The Heartache of
Restless Sleep

Poor sleep can affect
your cardiac health.

March/April 2017

By Linda Melone


Debra Wechter’s husband knew about her sleep apnea before she did.

“For years my husband told me I would start to fall asleep at night and invariably wake up choking myself snoring,” says Wechter, an engineer from Windsor, Massachusetts. “I didn’t know for sure until I was tested in a sleep study.” Although she never felt her abnormal sleep pattern harmed her, she often felt “very tired” but blamed the fatigue on her high activity level as a triathlete.

The sleep lab diagnosed Wechter with a mild case of sleep apnea. In this condition, muscles in the neck fall during sleep, forming an obstruction during sleep’s deeper stages that blocks air flow. Snoring results when all the tissues vibrate as air tries to get through this narrowed passage.

Wechter’s doctor prescribed a CPAP machine to help her breathe at night. “I immediately noticed a difference,” she says. “I began dreaming and remembering my dreams, which indicated I was achieving stage five (REM) sleep, a level of sleep I was previously unable to reach due to sleep apnea.” In addition to dreaming, Wechter felt more rested during the day and had more energy when working out.

In addition to resolving her energy issue, Wechter also reduced her risk of cardiovascular disease by improving the quality of her sleep. Lack of sleep and poor-quality sleep takes a toll on your heart: Adults over age 45 who sleep fewer than six hours a night are twice as likely to experience a stroke or heart attack as people who sleep six to eight hours nightly, regardless of age, weight, smoking or exercise habits, according to the National Sleep Foundation.

Working at a job requiring long hours or interrupted sleep can also impact heart health. In fact, even short-term sleep deprivation over a 24-hour shift, such as that often seen among emergency medical workers, affects blood pressure, heart rate and the ability of the heart muscle to contract (cardiac contractibility).

Chronic insomnia (defined as sleep difficulties that persist more than six months) and high blood pressure also go hand-in-hand, a 2015 study from the journal Hypertension shows.

The specific link between sleep and cardiovascular health remains unclear, but inadequate sleep and dysfunctional sleep often aggravate underlying health conditions such as glucose metabolism (which relates to diabetes risk), blood pressure and inflammation.

“Sleep is a very complex sequence of events that’s important to understand,” says George Ruiz, MD, chief of cardiology at MedStar Union Memorial Hospital and MedStar Good Samaritan Hospital in Baltimore. “It’s more than just putting your head on a pillow, and not all sleep is created equal. Individuals who have sleep issues can develop problems with their heart and people with heart problems may develop problems with sleep, so it works both ways.”

A hectic lifestyle in a productivity-driven society and using over-the-counter medications to stay alert drives people to look for ways to function on less sleep than they need.

What Is a Good Night’s Sleep?

Several factors comprise a “good night’s sleep,” says Allen Towfigh, MD, medical director at New York Neurology and Sleep Medicine. “Studies show most of us need between seven and nine hours of sleep on a consistent basis in order to reduce the likelihood of certain conditions such as heart disease and dementia. However, the exact amount of sleep each person needs varies.”

To calculate the amount of sleep you need, Towfigh suggests keeping a sleep log of all the snooze time you get over a two-week period and divide the total number of hours of sleep by the number of days. “Waking up to an alarm clock,” he says, “is usually a sign you’re waking up before your body is ready to wake up on its own.”

Sleep and Cardiovascular Risk

Sleep disorders such as apnea play a major role in compromised heart health. Without long, deep periods of quality sleep, chemicals responsible for lowering blood pressure and heart rate are not released. Over time, this can lead to higher blood pressure during the day. “Sleep has a restorative effect on vital physiological functions,” says Ruiz.

The Restorative Power
of Yoga Nidra

Considering that Yoga Nidra literally means “yogic sleep,” it’s not surprising that participating in it can give you the same physical benefits of hours of sleep.

“Yoga Nidra is said to have the physiologic effect of two to eight hours of restful sleep. It is dependent on the level of relaxation reached and is therefore somewhat subjective,” says Gina L. Sager, MD, RYT, a Maryland-based yoga teacher certified in Integrative Yoga Therapy. “Most people report feeling more deeply rested after Yoga Nidra than after eight hours of sleep at home, as well as sometimes
finding relief of mental, physical and emotional pain.”

Sager has taught Yoga Nidra for many years and says it doesn’t involve movement like a traditional yoga class does. “It is a practice of deep meditation and guided imagery,” she explains.

Sager begins her 90-minute classes with 20 to 30 minutes of meditation and breath awareness, either seated or lying down.

“Everyone is so busy and unaccustomed to being still, that it seems to take at least that long to settle. Once Yoga Nidra begins, participants lie on the floor on their backs with their eyes closed for the rest of the practice.

Part of the reason for this position is to minimize the sensory information being directed to the brain as the back body has fewer sensory nerve endings. After the guided relaxation, there is a period of guided imagery meant to help release all the unprocessed emotions and experiences stuck in the subconscious mind.”

Yoga Nidra can be used daily to help improve sleep quality, Sager says. “Yoga Nidra explores and lengthens the alpha state, a thin space between sleep and wakefulness, a brain wave length often sought for higher-quality rest,” she explains. “In this state, one is balanced mentally, physically, emotionally, and spiritually.

Yoga Nidra is specifically designed to guide
participants to these deep levels.

It rebalances the nervous system so you arise with a ‘clean slate,’ starting from a refreshed, rebalanced state.” (To learn more, go
to yoganidranetwork.org.)
—Michele Wojciechowski

The obstruction and snoring associated with sleep apnea may or may not rouse the person, depending on the severity of the obstruction, explains Ruiz. “This may wake the person up not to the point where they are conscious, but it prevents them from falling into deeper sleep. So they wake up feeling exhausted and never quite get to the replenishing effect of deep sleep.”

This scenario also causes adrenaline levels to increase because the body thinks it’s being choked, Ruiz adds. The surges in stress hormones (adrenaline) raise blood pressure, which can also raise pressure in the heart and in the blood vessels of the lungs (pulmonary hypertension), increasing the risk of cardiovascular disease. “As a heart failure specialist, I check for sleep apnea because nearly 50% of those patients have problems with sleep because their heart’s not working well and the pressure in the heart is high,” says Ruiz.

In addition, obstructive sleep during the night results in a drop in oxygen, which triggers the restriction of blood vessels and can lead to high blood pressure, notes Rami N. Khayat, MD, clinical professor of pulmonary critical care at Ohio State University, who specializes in sleep-disordered breathing and cardiovascular disease. He says, “If you’re not getting six to nine hours of sleep, you already have a problem. Approximately 25% of people get less than six hours of sleep a night.”

The danger lies in getting used to this amount of sleep even though it results in decreased function, irritability and increased risk of injury while driving and operating equipment. “Sleep not only rests the heart, but it dilates the blood vessels, gives body organs a rest and clears metabolites from the brain that accumulate from the day,” says Khayat.

The key lies in finding a balance, since too much sleep may also increase coronary heart disease risk, according to a study published in the International Journal of Cardiology (3/15/16) involving 400,000 adults. People who reported sleeping more than eight hours a night had a 53% increased risk of dying from coronary heart disease compared with study participants who slept between six and eight hours a night.

Trying to Catch Up

Sleeping in on weekends in an effort to “catch up” on deficient sleep during the week sounds good in theory, but doesn’t work in the long term, says Khayat. “For example, if you require eight hours’ sleep a night but get by on seven hours during the week, you can’t make up for that time by sleeping more on weekends. It only counts for being refreshed on that day.” In general, you should try to obtain the sleep you need on a daily basis.

The lasting effects on the heart cannot be reversed aside from the day you’re sleeping in, Khayat adds. “We’re talking about long-term sleep deprivation. A bad week or one day here and there is not an issue. As long you go back on a regular sleep rhythm it’s fine. Try to make up for it immediately and allow your body to recover.”

Khayat notes that no specific time frame has been determined after which cardiovascular damage occurs. “It may take months or years for damage to affect cardiovascular health, but it’s only estimated.”

Since a link between sleep deprivation and heart health rarely exists in a vacuum, other important factors must be taken into account. “For example, if someone currently has coronary artery disease, a week of sleep deprivation usually worsens coronary risk factors,” says Khayat. Most people have sleep deprivation along with other issues, however, such as family history or abnormal cholesterol, so increasing the quantity and quality of sleep would be part of a complete plan to prevent a heart attack from occurring.

In addition, stress and inflammation damage blood vessels and the heart. Sleep loss is known to contribute to obesity and glucose intolerance, which sets the stage for sleep apnea, indirectly leading to high blood pressure and an increased risk of heart disease.

Getting Better Sleep

In general, improving sleep habits requires taking a look both at the quantity as well as the quality of the sleep. “If you’re not getting enough sleep, try going to bed earlier or changing your morning routine to one that allows you to get more sleep,” says Towfigh. “You should wake up feeling refreshed upon arising or within 15 minutes of waking, and have enough energy to get through your day without feeling listless or fatigued.”

To sleep more soundly, you should:

• Avoid napping, which can disturb your natural patterns of sleep and wakefulness.

• Keep regular bedtime routines and avoid emotionally upsetting discussions or activities at that time.

• Avoid drinking water within an hour or two of going to bed to avoid waking up for a bathroom visit.

• Cut back on caffeine during the day, which may keep you awake at night.

• Exercise earlier in the day, not immediately before sleep. Gentle practices such as yoga or Tai Chi are fine, as they promote relaxation.

“If you do these things and you still don’t wake up feeling refreshed, then there’s likely an issue with the quality [not quantity] of your sleep,” says Ruiz. While it’s tempting to reach for sleeping pills to help Mother Nature along, it often makes the situation worse, he adds. See your doctor to rule out sleep apnea, which disrupts sleep and raises blood pressure.

“Hypertension is a risk factor for cardiovascular disease and sleep apnea is a risk factor for hypertension.”

Make sleep a priority to reduce your risk of cardiovascular disease and improve your overall health.

Natural Sleep Aids

Chamomile
An herb with a long history of use for its relaxing properties

GABA
A calming brain chemical thought to promote melatonin production

Melatonin
A hormone that regulates sleep and wakefulness

Passionflower
An herb long used to treat insomnia and anxiety

P5P
A form of vitamin B6 that helps normalize sleep/wake cycles

Valerian
An herb known to help relax the central nervous system

 

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