The Link Between Insomnia and Heart Failure

Insomnia can increase the risk of heart disease, stroke, and heart failure. However, whether insomnia causes these conditions or is merely associated with them remains unclear.

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The Link Between Insomnia and Heart Failure Risk

Insomnia is characterized by difficulty falling asleep, difficulty staying asleep, or waking up too early in the morning (or all three). A 2013 study related heart failure risk to these three major insomnia symptoms. The results showed an increased heart failure risk when people have any of these sleep problems. If you have all three at once, your risk is substantially higher (more than three-fold), compared with people without insomnia.

Women appeared to have a higher relative risk of heart failure associated with non-restorative sleep and with the cumulative symptoms of insomnia. Still, researchers say the reason for increased heart failure risk in people with insomnia remains unclear. However, they outline two theories: The researchers say there are indications that there might be a biological cause. Another possible explanation is that insomnia activates stress responses in the body that might take a toll on heart function.

Insomnia's Impact on Heart Health

Generally, insomnia increases the risk for heart disease and stroke in people with the following conditions. All three can be precursors to heart failure.

  • High blood pressure (hypertension): During normal sleep, your blood pressure drops. If you are unable to sleep, your blood pressure stays higher for a longer amount of time. High blood pressure is one of the greatest risk factors for heart disease and stroke. About one in three adults have high blood pressure.
  • Type 2 diabetes: Diabetes is a chronic disease that affects how your body metabolizes glucose (sugars). Diabetes can damage your blood vessels. Some studies show that getting sufficient good sleep may help people improve blood sugar control.
  • Obesity: Lack of sleep can lead to unhealthy weight gain. Not getting enough sleep may affect a part of the brain that controls hunger and lead you to eat during hours when you should normally be asleep.

Conditions That Interrupt Sleep

While insomnia may increase heart failure, there are a number of conditions common in heart patients that impact their ability to sleep. These conditions can compound the severity of existing insomnia and sleep deprivation. Consequently, it is important your doctor address such conditions in your heart failure therapy. You may need a sleep study (polysomnogram) to make a specific diagnosis, so your doctor can initiate appropriate treatment.

Obstructive Sleep Apnea

Obstructive sleep apnea affects up to 50% of patients with heart failure. People with sleep apnea have prolonged pauses in their breathing during sleep. These breathing pauses cause sudden arousal from deep sleep, often many times per night, and result in significant sleep deprivation. Patients with sleep apnea are often unaware of their nighttime arousals, and may not complain of insomnia—but they do experience many of the signs of sleep deprivation.

Sleep apnea tends to make heart failure worse, and worsening heart failure often makes sleep apnea worse—so a vicious cycle can begin. It is critical for heart failure patients with sleep apnea to have optimal treatment for both conditions for this reason.

There are a variety of noninvasive sleep apnea treatments. Positive airway pressure (PAP) machines are the most widely used treatment for moderate and severe sleep apnea.

PAP machines come with a variety of breathing masks. The mask, worn snugly over the nose, or nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper’s throat. The increased air pressure prevents your airway from collapsing.

The pressurized air is supplied through a tube from one of several types of PAP machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that people with sleep apnea who consistently use their machines feel better and encounter fewer complications of heart disease as a result of the reduction of apnea episodes during sleep.

Nocturnal Movement Disorders

Patients with heart failure are more likely than the general population to develop two kinds of nocturnal movement disorder that can interrupt sleep—restless legs syndrome and periodic limb movement disorder.

Restless Legs Syndrome

Restless legs syndrome (RLS) is characterized by several very uncomfortable symptoms in the legs that typically happen when you get into bed for a night’s sleep. These symptoms include burning, twitching, and/or creeping sensations that compel sufferers to begin moving their legs around for relief (hence, “restless legs”). They will report making almost involuntary sudden jerks or shaking movements of their legs. As a result, these patients often have trouble getting to sleep. Fortunately, treatment can be quite effective.

Periodic Limb Movement Disorder

Periodic limb movement disorder (PLMD) is similar to restless leg syndrome, in that it involves an involuntary movement of the legs (jerking, kicking, or twitching) associated with sleep. The main difference is that PLMD occurs during sleep, and may not be directly noticed by the sufferer (though it is likely to be noticed, often painfully, by a sleeping partner). However, PLMD often interrupts deep sleep, which leads to sleep deprivation.

What causes PLMD is unknown, but similarly to RLS, it can be treated once it is recognized.

  • Avoiding caffeine: Caffeine can make PLMD worse. Be sure to avoid caffeinated products, energy drinks, chocolates, and medications that contain caffeine (Excedrin).
  • Check iron levels: Your doctor may check your iron and folic acid levels. Low levels of these nutrients can exacerbate PLMD symptoms.
  • Take medications: Several different types of drugs that play a role in regulating muscle movements can be tried as a last choice in severe cases. These may include dopaminergic agents (such as carbidopa-levodopa and other newer compounds like ropinirole), benzodiazepines (clonazepam), and certain anticonvulsants (gabapentin) among others.

Treatment

While it is unclear what the causal link is between insomnia and increased heart failure risk, knowing such a connection exists remains pertinent. This knowledge underscores the importance of treating and eliminating insomnia as a heart failure risk factor.

Insomnia can take a toll on your wellbeing. Insomnia leads to symptoms of sleep deprivation during the daytime, such as sleepiness, fatigue, lack of energy, moodiness, and difficulty concentrating. It is vital to tell your doctor if you are experiencing regular sleep disturbances so they can help map a plan to get more rest. Meanwhile, there are some effective ways you can reduce insomnia naturally on your own. Some tips for better sleep include:

Take Charge of Your Sleep Routine

  • Limit activities in bed to sleep and sex (no phones, laptops, or TV)
  • Get up at the same time every morning, even on weekends
  • Go to bed only when sleepy
  • If you have not fallen asleep within 20 minutes, get out of bed and do something relaxing elsewhere under low light. Return to bed only when sleepy. Repeat.
  • Don't watch the time

Monitor Your Sleep Hygiene

  • Avoid naps during the day
  • Avoid caffeine after noon
  • Avoid nicotine, alcohol ,or heavy meals within two to three hours of bedtime.
  • Consistently employ a relaxing bedtime ritual
  • Exercise during the day versus right before bed so you are more tired at night
  • Get some sunshine during the day
  • Make sure your room is dark, quiet, and a comfortable temperature. Use earplugs or eye mask if needed

A Word From Verywell

People with heart failure are prone to common causes of insomnia that can affect anyone. But the added stress of having a chronic illness and a higher chance of developing depression, make the risk of insomnia greater than it is for most people. Insomnia affects 10% to 15% of people in the general population. But nearly 44% of people who have heart problems report frequent insomnia, making this one of the most common symptoms of heart failure.

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  4. American Sleep Apnea Association. Sleep apnea treatment devices.

  5. Cleveland Clinic. Restless legs syndrome. Jan. 24, 2020.

  6. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidenceSleep Med Rev. 2015;22:23-36.doi:10.1016/j.smrv.2014.10.001

  7. American Academy of Cardiology. Insomnia and heart disease. Aug. 2, 2016.

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