If you want dramatic shadows, you obviously need to prevent light from falling on those shadow areas. There are a few obvious sources of that light:

• ambient light. Room/window light which is not coming from your main lighting source. Turn off your main light and see what other light is falling on the subject. Try to block that light (shut windows, turn off lights, close doors)

• reflected light. If you have white walls, white bed sheets, you'll get a lot of reflected light. Out of camera shot, try to use black materials to absorb the light rather than reflect it.

• main light

  • if your main light source is too large the light may wrap around the face. For more dramatic lighting use small, hard lights.

  • Light may be scattered onto ceilings and walls - if you can use snoots, grids or barn doors to concentrate and direct the light, you'll get more contrast on the face. Not sure what lamps you're using, but try to shield them so the light is directed only at your subject.

  • Light falloff - the closer you get the light to your subject, the more light falloff you'll have (due to the inverse square law), so move your light as close as you can without being in frame (or remove in post processing if you must)

• fill light. In addition to your main (key) light, you may have other lights you're using. If you don't have the lighting (contrast) ratio you want, use less fill. Turn those lights down if you can, or move them further away.