Raising Head Of Bed

  • This is an interesting one, as we can take advantage of tricking our kidneys into retaining more sodium and water while sleeping!

  • Many individuals in our community are most symptomatic in the morning, as orthostatic intolerance can be worsened by a reduction in overall blood volume overnight. Researchers have discovered, however, that “mild orthostatic stress induces fluid shift to the lower body and decreases central blood volume and the effective circulating blood volume, which activate the renin-angiotensin-aldosterone system (RAAS), leading to salt-water retention and volume expansion” (Coleby, 2022; Williams et al., 2022; Fu et al., 2018).

  • So what does this mean? The kidneys often don’t get enough credit for all of the amazing work they do, but they can also contribute towards increased symptom burden and severity in individuals with POTS given how decreased stroke volume, and lower subsequent central venous pressure, can lead to paradoxical diuresis and hypovolemia (see Medical Terminology section for definitions) (Coleby, 2022).

  • When the lower central venous pressure increases the kidney’s glomerular filtration rate, this in turn leads to a cascade that involves paradoxical diuresis, a subsequent reduction in renin and aldosterone release (which help us retain salt and water), and hypovolemia (lower circulating blood and plasma volume) (Coleby, 2022).

  • Given the significance and importance of volume expansion when managing POTS symptoms, it should not be surprising that researchers have been tirelessly trying to figure out a way to trick the kidneys into retaining more salt and water while we sleep!

  • This can be achieved by increasing the head of the bed (not by propping yourself up on pillows, but by tilting the entire bed/mattress) so it is on a downward slant, as researchers have discovered that mild orthostatic stress activates the RAAS, increasing salt and water retention overnight (Coleby, 2022; Wieling et al., 2002; Fu et al., 2018).

  • Usually, it is recommended to try a 4-8 inch tilt by propping up the head of the bed with risers (Fu et al., 2018). Please consult with your medical team prior to making any changes to ensure these recommendations are safe for you.

Sources:

Coleby, C. (2022, October). Non-Pharmacologic Treatment Overview. POTS & Beyond. Salt Lake City; Utah.

Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of pots. Autonomic Neuroscience, 215, 20–27. https://doi.org/10.1016/j.autneu.2018.07.001

Williams, E. L., Raj, S. R., Schondorf, R., Shen, W. K., Wieling, W., & Claydon, V. E. (2022). Salt supplementation in the management of orthostatic intolerance: Vasovagal syncope and postural orthostatic tachycardia syndrome. Autonomic Neuroscience, 237, 102906. https://doi.org/10.1016/j.autneu.2021.102906