Raise the head of the bed, not the pillow count
Raise your chest and head together, with your waist lower down. The NHS advice on heartburn and acid reflux is to raise the head of your bed by around 10 to 20 centimetres using wood, bricks or books.4 Lying flat lets stomach contents reach the oesophagus, the tube between your mouth and stomach; raising your upper body uses gravity to help keep those contents down.
Extra pillows lift your head without reliably raising your chest. They also bend your neck and slide around. You can arrange them beautifully before bed, very boutique hotel, then wake with the whole arrangement somewhere else. The NHS says extra pillows can make symptoms worse, so use a stable way of raising your upper body instead.
The 2021 review by Albarqouni and colleagues covered five small controlled trials involving 228 adults with reflux.5 They used blocks under the bed legs, a wedge pillow, or both. Symptoms improved in the four trials that measured them. All five trials were at high risk of bias, and the reviewers said the evidence did not allow a firm recommendation, although they described head-of-bed elevation as cheap and safe to try. These trials studied blocks and wedges, not adjustable beds.
To my mind, that is a good reason to begin with the simple arrangement. You don't need a remote control just to sleep on a slope, however much fun the showroom demonstration is. The three options differ mainly in how you get raised and what else you can do with the bed:
- Blocks under the head-end legs: the NHS suggests wood, bricks or books. Raise the two legs at the head end so the whole bed slopes. Check that the supports and the bed are stable before using it.
- A foam wedge: place one under the mattress at the head end or use an upper-body wedge that supports your chest as well as your head. This creates a slope without raising the bed legs.
- An adjustable base: the head section lifts, and you can change its position. This requires a mattress designed to bend with it.
I think adjustable beds are overpriced for most people buying solely for reflux. Blocks or a wedge provide the raised position for a fraction of the outlay. Pay for an adjustable base if its other functions are useful to you too, especially sitting up and getting out of bed.
Left-side sleeping is worth trying, and comfort helps you stay there
Try your left side before settling on your right: the small laboratory studies found less acid exposure in that position. You don't need to turn bedtime into a choreography exercise, but the side you lie on is worth paying attention to.
In van Herwaarden and colleagues' 2000 study, ten healthy people were measured lying on each side after a high-fat meal. Acid exposure in the oesophagus was greater on the right, at 7.10 per cent of the time compared with 2.0 per cent on the left, because more reflux episodes occurred. This was a laboratory study in ten healthy people.
Person and colleagues' 2015 trial involved twenty healthy volunteers, each completing four six-hour sessions after a standard meal.2 The researchers compared a positioning device used on the left and right sides, a standard wedge, and lying flat. Acid exposure was lowest with the device holding people left-side-down with their head and torso raised, and highest when used right-side-down. This was a small study of healthy volunteers using one device.
The practical difficulty is staying comfortable enough to remain on your left. If your shoulder barely sinks and your hip feels perched on the surface, you're unlikely to enjoy the arrangement. The showroom habit of calling everything harder "more supportive" gets tedious here. Choose a comfort layer that lets your shoulder and hip sink a little, with a supportive core beneath it.
I work from your weight first, then adjust for your sleeping position. These are comfort-shopping rules of thumb, not medical thresholds; firmness labels also vary between makers.
| Your build or sleeping habit | What to look for |
|---|
| Lighter build | A softer surface that gives beneath your shoulder and hip. A mattress labelled medium-firm can feel much harder under a lighter person. |
| Heavier build | A firmer, supportive core with enough cushioning above it for side sleeping. |
| Usually a back or front sleeper, trying your left side | Some extra surface give compared with the feel you usually choose, without your waist sinking deeply. |
| Already a comfortable side sleeper | Keep the feel that suits you and assess whether raising your existing bed is enough. |
Also leave time between eating and lying down. The NIDDK's reflux treatment guidance includes raising the head of the bed and avoiding lying down soon after eating among its lifestyle measures, alongside weight and diet changes.3 That applies to the post-dinner sofa sprawl too, tempting though it is.
An adjustable base needs a mattress built to bend
If you choose an adjustable base, buy a mattress explicitly made to flex on it. Foam, latex and suitable pocket-sprung mattresses are the constructions to consider. A mattress being soft enough to squash in the shop tells you very little about whether it will bend repeatedly on a moving base. Please don't make an expensive purchase on the strength of an enthusiastic elbow press.
Pocket springs are the sprung option I favour, but they must be built for adjustable use. Avoid open coil and rigid rod edges on a moving base: the mattress needs to follow the raised head section without resisting the bend. Check compatibility for the exact mattress and base together. You can narrow the search to mattresses for adjustable bases, then confirm the pairing before ordering.
Keep depth sensible and within the base maker's limit. An especially deep mattress is harder to bend neatly, and you still need it to sit correctly against the base when raised. The industry's enthusiasm for making everything thicker is quite something; you then get to buy the deeper fitted sheets. A moderate depth is the more practical place to start.
The mattress also needs to stay put on the slope. Look for a retaining bar or suitable straps, with the base's grip arrangement, so it doesn't creep towards the foot end when raised. Check that the mattress fits the base properly, because flexibility alone doesn't keep it in place.
For the surface feel, choose enough cushioning for your left shoulder and hip without a deep, difficult-to-turn-in sink. Memory foam suits people who enjoy a close-fitting feel, but I steer hot sleepers towards suitable pocket springs or latex. If you already throw the duvet off before midnight, don't add deep memory foam to the shopping basket without considering the warmth.
Meal timing and frequent symptoms matter more than another bed purchase
Follow the NHS's everyday advice alongside changing your sleeping position, and book a GP appointment if heartburn happens most days. A new bed is a much more entertaining purchase than changing dinner time, I know. The NHS advice still applies when the mattress is lovely.
- Eat smaller, more frequent meals. The NHS recommends this as a self-help measure for reflux.
- Leave three or four hours between eating and bed. The NHS advises avoiding food in that window, so work backwards from your usual bedtime when planning dinner.
- Avoid foods and drinks that trigger your symptoms. Use your own experience to identify them; the NHS advice is about your triggers.
- Try to lose weight if you're overweight. This is part of the NHS self-help advice.
- Avoid tight clothing and find ways to relax. Both appear in the NHS guidance. Loosening the waistband is at least one bedtime change without a subscription.
- Do not smoke, and avoid drinking too much alcohol. These are also NHS self-help recommendations.
See a GP if lifestyle changes and pharmacy medicines aren't helping, or if you have heartburn most days. Food getting stuck in your throat, frequently being sick or losing weight for no reason are also reasons to seek medical assessment. Do not stop taking prescribed medicine without speaking to a doctor.
Skip the pillow stack and the unnecessary upgrade
Avoid these choices before spending money. I love a useful bed upgrade, but a motor is an expensive addition if all you need is a raised head end.
- A stack of ordinary pillows: the NHS warns that extra pillows can worsen symptoms.
- Open coil on an adjustable base: choose a construction made to bend with the base.
- An adjustable base solely for reflux: try suitable blocks or a wedge first if raising your upper body is the only function you need. The remote can stay in the showroom.
- Settling on your right side when the left is comfortable: the small laboratory studies favour trying the left.
- Shopping for a bed instead of seeking help for heartburn most days: book a GP appointment.
When heartburn needs a GP, not a different bed
Some reflux needs medical assessment rather than a change of position. NHS guidance on heartburn and acid reflux says to see a GP if lifestyle changes and pharmacy medicines are not helping your heartburn, if you have heartburn most days, or if you also have other symptoms, like food getting stuck in your throat, frequently being sick, or losing weight for no reason.
The NHS advises raising the head of your bed by around 10 to 20cm using wood, bricks or books, so that your chest and head are above your waist, and not using extra pillows, which can make symptoms worse. Do not stop taking any prescribed medicine without speaking to a doctor.
