THEORY SUMMARY BOX
Inclined Bed Therapy (IBT)
There is now clear evidence of an association between sleep problems and health;
But can the position we sleep in influence those sleep problems and our health ?
According to Nasa Research, lying flat for a long time reproduces the degenerative effects of travelling in microgravity as experienced by astronauts in space;
IBT theory is based on the idea that gravity plays a key role in the way our bodies function;
When we are lying flat, the positive effects of gravity on our bodies are materially reduced;
As we spend, on average, a third of our lives sleeping flat, IBT theory suggests that over time the reduction of gravities impact during sleep has long term cumulative effects on our health;
Calculations indicate by changing the angle at which we sleep, gravities effects also change;
IBT hypothesizes that by raising the head of our beds gravities role on our bodies while we sleep is increased positively;
The result is both improved sleep quality and long term health benefits due to the increased exposure to the earth's gravitational pull;
You can read more details below.
About the importance of Sleep
We have all experienced a bad night's sleep including the consequences it can have on our well being the next day.
Not surprisingly, sleep is a growing field of scientific enquiry and I could list a vast number of publications on the subject. There are many notable studies, one I would recommend is : Sleep epidemiology - a rapidly growing field by Jane E Ferrie et al (2).
This work presents a multitude of interesting facts about sleep and sleep problems. For example, did you know that "... seventeen hours of sustained wakefulness in adults leads to a decrease in performance equivalent to a blood alcohol level of 0.05%, the legal limit for driving in many countries" ; or that "Rats deprived of sleep die after a month". It is also not surprising that sleep deprivation is used as a common form of torture.
Principally, this work explains clearly the principle reasons why there is a growing interest in sleep by scientists, and in particular the "...increasing awareness of the association between sleep problems and health. Immediate effects at the individual level relate to well-being, performance, daytime sleepiness and fatigue. Longer term evidence has accumulated of associations between sleep deprivation and sleep disorders and numerous health outcomes including premature mortality, cardiovascular disease, hypertension, inflammation, obesity, diabetes and impaired glucose tolerance, and psychiatric disorders, such as anxiety and depression".
Despite scattered headlines such as that of The Guardian on 24th September 2017:
The shorter you sleep, the shorter your life : the new sleep science', or references on the NHS website which warns us that "...one in three of us suffers from poor sleep" and "regular poor sleep puts you at risk of serious medical conditions", we still don't hear enough about the importance and potential impact of Sleep problems, which is considerable.
Some scientists, like neuroscientist Pr Matthew Walker, are fighting for increased political involvement in this Public Health problem because they believe sleep is probably the most important factor to our long term health :
'I take my sleep incredibly seriously because I have seen the evidence. Once you know that after just one night of only four or five hours’ sleep, your natural killer cells – the ones that attack the cancer cells that appear in your body every day – drop by 70%, or that a lack of sleep is linked to cancer of the bowel, prostate and breast, or even just that the World Health Organisation has classed any form of night-time shift work as a probable carcinogen, how could you do anything else?'
Pr M Walker, director of the Centre for Human Sleep Science at the University of California
According to multiple research sources, sleep deprivation and sleep disorders are associated with premature mortality, cardiovascular disease, hypertension, inflammation, obesity, diabetes and impaired glucose tolerance, and psychiatric disorders, such as anxiety and depression.
About the risks of Bed Rest and Sleep
Accepting the importance of sleep for our long term health, perhaps you now believe the answer is simply spending more time in bed? Sadly, the old saying "...you can have too much of a good thing" holds true.
Prolonged bed rest can be dangerous for you !
"It is always assumed that the first thing in any illness is to put the patient to bed. Hospital accommodation is always numbered in beds. Illness is measured by the length of time in bed. Doctors are assessed by their bedside manner. Bed is not ordered like a pill or a purge, but is assumed as the basis for all treatment. Yet we should think twice before ordering our patients to bed and realise that beneath the comfort of the blanket there lurks a host of formidable dangers"...."Look at a patient lying long in bed. What a pathetic picture he makes! The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul".
In the same decade, studies of large series of patients showed no advantages for complete bed rest after surgery, and instead dangers such as deep-vein thrombosis, bedsores, osteoporosis, and pneumonia were identified. Such critical analyses gradually led to a shortening of prescribed postoperative periods of bed rest from weeks to days (4, 5).
But despite the provoking message of RAJ Asher and different studies, 'Ideas about bed rest seem so entrenched that medical practice has been slow to change even when faced with evidence of ineffectiveness'(5).
In 1991, this observation prompted Paul Corcoran (6) to precise : '...the severity of an illness may leave no choice except bed rest, but the rest itself is rarely beneficial. On the contrary, virtually every organ and body system promptly and progressively deteriorates when inactivated'. He summarises the negative effects of bed rest in this table :
In 1999, Allen C et al. publish 'Bed rest: a potentially harmful treatment needing more careful evaluation'(5):
They searched the literature for evidence of benefit or harm of bed rest for any condition. 39 trials of bed rest for 15 different conditions (total patients 5777) were found. In 24 trials investigating bed rest following a medical procedure, no outcomes improved significantly and eight worsened significantly in some procedures (lumbar puncture, spinal anaesthesia, radiculography, and cardiac catheterisation). In 15 trials investigating bed rest as a primary treatment, no outcomes improved significantly and nine worsened significantly for some conditions (acute low back pain, labour, proteinuric hypertension during pregnancy, myocardial infarction, and acute infectious hepatitis)'.
Even if the medical practice is still struggling to integrate completely those findings, there is a consensus on the fact that medical indications to prescribe bed rest are now very rare. And the importance of moving around as soon as possible after surgery is now well known. The NHS writes "...this will encourage your blood to flow and your wounds to heal, and will build up strength in your muscles".
So, lying in bed too long is bad for us, but is there a resting time that is optimal ? A limit not to be exceeded ? The answer may be yes.
Recent research provides strong support for association between premature all-cause mortality and shorter sleep (less than seven hours), but more surprisingly it provides also the same strong support for association between premature all-cause mortality and longer sleep (more than eight hours)" (2).
The author prudently remarks that "...the debate about whether sleep is a risk factor or risk marker continues". Meaning that if you sleep more than eight hours it could be because there are health related reasons that drive you to sleep more and it could be those behind the increase in mortality risk. But since research suggests that bed rest may delay recovery and harm the patient, let's assume that sleeping too long does have a negative impact on our health.
The next question coming to mind is why sleeping too long is bad for us ?
According to research, our daily sleep should not exceed eight hours.
Research gives little support for bed rest as a form of management in a wide range of conditions, and suggest that it may actually delay recovery and harm the patient.
The reason for the negative impact of prolonged bed resting or sleeping could be the lack of gravity we expose our body when doing it.
What is Inclined Bed Therapy ?
How does it work?
Inclined Bed Therapy (IBT) consists of the idea that by raising the head end of your bed by 15 cm (6 inches) you will improve both your sleep and your health quality.
The theory is based on the fact that gravity plays a key role in the way our bodies function. Of this, there is no scientific doubt.
What is Gravity ?
Gravity is the force that attracts a body towards the centre of the earth (or towards any other physical body having mass).
Earth's gravity is what keeps you on the ground and what makes things fall.
Earth's gravity comes from all its mass. All its mass makes a combined gravitational pull on all the mass in your body. That's what gives you weight. And if you were on a planet with less mass than Earth, you would weigh less than you do here. It is for example the case on the moon.
But what is the link between gravity and sleep ?
NASA used this fact to reproduce the micro-gravity environment of space on vonlunteers by having them lie flat for days. The result was that the negative health effects of space travel experienced by astronauts were replicated.
As we spend, on average, a third of our lives sleeping, IBT theory suggests that over time these periods of lower gravitational force impact our health. And the more we sleep, the more our bodies lack the pull of gravity, which could explain why research has found a positive correlation between premature mortality and longer sleep patterns.
How raising the head end of your bed could help ?
On an inclined plane, the force of gravity can be represented into two components FI and FII. It means when you lie on an inclined bed, FII will pull in a head to toe direction :
We know some astronauts fully recovered a few weeks after coming back to earth’s gravitational pull, so could we improve our health after a few weeks, months or longer of IBT ?
This is the question we'll try to answer in this study.
Scientific observations resulting from NASA studies relating to the impact of gravity on astronauts confirmed clear negative health impacts when humans were exposed to lack of gravitational force for material periods of time.
When we lie flat in bed at night, for example on our back, gravity can no longer pull on our body in a longitudinal direction (head to toe), which is the maximal effective direction. Instead, it can only pull on our body in an antero-posterior direction (front to back) which has less impact on our bodies.
When you raise the head end of a classical bed by 15 cm (6 inches), the result is that your body will now be inclined by five degrees. This angle will allow gravity to pull in a longitudinal direction (head to toe) which increases its positive impact on your body.
What IBT was inspired by ?
A few facts and findings are cited by supporters of this theory :
- First of all, there is no proof that laying completely flat is the best way to sleep. We just do it because our parents were doing it and it's comfortable.
- Our three core body fluids play a vital role in our on-going health.
- However, only our blood is circulated using a pump (our heart). How do the other two fluids (lymphatic and cerebro-spinal fluids) circulate continually?
- Trees and other plants don't have a pump like our heart to circulate sap and yet the sap must travel from the roots to the top of their branches. An explanation could be combination of gravity and changing density of the sap. With the evaporation of water from the leaves the sap changes density. The changing densities aided by gravity could be an explanation of this circulation without a central motor (other theories exist).
- IBT supporters think it is possible that comparable density changes also occur in our fluids and could play a role in the effect of gravity on their circulation and consequently on our bodies.
This would include our blood circulation which is driven by our hearts. But it also includes the circulation of our lymphatic (LF) and cerebro-spinal fluids (CSF) both of which circulate, in large, without help from our hearts.
What we know for sure is that these fluids all play critical roles in our health;
Blood ensures different vital functions : transports (oxygen, nutrients, blood cells, hormones, enzymes...), maintains body temperature, controls pH, removes toxins and regulate body fluids electrolytes through kidneys.
Lympathic fluids performs drainage of excess interstitial fluid and proteins back to the systemic circulation (prevents the development of edema); regulation of immune responses; and absorption of lipids from the intestine.
Cerebro-Spinal Fluids (CSF) provides a mechanical and immunological protection to the brain, allow the clearance of waste molecules from the brain and support its development and functioning. Important physiological functions, for example the regeneration of the brain during sleep, may depend on CSF circulation.
And we also know that gravity influences the circulation of these fluids (We'll explore it more in the next chapter).
IBT is supported by some interesting facts :
- NASA research used subjects lying flat for days or weeks to reproduce the degenerative effects of travelling in microgravity as experienced by astronauts in space, because lying flat reduces the effect of gravity on the body. NASA studies demonstrated that lying flat for long periods of time resulted in negative effects on the human body. These impacts included bone decalcification, tendency to faint on standing up, problems on balance and coordination...
In this 2012 talk at NASA's Ames Research Centre, Dr. Joan Vernikos, research scientist and former director of NASA’s Life Sciences Division, explains how studying astronauts both during and after space travel, as well as volunteers lying continuously, has shown that as we use gravity less, the rate of physical aging increases (video 10 min : you can watch from min 5 if you are in a hurry).
We maintain this position when we sleep for less consecutive hours than the subjects of those studies but every day for our whole lives.
So why should we not assume this may also be harmful ? Isn't it intriguing that impacts of lack of gravity on Astronauts are like those of ageing ? Could it be possible that those symptoms appear on old people, at least partially, because they spent so many cumulative hours lying flat ? Or because they spend more and more time of their days resting ?
Would it be possible to slow down the processes of ageing by sleeping inclined ?
Our Fluids are Critical to our Bodies, Gravity Influences their Circulation, then it's logical that Gravity also play a Critical role in our Health.
NASA research has shown that as we use gravity less when lying, our rate of physical aging increases.
- The Ancient Egypt used inclined beds (elevated 15 cm, six inches, higher at the head end).
This is the civilisation that built the pyramids. We still (with all our technology and advances in engineering five thousand years later) struggle to understand how they did this! Why did they use beds inclined in this way? Perhaps they knew and understood something we do not.
Inclined Bed of Queen Hetepheres I (2575–2528 B.C) : the queen would have slept on her side with her cheek resting on the headrest. A foot-rest, decorated with a gold and faience design ofstylized plant motifs, both served as decoration and prevented her from slipping down (Museum of Fine Arts, Boston).
Click on the pictures for more information on this bed.
Gravity & microgravity :
The constant force of gravity has played a central part in the evolution of life on earth and is a major component of our physical environment. Man was designed or has evolved to function in the upright position in the earth gravitational environment.
Emily Roberge gives an interesting description of the consequences of microgravity on our bodies in her article The gravity of it all : From osteoporosis to immunosuppression, exploring disease in a microgravity environment holds promise for better treatments on Earth (7):
She explains how Space exploration missions quickly revealed that microgravity, or weightlessness, had profound, unique effects on biological phenomena.
Two remarks :
those changes also occur on Earth in Bedridden patients (to a lesser extent): lying flat reduce impact of gravity on our body and reproduce the microgravity of space;
those changes are like those of ageing;
which raise the question of the link between cumulative time passed bed resting (exposing your body to a micro-gravity) and ageing.
What about the specific impacts of MicroGravity on our fluids ?
Our body must adapt to the reduced gravity and the fluid shift it produces, meaning many physiological responses occur. This process is named 'deconditioning' (adaptation of our organism to a different environment).
1. Concerning our Blood and Cardio-Vascular System (8,9,10,11):
Humans are particularly sensitive to changes of the magnitude of the gravitational field or its direction relative to the body because of the combination of their normally erect posture and the large body mass and blood volume below the level of the heart;
The interaction between the gravitational field, the position of the body, and the functional characteristics of the blood vessels determines the distribution of intravascular volume, and this distribution largely determines cardiac pump function ;
Bed rest deconditioning is accompanied by a reduction in the diameter of the conduit arteries;
Plasma and blood density change with the posture;
Prolonged bed rest leads to increased risk of venous thromboembolism, decreased blood volume and orthostatic intolerance;
Deconditioning is a risk factor for cardiovascular disease;
Basic vascular pressure-volume characteristics are regulated to provide optimal tissue perfusion in the upright position;
There is probably an optimal time requirement each day that the body should be maintained in the upright position for stimulation of the blood pressure mechanism to ensure its proper function, but this time period has not been determined.
2. Concerning our Lymph and Lympathic System (12,13,14,15,16):
The lymphatic circulation exists in parallel with the blood vessel system and forms an accessory pathway to return the excess fluid and proteins from the tissue spaces back to the blood stream; It also serves as a route of transport of immune cells, hormones and enzymes, and secretes physiologically active components;
The unidirectional lymphatic circulation is devoid of any central pump and is classically explained by the combination of different mechanisms: rhythmic spontaneous contraction of the smooth muscle in the lymph vessel wall, valves every few millimetres in the lymphatic vessels to prevent retrograde flow, and external forces exerted to the lymph vessels : forces of massage, joint movements, arterial pulsation, etc. known as passive transport.
Passive transport also includes movements of lymph due to gravity as in the head and neck region (13).
An histological investigation of rats in conditions of weightlessness (micro-gravity) has stated an involution of lymphoid organs (14);
During the NASA Apollo and Shuttle eras, multiple spaceflight studies showed depressed lymphocyte activity under microgravity conditions (15)
Microgravity causes a potent inhibition of pressure/stretch-stimulated pumping in lymphatics in rats (16)
CSF circulation is influenced by arterial pulse wave, respiratory waves, the subject's posture, jugular venous pressure and physical effort (17);
How this circulation is done effectively seems very complicated and is still debated (18);
CSF pressure determines intracranial pressure;
Gravitational effects within the venous system are transferred to the CSF system explaining the effect of posture on intracranial pressure;
Exposure to microgravity can result in a spectrum of intraorbital and intracranial findings similar to those in idiopathic intracranial hypertension (20,21);
CSF production is modified in rats during long-term (9, 13 or 14 days) adaptations to microgravity (22);
Disorders of CSF hydrodynamics and composition are responsible for the major alterations of cerebral physiology observed in hydrocephalus and dementia,
Reduction of the CSF turnover rate during ageing leads to accumulation of catabolites in the brain and CSF that are also observed in certain neurodegenerative diseases (17).
Microgravity induces a vast array of changes in our organism:
Bone Loss : bone mineral density decreases;
Muscle Atrophy : skeletal muscles lose both mass and strength;
Fluids Shift : bodily fluids shift from the lower to upper extremities causing health problems such as increased intracranial pressure (linked to migraine headaches and strokes), cognitive issues, and sensory problems such as impaired smell, taste, and vision (mimic age-related macular degeneration).
Immunological effects : inhibited cell-mediated immunity, reactivation of latent viruses, and altered or decreased production/activation of almost all types of immune cells and proteins.
Which medical conditions could IBT help ?
What are the current medical indications ?
Do medical contraindications exist ?
I want to try IBT, should I stop any treatment or change my habits ?
The supporters of IBT believe it can improve a diverse array of medical conditions including : Arthritis, Osteoporosis, Incontinence, Cellulite, Skin Conditions, Psoriasis and Eczema, Varicose Veins, Depression and Mood Swings, Insomnia, Sleep Apnea, Glaucoma and Macular Degeneration, Fibromyalgia, Gastro oesophageal Reflux Diseases and Digestive Disorders, Irritable Bowel Syndrome, Ulcerative Colitis, Crohn's Disease, Diabetes, Headaches and Migraines, Multiple Sclerosis, Epilepsy, Spinal Cord Injury, Coma, Infertility, Libido problems...
They also believe you don't need to be ill to benefit from IBT. Inclined sleeping may play a critical role in prevention of many of these conditions. It is also believed that it can improve areas from quality of sleep, anxiety and recovery from physical exertion to improving mental alertness and overall functioning of our immune systems.
At the moment, the medical indications of IBT are limited. Today the medical community endorses only one benefit of Inclined sleeping. It is currently often prescribed for the treatment of Gastro oesophageal Reflux Diseases as it helps keep acidic gastric juices from rising up the oesophagus during the night. Different studies have revealed that bed head elevation is an effective therapy in relieving the symptoms of reflux.
Little or no proper studies have been conducted on the other potential benefits proposed by supporters of IBT. Why ? It is understandable that this is of little interest to corporate (pharmaceutical) funding given proving this theory would not result in the production of a drug.
Because IBT has been studied directly so little there are no contraindications known. Due to the belief that gravity impacts our circulation and potentially blood pressure, it may not be appropriate without proper monitoring for those who suffer from Renal Insufficiency, Diabetes or High Blood Pressure.
IBT could alter how medications perform. Take a medical advice if you detect a variation in your medical condition when using IBT and if you think your prescribed treatment should be adjusted.
Don't stop any treatment if you want to try IBT. In fact, don't change anything (same food, same habits, same activities...). There is no indication at the moment that Inclined sleeping cures serious illness. Supporters of IBT believe it can help numerous conditions and that it has a number of positive effects (listed above). It is also important that you do not change anything to better understand if IBT brings any positive benefit. Changing several material things at the same time makes establishing cause and effect difficult. This is the basis of most scientific studies.
Why this research choice ?
- There are convincing facts about IBT including NASA research and it is certainly intriguing that ancient Egyptians slept inclined.
- There are numerous reports that Inclined sleeping has resulted in health and well being improvements.
- It is important to explore ideas that come from outside the direct medical or pharmaceutical community.
- Raising the head of a bed can be easily done for free.
- If IBT theory is correct the impact on health care spending could be substantial.
If IBT theory could be proven it would provide a simple cost effective way to treat or prevent potentially many serious conditions that today can only be treated with drugs. Money currently directed on treatment could be redirected to other things such as research, improving public health even further. In order to prove IBT theory more studies and data is required. If proven, inclined sleeping could become a public health guidance principal like "FIVE A DAY".
If you are interested in assisting in data gathering to support either the validation or invalidation of the theory then please click the blue button below to join the study. More people participating, stronger the conclusions of the study will be !