For people suffering from Orthostatic Intolerance, Postural Orthostatic Tachycardia, Mast Cell Activtation or EDS. Follow me as I document my struggle towards better health.

Heads Up or Heads Down to treat Orthostatic Intolerance

In cruising various POTS and OI discussion boards I sometimes come across posts by people who advocate sleeping with the head down to alleviate symptoms of orthostatic intolerance.  What is the answer to the debate as to whether it is better to sleep with our feet in the air or with our body elevated heads up?

I think whatever treatment we choose in our quest to recover/feel better from POTS or OI should be evidence-based where possible. 

There is so much speculation on what works and what doesn't that it makes it very difficult for a patient to decide...particularly when their own doctors engage in speculation. 

Thankfully there seem to be more and more clinical studies being done to help us out. Regarding the raising the foot or head of bed- I have found one clinical study proving the effects of raising the head of the bed. The report is entitled "Physiological effects of sleeping with the head of the bed elevated 18 in. in young healthy volunteers"

As for raising the foot of the bed - that has actually been used to induce orthostatic intolerance in patients for studies out of Texas. My speculation: It appears that raising the feet above the head is an emergency measure to be taken when someone has fainted but not to be used long term as it can can exacerbate OI.

Here are a couple of clinical studies regarding inducing othostatic intolerance in study patients through -6 degree negative tilt (head down, feet up) bed rest.

Orthostatic intolerance in 6 degrees head-down tilt and lower body negative pressure loading.

Cardiac Atrophy After Bed-Rest Deconditioning

What these studies show is after patients lie head down for a given period you can give them orthostatic intolerance and that the stroke volume of the heart upon standing is reduced after tilt-down rest. 

Not good! I would suggest that anyone currently sleeping with head down may be worsening their symptoms.


  1. Great topic. When I first started getting symptoms of POTS, I was misdiagnosed with a spontaneous cerebrospinal leak. I spent months upon months in the Trendelenberg postion (head lower than body). What happened? I got worse and worse and worse, until I could no longer even sit up and someone finally figured out that I had POTS and not a spinal leak. Now, I try to rest in a rocker or recliner during the day and will try the bed wedge at night next.

  2. Oh my what a nightmare!! My hope is that POTS and OI become included in the normal diagnostic SOPs for general practitioners.

  3. Do you think sitting in a recliner during the day works as well?
    Has it gotten warm in Canada yet? I was wondering how the heat was affecting you now that you are doing better?
    Are most of your days now like the posted "best day ever"?

  4. Hi Lucy - I don't see any reason why a recliner wouldn't be just fine.

    The weather is warming up here and gardening is on my mind...(you can see my plantings in my organic garden on

    I have a "best day ever" every few days but I think that's progress!

  5. Sounds good! So sleeping feet up like the dr told me & recliner during the day I'd ok?
    What are your inbetween best days ever like?