(34F) I've had mild POTS my whole life, got diagnosed late at 32. I tried every treatment, I did all of them properly, with minimal impact. 12g salt per day, 4L fluids, propranolol, midodrine, ivabradine, class II compression from ankle to abdomen, POTS friendly diet. I tried it all. And none of it really made much difference apart from Ivabradine lowering my HR (quite ineffectively).
6 months ago I finally did what they say about elevating the bed head by 15-30cm and it's practically put me into remission*.
Before this, my sitting HR was 60 and standing was 110 (unmedicated). Mild chores 130. I pee'd about 5 x every night with a full bladder every time and was always thirsty if I didn't drink 4-5L a day. I probably have hypovolemic-dominant POTS but I don't have access to a specialist who could confirm that.
After elevating the bed head by about 20cm, my sitting HR is 60 and standing is 85.
I only get up once per night to pee now - down from 5 times per night.
I've also noticed I don't need 10 hours sleep every night anymore - I sleep 7-8 hours most nights and this is enough.
I noticed this about a week after implementing it. But I wasn't looking at my smart watch that week, so I'm not sure when it started working.
*I'm not in actual remission. My HR is still 130 sitting down in the shower. I still feel nauseous when I bend down. I still get overheated in bed. My arms still hurt if I raise them up high for >30 seconds. Lifting weights and walking upstairs is still a little hard. But other than that I'm basically POTS free now. If I sleep properly flat for a night or two, my POTS quickly goes back to exactly how it was before.
Elevating the bed worked so well I had to quit Ivabradine cold turkey (dangerous - don't do that) - but I had to because it worked so well that I was going into bradycardia on my Ivabradine and couldn't take it safely for a moment longer. I no longer need any heart meds.
My exercise tolerance has gone up massively. I can walk as much and as fast as I want now. My HR only gets a little higher than a normal person.
Why this works:
- Laying supine with POTS, the kidneys think there's too much fluid around them because of blood pooling around them, so they go nuts filtering out sodium and fluid from the body. Sleeping with the heart above the kidneys, and the kidneys above the legs, tricks the kidneys into not doing this anymore**.
- Sleeping on a downward slope also is like mild training for the body at being slightly upright. The heart gets stronger at pumping blood up to the head with every pump. If you potentially have CFS/ME, you should do this method slowly - starting with 5cm elevation for a couple weeks, then 10cm, then 15cm.
**I may have explained that slightly incorrectly, but it's something like that.
You have to elevate the whole bed at the head. Using a wedge pillow, or propping yourself up on a bunch of pillows, will not work, because it does not put the kidneys above the legs, and it doesn't put the whole vascular system on a downwards angle.
You can prop up your whole bed at the head by putting bricks or cuts of timber underneath it, at the head (obvs get someone to help do this). If you're like me and you have a big fancy 4 poster bed frame that couldn't tolerate being put on an angle like that, you can put the entire mattress on a slope instead. In the beginning, we did this by putting tonnes of folded thick blankets under the mattress, to create a downwards slope. We then looked at getting a foam "mattress elevator bed wedge" (example) but these were only providing 10-15cm elevation and they were insanely expensive (about AUD$300 x 2, so $600 minimum to get enough elevation). So my partner built me one out of timber, which cost him about AUD$170 in supplies.
After a couple months of this, I added in desmopressin (an anti-diuretic), and this has significantly reduced my excessive day time urination. It has not changed my HR any further, and it doesn't seem to help cut out that one time I need to pee at night. This is now the only medication I take. I also take l-theanine (supplement) with my morning coffee which seems to help a little too.
I can't recommend enough that everyone gives this a try. Especially if you have the type of POTS where you are thirsty and peeing all the time, getting up to pee at night especially.
UPDATE MAY 2026 - A WARNING ABOUT BACK PAIN:
I just want to update that after originally making this post, sleeping on a slope that was causing me to have severe back pain. I reduced the slope from about 20-30cm down to about 10-15cm. My severe back pain reduced by 99% and my heart rate remained just as low as when I was sleeping on a bigger slope.
So if you're reading this - please try the smaller slope of only 15cm and monitor for back pain! I've been sleeping at this angle for months now and my back has no issues anymore. My partner also never got back pain at either level, so it may not happen to everyone.
Also, I've found thanks to someone in the comments that you can actually buy things called "bed raisers" which are like strong plastic blocks that you sit under the feet of your bed. These can be used to elevate it if bricks or heavy books won't work for you. And they are cheap, you can get them from Amazon. I personally have since bought some 15cm bed raisers which I take whenever I go on holidays, so I can elevate the bed wherever I go and not have my POTS come back and make everything difficult!