Gastroesophageal Reflux Disease (GERD) is a chronic digestive disorder where stomach acid flows back into the esophagus. This reflux often causes a burning sensation known as heartburn, and symptoms frequently worsen when a person lies down. Nocturnal reflux can significantly disrupt sleep and may lead to complications over time. For many individuals, one of the most effective non-pharmacological lifestyle changes is the elevation of the head of the bed. This simple physical adjustment uses gravity to help manage symptoms, offering a drug-free approach to nighttime relief.
The Recommended Elevation Height
Medical guidelines widely suggest a specific range for raising the head of the bed to effectively counteract nighttime reflux. The recommended elevation is between six and eight inches at the head of the bed. This height is considered the “sweet spot” because it provides enough incline to be effective without causing significant discomfort or making the sleeping position too steep. Raising the bed to this degree creates a gentle slope that helps keep stomach contents from moving into the esophagus. The goal is to elevate the entire torso, not just the head and neck, to maintain a comfortable and straight body alignment.
Achieving this six to eight-inch lift balances maximizing the effect of gravity and ensuring sound sleep. If the elevation is too low, stomach acid may still back up into the esophagus. Conversely, raising the bed too high, perhaps beyond nine inches, can lead to a feeling of sliding down the mattress or introduce issues like lower back pain. Adhering to the six to eight-inch range offers the best compromise for therapeutic effect and sleep quality.
The Mechanism of Action
The effectiveness of head-of-bed elevation relies on the physiological principle of gravity. When a person is lying flat, the opening between the stomach and the esophagus, controlled by the lower esophageal sphincter (LES), is nearly horizontal. If the LES weakens or relaxes, stomach acid can easily pool in the lower esophagus, leading to prolonged acid exposure. Raising the head of the bed introduces a downward slope that uses gravity to keep the acid inside the stomach.
This incline also plays a role in acid clearance. Even if a reflux episode occurs, the elevated position helps the esophagus clear the acidic material much faster than when lying flat. A quicker clearance time reduces the total duration of acid contact with the esophageal lining, which is a major factor in symptom severity and potential tissue damage. Furthermore, studies suggest that the elevated position can reduce the frequency of transient lower esophageal sphincter relaxations, which are brief openings of the LES that often allow reflux to occur during sleep.
Practical Methods for Bed Elevation
Properly elevating the entire bed frame is necessary for achieving the therapeutic angle and ensuring a safe, stable sleep environment. The most effective method involves placing sturdy supports directly under the bedposts at the head of the bed. Specialized plastic or solid wood bed risers, sometimes called blocks, are readily available and designed to safely bear the weight of the bed and sleeper. These supports must be placed only under the legs at the head of the bed, creating a consistent slant across the entire frame.
It is important to use materials that are stable and capable of securely holding the bed’s weight without wobbling or collapsing. The entire bed frame needs to be raised to maintain a straight line from the hips to the head. This method ensures the torso is elevated uniformly, preventing the body from bending at the waist or hips, which would otherwise defeat the purpose of the elevation.
Another recommended method is the use of a specialized foam wedge placed either under or on top of the mattress. Wedges placed between the mattress and the box spring or foundation are preferred because they lift the entire sleeping surface and maintain the feel of the mattress. Under-mattress wedges create a smooth, continuous incline from the waist up, which is ideal for a flat sleeping surface.
Alternatively, some people use large, therapeutic foam wedges placed directly on top of the mattress, under the sheets. When using a top-of-mattress wedge, it is important to choose one that is long enough to support the entire upper torso, including the shoulders and back. A wedge that is too short will only prop up the head, causing the body to bend at the middle, which puts pressure on the abdomen and can actually worsen reflux. It is important to explicitly avoid stacking ordinary pillows, as they only raise the head and neck, causing a counterproductive bend at the waist that increases abdominal pressure.