GERD is a chronic condition where stomach acid frequently flows back into the esophagus. This backward flow, or reflux, causes a burning sensation in the chest called heartburn. Symptoms often worsen when a person lies down flat at night, leading to nocturnal reflux. Elevating the head of the bed is a widely recommended, non-pharmacological strategy that uses a simple physical principle to manage these occurrences.
The Recommended Height for Effective Relief
To achieve a meaningful reduction in nocturnal acid reflux, the head of the bed should be raised to a specific incline. The clinically recommended range for effective relief is an elevation of approximately six to nine inches (15 to 22 centimeters). This height is necessary because a shallower incline is often insufficient to overcome the acid’s tendency to flow backward.
The goal is to create a gentle, continuous slope for the entire upper body, utilizing gravity to keep stomach contents in place. While raising the bed more than nine inches may prevent reflux, it often makes sleeping uncomfortably steep, leading to poor sleep quality. Achieving the correct elevation for the entire torso is important. Stacking pillows under the head alone is not advised, as this common mistake causes the neck and abdomen to bend, which can increase pressure on the stomach and potentially worsen reflux symptoms.
Practical and Safe Methods for Bed Elevation
There are two primary methods to safely and effectively achieve the recommended six to nine inches of elevation. The most secure method involves raising the entire bed frame using bed risers or blocks placed under the bedposts at the head of the bed. These specialized blocks ensure the entire sleep surface is uniformly angled, preventing the body from bending at the waist.
When using bed risers, confirm that the bed frame is stable and the risers are securely positioned to prevent slippage or collapse. An alternative for those who cannot raise the entire frame is using a specialized high-density foam wedge. This wedge is placed either on top of the mattress or between the mattress and the box spring, creating the necessary incline.
A therapeutic wedge pillow is designed to elevate the torso from the waist up. This ensures the lower esophageal sphincter remains higher than the stomach, which is distinct from using multiple standard pillows that only raise the head and neck. The wedge must be long enough to support the upper body fully, preventing uncomfortable bending that negates the reflux-reducing benefits.
How Gravity Reduces Reflux Episodes
The elevation works by directly leveraging the force of gravity to counter the effects of a weakened lower esophageal sphincter (LES). The LES is a ring of muscle that acts as a valve between the esophagus and the stomach. In individuals with GERD, this muscle may relax inappropriately or be weak, allowing stomach acid to escape back into the esophagus when lying flat.
By raising the head of the bed, the stomach is positioned below the esophagus, causing the liquid contents to pool at the bottom. This simple incline makes it mechanically difficult for the corrosive stomach acid to flow upward past the LES into the esophageal lining. Furthermore, if acid manages to reflux while sleeping, gravity assists in faster esophageal acid clearance. The speed at which escaped acid flows back down is increased, reducing the total time the esophageal lining is exposed to the damaging acid.