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He has fallen out of bed three different times. We have changed to a lower bed, changed position of the bed, etc. Is a side rail the answer?

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Yes, side rails would be in order. Do not even think about tying him to the bed though. (Once I had my mother stay with me and I put the bed on the floor and just helped her out in the a.m.)
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A low bed was a good idea...even so low as to placing his mattress directly on the floor. That way, if he rolls out, he only has 7" to go ibstead of 20+ & the likelihood of injury is greatly reduced. You can also purchase pool noodles at your local Walmart and insert them between the mattress & the floor (or box spring or bed frame if you choose to continue using them) along the long sides of the bed. Dad would have to roll "uphill" in order to fall out. Lastly, it won't prevent a roll out of bed, but if you buy padded exercise mats & put them on the floor next to his bed, it will help to cushion him & prevent injury should he roll out despite the pool noodles & low bed.
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My husband was/is like that, first I put a pillow between box spring and mattress, there was just enough of a "hill" that he didn't roll out of bed, we had to graduate to a rail and now a hospital bed....
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My mom had dementia, and we did get to a period where she would fall out of bed. I found a very useful item, not wanting to use side rails after reading of some bad situations occurring. It's from a company called Stander. It's kind of an upside down U that is along the bed, covered with a fabric (and pockets for remotes, etc.). It is lightweight yet supposed to hold up to 400 pounds. It slides under the mattress to secure in place. It was enough to keep my mom in bed, but another feature of it was if she decided to get up, she would need to sit up in bed, and the item could assist her in getting out of bed. I also had a camera in her room so I could monitor her by vision, audio or both.
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You may want to have his medications checked. Some side effects include bad dreams. I heard of someone once diving out of bed right on to the floor. They imagined they were at their swimming club. A side rail might not be a bad idea in the meantime
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My mom was a sleep walker, and even after she couldn't walk she still wanted to sleep walk and would just fall down. Before she died, I was staying the nights with her in assisted living, all night long was a battle to keep her in that bed. Hospitals and facilities don't allow rails or restraints anymore, probably with good reason. You can buy a motion detector with an alarm for $25 on-line and place it next to the bed so the alarm goes off if any part of his body hangs off the side or if he even puts one foot on the ground, you'll know. You have my sympathy, the motion detector was a very useful tool for me, even during the day (I'd move it to the living room, one step off the sofa and I'd know!). The motion detector was two separate units, the detector was one half, the sounding alarm was a small square I could carry in my pocket. Hope this helps...
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You can buy a U shaped Hand Bed Rail from Amazon. They can't get their head stuck in it. It slides between the mattress and box spring. They can use it to steady themselves when getting up at night and it is gentle reminder to keep them from rolling out of bed. I got one for my Dad when he rolled out of bed and he hasn't rolled out since. Also you can get a bed alarm and keep a pad on the floor in case they do roll out. A low bed is, also, a great idea.
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Wow- the "tied to the bed" or "zippered in" stories are wild- restraints of any kind (and that includes drugging people into submission) are not allowed in today's medical world- nursing homes are in the hot seat for anything that happens and "restraints" are near the top of the list.
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How about putting the mattress and box spring directly on the floor? This would also likely alleviate him being able to rise to standing unassisted (though also making you do this for him when you DO want him to be up and about).
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Ahh- the bedrail debate- good, bad and in-between. People have been killed/injured by them over the years but they have also saved countless injuries. Homecare rails have no real standards so there are many flimsy versions- most made as cheaply as possible overseas. Best example I saw was one advertised with 250# capacity and shipping weight was about 2#- what a joke. The ones that slide between mattress and boxspring can often be felt under your back and do not work well with adjustable/hospital beds. Good suggestions above- much depends on the mental/physical state of the person. If mostly mental- the mattress on the floor or the swim tubes may be the best option. If falls are because of physical problems there are assistive products that would be good/safe solutions- even ones that allow a person to remain in a wide, comfortable bed instead of a narrow bed. If I can make suggestions please let me know.
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