I read somewhere else (can’t remember where) that you have to have the whole body at an angle, and not just the head?
I thought I’d read the same.
This is a very interesting article, Cort. I read up on it a few years ago and even had a bed-length foam wedge cut to my spec for about £120/$160 but felt worse lying down on it. Someone had raised a concern (not sure if it was theoretical) that sleeping on a tilt could result in supine hypertension for some people and that made me nervous about attempting to sleep in that position.
All you can do is try. I imagine there will be a variety of responses with all the different autonomic nervous system stuff going on..Thanks for the report.
Singer recommends either risers or a long wedge shaped piece of foam – so you may be right/
Singer suggests slightly elevating the feet as well but I wonder whether that would be a good idea given that ME/CFS patients appear to pool blood in their abdomen.
I think putting risers under the legs at the head of the bed might just tilt the bed up enough that you get a full body tilt.
Has anybody tried this? Any results to report?
There’s some conflicting information in the article about how much to raise the head of the bed. Near the end it advises that in the study the rise was 18″, which I just can’t do to my bed.
Has anybody experimented and discovered how high a prop at the head is required for a 10% incline? 30%?
Lots of us POTS people have to sleep with our heads elevated. It is more common than not for us to do this. I use pillows – at least three at my head and gradually slope others down under my back – so the support is there. I also have to put pillows under my arms – as the other pillows don’t seem to give enough support there. Then I put a pillow under my knees to have the right bend in my knees with the upper body being at such a slope. My husband says it’s my cocoon. But, it for sure makes a difference. I can not lie flat – it will give me issues with breathing and bring on all sorts of symptoms.
I tried just elevating the head of my bed and hated the full body angle. It wasn’t comfortable. And for sure, I didn’t sleep well.
Issie
everyone seems to say six to nine inch blocks at the head of the bed. You are raising the frame not the mattress. Mayo and Hopkins said you cannot do this with just more pillows. I am shopping for some sort of system now.
Good luck
raising the head of the bed helps silent reflux
http://www.webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux
I believe this may be behind sinusitis and the raised intercranial pressure. Those who find raising the head of the bed helps might benefit from a trial of omeprazole
I have been researching sleeping inclined for 25 years now and we have a lot of testimonials that are very interesting. The site also has methods of raising a variety of beds, along with interviews explaining why it is useful to do so.
This research can be found using Inclined Bed Therapy or IBT in a search engine, for more resources.
Hope this is helpful
Andrew
http://inclinedbedtherapy.com
Thanks!
I’m going to lie two lengths of timber (3”x2” boards) on the floor that go under the entire bed head end and poke out a few inches each side of the bed. They will be joined together at each end by very short lengths of the same thickness timber (6” long). Then on one end of the long lengths of timber, I’ll place a piece of timber about 4 feet long at night angels to the long lengths of timber, I’ll securely bolt that to the two lengths that are just poking out from under the bed. Now I’ll be able to lift the 4 foot length of timber off the floor into the vertical position, and the bed should rise 12” with ease. I’ll need an angled strut to lock into place that lifted length while in the vertical position.
But I think it will work easily even for us ME weaklings lol . It’s cheap too.
( Is there anywhere I can post a photo? )
I have spent 40 years in the bedding business and have worked with many customers who found a benefit with sleeping on an incline but did not know how to do it or broke their bed trying to do it. For that reason, I designed the Beds Up Insert, it is a safe and affordable way to incline your bed for a healthy night sleep.
http://www.bedsup.com
Sleep Healthy,
jerome
found interesting article on icp:
Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure?
from: https://www.researchgate.net/publication/317912909_Chronic_fatigue_syndrome_and_idiopathic_intracranial_hypertension_Different_manifestations_of_the_same_disorder_of_intracranial_pressure
by: Higgins, Pickard, Lever
This article seems to suggests head elevation ICP change might be from decreased pressure on brain versus drainage :
“”For example, the decrease in extracranial venous pressure by head elevation causes a corresponding increase in Rout, preventing the extradural venous pressure decrease from being transferred in retrograde manner to the brain (31). There will, therefore, be no increase in venous drainage from the brain (i.e., no decrease in intracranial venous blood volume) after head elevation, as has also been suggested previously (36, 37) (cf. Figure Figure3).3). The immediate decrease in ICP after head elevation can instead be explained by passive decrease in intracranial blood volume on the arterial side, when arterial pressure to the brain is reduced
from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495987/
(but so much in ME/cfs breaks the mold already….)
(missed giving article title for above quote:
Critical Evaluation of the Lund Concept for Treatment of Severe Traumatic Head Injury, 25 Years after Its Introduction