Woman With Low Blood Pressure

How to Sleep Better With Low Blood Pressure (Doctor’s 5 Tips)

by
Dr-Babar-Naeem.

This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

Low blood pressure (hypotension) can be caused by multiple factors, including decreased fluid intake, vitamin B deficiency, dehydration, drugs, pregnancy, heart disease, hormonal imbalance, kidney disease, anemia, and septicemia.

Symptoms of low blood pressure include dizziness, headaches, vertigo, pale skin, sweating, irregular heartbeat, blurred vision, and fainting – which may make it difficult to get to sleep.

So how can you sleep better when you have low blood pressure?

The most effective way to sleep better with low blood pressure is to elevate your legs using pillows or the lower section of an adjustable bed. Drinking more water and increasing vitamin B12 and folate intake – whilst avoiding medications that lower blood pressure – can also help.

However, you should always consult with your own doctor for the best treatment of your low blood pressure.

You should also talk to them about managing your low blood pressure for better sleep.

The rest of this article expands upon the points above using the knowledge I have gained as a practicing medical doctor.

Related: 7 ways to sleep better with high blood pressure.

5 Ways to Sleep Better With Low Blood Pressure

What Causes Low Blood Pressure? – Dr.Berg

Here are 5 ways to sleep better when you have low blood pressure:

1: Sleep With Elevated Legs

There are two sleeping positions that are the best options for patients with hypotension:

  • Trendelenburg (sleeping with the head at a lower level than the legs).
  • Modified Trendelenburg position (elevated legs only).

Use an Adjustable Bed or Pillows to Elevate Your Legs

The best way to get yourself into the Trendelenburg – or modified Trendelenburg – position is by using an adjustable bed.

Adjustable beds make it very easy for an individual to raise the legs or lower the head.

This is a good investment for patients who suffer from sleep disturbance.

If you want to know the pros and cons of using an adjustable bed, check out this article: Should You Get an Adjustable Bed? (Pros v Cons).

The second method is the use of cushions and pillows.

You can place 1 to 2 pillows or cushions under your legs to raise them up.

You should always keep in mind your comfort level.

Raising the legs too much can cause sleep disturbances by making you uncomfortable.

You should adjust to the position that works best for you.

Click here to discover the 8 ways that sleep affects blood pressure.

The Science Behind this Position

Blood pressure is significantly affected by the position of the body.

When you lie in a supine position (on your back), the effect of gravity across all parts of the body is the same.

So blood is usually pooled up in the dependent areas of the body (especially the legs), and cannot return to the heart, due to the absence of pumping force.

When a person has low blood pressure, the flow of the blood to the brain decreases, creating a lot of problems.

To tackle this problem, a German scientist, Dr. Friedrich Trendelenburg, suggested a position, which was then called the “Trendelenburg position”.

This position requires the patient to lie with the head lower than the abdomen, and the legs slightly elevated.

This position facilitates the drainage of blood from the legs to the heart.

As a result, more blood is available for the heart to pump, and blood pressure increases.

The second advantage of this position is that more blood flows to the brain and upper body, due to gravity [2].

This position was very popular in World War I for treating patients with hypotension and shock.

This position is also known as auto-transfusion, as blood moves from the legs to the vital organs, providing the same benefits as having a blood transfusion.

We commonly use this technique in operation theatres, emergency rooms, and intensive care units, to manage critically sick patients with low blood pressure.

At West Virginia University, USA, C.L. Ostrow conducted a survey to assess the popularity of Trendelenburg’s position among health professionals.

He found out that about 80% of health experts believe that Trendelenburg’s position improves low blood pressure [3].

Some potential adverse effects associated with this position are increased intracranial pressure, decreased expansion of the lungs, discomfort, and increased risk of injury to the brachial plexus [2].

So experts suggested a new position, which they called the “Modified Trendelenburg Position”.

In this position, only the legs are elevated, while the head lies at the same level as the abdomen.

This position avoids the risks associated with the lower head level, while providing the same benefits for patients with low blood pressure.

Get Up Slowly

Another very important piece of advice is to avoid sudden jerks, and standing up quickly from a lying down or sitting position.

When we stand up from a lying down or sitting position, blood pools up in the legs due to the effect of gravity.

Therefore, less blood is available for the heart to pump, and supply to vital organs.

This decrease in blood pressure due to a change in posture is known as orthostatic hypotension.

This fall in blood pressure is rapidly compensated for by vasoconstriction of the arteries, in normal individuals.

But individuals who already have low blood pressure are not able to compensate for this, and experience headaches, vertigo, or fainting.

My advice is to get up from the lying down position slowly.

After waking up from sleep, you should remain in a sitting position for a minute or two, so that your body can compensate for the fall in blood pressure.

Then gently stand up while holding on to something to avoid the risk of falling down.

2: Drink Plenty of Water

Drinking lots of water is necessary to combat dehydration and maintain normal blood volume.

Dehydration results in a decreased amount of fluid inside the blood vessels, and therefore, low blood pressure.

Dehydration can be caused by reduced fluid intake, vomiting, diarrhea, or excessive sweating.

The state of low body water, known as hypo-hydration, stimulates thirst and activates the body’s fight or flight response.

Hypo-hydration decreases physical and mental functions, increases fatigue, and impairs thermoregulation [4].

I always recommend drinking plenty of water to avoid dehydration, especially if you have gastroenteritis, or are working out in a gym.

Working in a hot climate can also lead to dehydration and sunburn.

Therefore, you should ensure that you increase your fluid intake when working in a hot environment.

If you want to read more about the causes, symptoms, and treatment of sunburn, check out this article: How to Sleep Comfortably with Sunburn (13 Ways).

The other benefit of drinking plenty of water is that it increases the total blood volume, which raises blood pressure.

Researchers in Switzerland did a study and demonstrated that drinking 100 to 500 ml of water before a meal increases cardiac output stroke volume, and prevents postprandial hypotension.

Subjects who drank 500ml had more marked effects than those who drank only 100ml of water [5].

Another study conducted at the University Hospital of Linkoping, Sweden demonstrated that healthy individuals who drank 2 liters of extra water for two weeks, had significantly increased blood pressure, and decreased symptoms of vertigo [6].

3: Manage Low Blood Pressure by Changing Your Diet

Small, frequent meals and increased intake of salt, vitamin B12, folate, and caffeine can help you prevent a decrease in blood pressure.

Vitamin B12

Vitamin B12 is an essential vitamin for people with low blood pressure.

B12 deficiency causes megaloblastic anemia, which results in low blood pressure.

B12 supplementation, and foods that contain a high amount of B12, are helpful in these conditions.

Foods with abundant vitamin B12 include fish, poultry, eggs, and cereals.

Folate

Folate is another vitamin whose deficiency can result in megaloblastic anemia.

Foods rich in folic acid include green, leafy vegetables (eg. lettuce, spinach, turnip, broccoli), beans, whole grains, and liver.

Salt

Salt is well known for its role in increasing blood pressure.

The main active ingredient is sodium, which causes constriction of the arteries, resulting in hypertension [7].

It also causes retention of water in the body, which raises blood pressure.

Canned foods, pickled items, salted nuts, cheeses, and processed foods are high in sodium.

Please remember that excessive intake of salt is harmful.

The World Health Organization (WHO) recommends limiting salt intake from all sources to 5 grams per day.

Postprandial Hypotension

This is a unique condition that results in low blood pressure after eating a meal.

This condition is common in older people and can create serious problems.

It is caused by increased blood flow to the intestines to absorb nutrients.

Normally, arteries in other parts of the body constrict to compensate for the fall in blood pressure.

Increased insulin release, caused by high carbohydrate intake, interferes with the compensatory mechanism and causes low blood pressure.

A doctor can use 24 hours of ambulatory blood pressure monitoring to make a diagnosis of postprandial hypotension.

It would be best if you decreased your high carbohydrate intake at night.

Some experts also recommend taking smaller, low-carb meals throughout the day, to tackle this problem.

Another recommendation is to avoid standing up immediately after eating a meal, to avoid the hazards of hypotension.

Researchers at the University School of Medicine, Boston showed that increased water intake and substituting six smaller meals, rather than three large ones, is helpful for combating postprandial hypotension [8].

One thing that I have realized in my practice is that, when we choose a specific diet for a problem, it can exacerbate other health conditions.

Therefore, general advice for everyone is to eat a balanced diet, with plenty of vegetables, fruits, complex carbohydrates, and meat.

Small, frequent meals, smoking cessation, and optimum hydration are also helpful.

4: Avoid Drugs that Decrease Blood Pressure

There are a variety of drugs that can decrease blood pressure, and create many problems.

Knowledge of these drugs is essential, as they are often commonly prescribed [10].

You should be aware of these drugs, especially if you already have low blood pressure.

You should discuss with your doctor to find an alternative option, if possible.

I have prepared a list of commonly-used medicines that can worsen low blood pressure.

Anti-Hypertensive Medications

These are used to treat high blood pressure and are one of the common causes of low blood pressure.

The drugs in this category include diuretics, ACE inhibitors, beta-blockers, and calcium channel blockers.

Anti-Angina Medications

These are used to relieve the pain caused by heart attack and angina.

Drugs in this category include nitroglycerin, isosorbide mononitrate, and dinitrate.

These drugs have a powerful vasodilatory effect and can cause severe hypotension.

5: Know When to Consult a Doctor

Low blood pressure is usually not problematic for healthy individuals and causes only mild symptoms.

But please remember that it can indicate severe and life-threatening health conditions.

When blood pressure is below a critical level, blood flow to the vital organs, like the liver, kidneys, and brain, is impaired.

Low blood pressure is the final common cause of death in most diseases.

It is very important for you to make a decision about the severity of your low blood pressure, as mild low blood pressure doesn’t require medication, and can be easily managed with home remedies.

In contrast, severe hypotension may require medications like dopamine, adrenaline, fludrocortisone, or midodrine.

When in doubt, always consult a doctor.

You should always dial 911 if someone near you experiences low blood pressure and any of the following:

  • Loss of consciousness.
  • Difficulty breathing.
  • Confusion.
  • Cold, clammy skin, or bluish discoloration.
  • Weak or irregular pulse.
  • Seizures.

I also recommend consulting a doctor if hypotension is found in the elderly, pregnant women, or people with underlying heart conditions.

Conclusion

Low blood pressure is a common complaint, experienced by most people at some point.

If you experience any symptom of low blood pressure, you should sleep with your legs at a higher level than the rest of your body.

Increased water and salt intake, caffeine, vitamins, and avoidance of drugs that cause hypotension, are also helpful.

References

[1] “Ask the doctor: Should I worry about low nighttime blood pressure?” Harvard Health Publishing, 2012. https://www.health.harvard.edu/heart-health/should-i-worry-about-low-nighttime-blood-pressure (accessed Feb. 13, 2022).

[2] J. Duke, “CHAPTER 20 – Patient Positioning,” J. B. T.-A. S. (Fourth E. Duke, Ed. Philadelphia: Mosby, 2011, pp. 142–148.

[3] C. L. Ostrow, “Use of the trendelenburg position by critical care nurses: Trendelenburg survey,” Am. J. Crit. Care, vol. 6, no. 3, pp. 172–176, 1997, doi: 10.4037/ajcc1997.6.3.172.

[4] J. C. Watso and W. B. Farquhar, “Hydration Status and Cardiovascular Function,” Nutrients, vol. 11, no. 8, p. 1866, Aug. 2019, doi: 10.3390/nu11081866.

[5] B. Grobéty, E. K. Grasser, G. Yepuri, A. G. Dulloo, and J.-P. Montani, “Postprandial hypotension in older adults: Can it be prevented by drinking water before the meal?,” Clin. Nutr., vol. 34, no. 5, pp. 885–891, Oct. 2015, doi: 10.1016/j.clnu.2014.09.009.

[6] A. Jormeus, S. Karlsson, C. Dahlgren, T. Lindström, and F. H. Nystrom, “Doubling of Water Intake Increases Daytime Blood Pressure and Reduces Vertigo in Healthy Subjects,” Clin. Exp. Hypertens., vol. 32, no. 7, pp. 439–443, Nov. 2010, doi: 10.3109/10641961003686450.

[7] I. Biaggioni, “Blood pressure regulation in autonomic failure by dietary sodium, blood volume and posture,” Auton. Neurosci. Basic Clin., vol. 236, Dec. 2021, doi: 10.1016/j.autneu.2021.102891.

[8] G. L. Luciano, M. J. Brennan, and M. B. Rothberg, “Postprandial Hypotension,” Am. J. Med., vol. 123, no. 3, pp. 281.e1-281.e6, 2010, doi: https://doi.org/10.1016/j.amjmed.2009.06.026.

[9] S. G. Chrysant, “The impact of coffee consumption on blood pressure, cardiovascular disease and diabetes mellitus,” Expert Rev. Cardiovasc. Ther., vol. 15, no. 3, pp. 151–156, Mar. 2017, doi: 10.1080/14779072.2017.1287563.

[10] J. A. Schoenberger, “Drug-Induced Orthostatic Hypotension,” Drug Saf., vol. 6, no. 6, pp. 402–407, 1991, doi: 10.2165/00002018-199106060-00002.

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