Sleep And Heart Health: A Bidirectional Connection
The connection between quality sleep and heart health has been well established for some time now. But our understanding of the interaction or cause and effect has evolved over time. It is now believed that poor quality sleep contributes to things like coronary artery disease, peripheral arterial disease, congestive heart failure, stroke and heart attack. We also have evidence that coronary artery disease, peripheral arterial disease and congestive heart failure all contribute to poor quality sleep.
Because of this bidirectional connection, a vicious cycle results in the worsening of both heart health and sleep issues.
It’s Not Just Older People Who Need To Be Concerned About Heart Health
Studies have shown that adolescents who experienced poor quality sleep were more likely to develop cardiovascular issues later in life. They had higher levels of cholesterol and blood pressure as well as larger waists than their peers. All of which are risk factors for heart issues later in life.
In fact, a recent study found that while the recommended amount of sleep is 8-10 hours, only about 1/2 of them got more 7 hours on a regular basis.
The study also found that these teens were more likely to be depressed, do poorly at school and had a higher metabolic risk score. Metabolic syndrome puts people at greater risk of diabetes and heart disease.
Dealing with Sleep and Heart Health in Adolescence
Parents can reduce the risks associated with sleep deprivation by implementing the following.
- Make sure the teen goes to bed at least 10 hours before they need to get up.
- Ban all electronic devices 1 hour before going to bed. The blue light given off by their screens stimulates the brain and makes it difficult to fall asleep.
- Teach them how to organize their time efficiently. Between school, sports, homework and jobs, a teenagers day can get pretty full. So it’s doubly important that sleep becomes a priority. If your teen can’t fit in at least 8-10 hours of sleep per night, then something has to give. And considering lack of sleep can cause serious health problems, pick something else to eliminate.
- Consider getting involved in your community. Support efforts for more flexible school hours as teens are biologically wired to sleep late. Recently, there has also been a debate as to whether homework is beneficial for students or not. While that has yet to be determined, too much homework can cause fatigue and burnout as well as sleep deprivation.
Snoring, Heed The Warning Signs!
Snoring, that comical sitcom trope that always evokes canned laughter is really no laughing matter at all. Often times it is the first symptom of sleep apnea. A very serious and life threatening condition that requires immediate medical intervention.
Sleep apnea occurs when the airway becomes blocked normally by the tongue or excess tissue in the throat (although there are other causes). As the muscles in the throat and mouth relax, the tongue can slip to the back of the throat and any excess tissue in the throat can also cause a blockage of the airway. When this process happens, the air flowing over these tissues start to vibrate causing the sound we know as snoring. As the muscles continue to relax, they can block the airway completely. This is sleep apnea.
What Makes Sleep Apnea so Dangerous?
First of all, when your body stops breathing on its own, there is no guarantee that it will start back up again. That’s a pretty serious complication! But there are other, more subtle and insidious problems tied to sleep apnea.
- Sleep apnea releases stress hormones – When you stop breathing at night the oxygen level in your blood drops. As your brain is registering this drop it sends out a “panic” signal that releases stress hormones designed to “kick start” your breathing. That is why people with sleep apnea will often wake up “gasping” for air.
- It raises your blood pressure – Sleep is a time that your body repairs itself. Part of that repair process is the lowering of your blood pressure. Having stress hormones come flooding into your bloodstream causes a sudden rise in blood pressure. This can cause an increase in blood pressure during the day as well. This chronic cycle damages blood vessels, causes heart disease, stroke and kidney problems.
- It causes fatigue – It stand to reason that if you are waking up gasping for air several times a night that you would be tired during the day. But this fatigue can be dangerous. Studies have shown that people with sleep apnea are 2.5 times more likely to be involved in automobile accidents. Whether its from falling asleep at the wheel or because reaction times are slower when your tired, you risk hurting yourself or someone else driving with untreated sleep apnea.
- It can cause heart failure – The link between sleep and heart health is now commonly recognized. As stress hormones released during these episodes cause damage to the blood vessels in and around the heart. These damaged vessels then collect cholesterol and other fatty deposits narrowing the artery, causing both heart disease and heart failure.
Sleep and Heart Health: How Snoring and Sleep Apnea Contribute to Hypertension
The link between snoring, sleep apnea and high blood pressure has been well established for many years now. Hypertension is a well known risk factor for a host of serious health problems. Including heart attack, stroke, kidney disease and heart failure. Known as the ‘silent killer”, untreated hypertension often leads to sudden death.
So, how does snoring and sleep apnea contribute to high blood pressure? It turns out that it all has to do with oxygen. With both heavy snoring and sleep apnea tissues in the mouth, nose or throat block the airways depriving the body of oxygen.
This drop in oxygen levels is detected in a part of the brain called the medulla oblongata. The medulla oblongata not only monitors the oxygen level in the blood, but it also regulates it.
When the brain detects a decrease in oxygen levels it sends out a signal that releases adrenaline (a stress hormone). Adrenaline causes the heart to pump faster in order to pump more blood (and thereby oxygen) to the body. While at the same time constricting the arteries which increases the blood pressure within the artery.
All of this is done automatically in response to the body being starved of oxygen. With severe snoring and sleep apnea, these episodes can occur 30 or more times per hour.
As you can imagine, with so many episodes, your blood pressure remains elevated throughout the night and even continues during the next day. This vicious cycle results in the dangerous condition known as chronic hypertension. In fact you can calculate your risk for chronic hypertension based on the number of episodes you have per hour. Each episode increases your risk of chronic hypertension by 1%, so at 30 per hour your risk increases by 30%.
How Snoring and Sleep Apnea Contribute to a Risk of Heart Failure
Heart failure, sometimes called congestive heart failure or CHF, is a condition where the heart isn’t able to pump blood efficiently. This causes symptoms like:
- Shortness of breath
- Swelling in the legs, ankles or feet
- rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing
- Increased need to urinate at night
- Swelling of your abdomen (ascites)
- Very rapid weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
While there are many risk factors associated with heart failure including, smoking, drinking/drug use, obesity, coronary artery disease and heart attack, high blood pressure as well as chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism.
Chronic sleep apnea has been shown to be a risk factor independent of all these other factors. In other words, even if you don’t have any other risk factors for CHF, just having sleep apnea can put you into congestive heart failure.
Sleep And Heart Health: A Bidirectional Connection
Up until recently, the connection between sleep and heart health was thought to be one direction. Snoring, sleep apnea and other sleep disorders caused the associated health problems.
However, more and more research is pointing to the fact that this is a bidirectional relationship. In other words, these common sleep issues not only contribute to heart health, but your heart’s health contributes to the sleep issues.
Sleep and Heart Health: Obesity
While its been well understood that being overweight is bad for heart health. We’re just now understanding that sleep issues contribute to weight gain and obesity. Specifically insomnia, sleep apnea and snoring. But how is this happening?
Insomnia is the inability to fall asleep or to stay asleep, resulting in a disruption in the normal sleep cycle. This has several effects on the body that can cause weight gain.
Because people with insomnia aren’t getting rest at night, one of the biggest issues is day-time fatigue. Fatigue can cause weight gain in a variety of ways, including.
Low Energy – Feeling tired all of the time impacts our activity level. When we wake up tired all of the time, we’re less likely to go to the gym or for a walk. This lack of activity contributes to weight gain.
Cravings – When we get up fatigued and tired, our body sends messages to our brain signaling a need for high energy foods. This will combat the fatigue we feel, but those “high energy” foods tend to be high in sugar and carbohydrates. Combine that with lack of activity, and you have a double whammy.
Sleep and Heart Health: Sleep Apnea
Sleep apnea occurs when a person stops breathing during the night, causing a release of stress hormones that “jolt” the person awake in order to restart breathing. There are three types of sleep apnea.
- Obstructive sleep apnea – The most common. With OSA the airway gets blocked by either the tongue, or excess tissue in the nose mouth or throat, cutting off oxygen to the lungs.
- Central sleep apnea – Less common, and the airway isn’t blocked by tissue. Rather there seems to be a disruption in the part of the brain that controls breathing.
- Complex sleep apnea – The least common of the three. Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.
Whatever the cause, the effects on the body, and heart, are the same.
Release of stress hormones – This jolts the body awake in order to restart breathing (although they may not remember waking up). These episodes can happen over 30 times an hour disrupting normal sleep. In this respect, the effects are similar to insomnia with daytime fatigue, low energy and cravings for high sugar, high carbohydrate foods.
Increased blood pressure – With the sudden release of stress hormones, blood pressure rises, and with episodes ranging from 10 to over 30 per hour, your blood pressure never goes down. It even remains elevated during the day causing damage to the arteries and blood vessels in the heart.
Increase in blood ghrelin levels – Ghrelin is an appetite stimulant hormone secreted by the stomach. The increase associated with sleep apnea contributes to overeating/weight gain.
Lower leptin levels – Leptin is a hormone produced by adipose tissue (fat) that tells the brain when the body is satiated. Sleep apnea lowers this hormone. Combined with an increase in the appetite stimulant ghrelin, it’s no wonder people with sleep apnea tend to be overweight.
Sleep and Heart Health: Snoring
Similar to obstructive sleep apnea, snoring is caused by a partial blockage of the airways, either by the tongue, or excess tissues in the mouth, nose or throat.
While not as serious as sleep apnea, snoring also interrupts normal sleep patterns (as well as your partner’s)! Snoring can also be a warning sign of other more serious issues that you should take seriously.
Some of the health issues associated with snoring include:
- Dry mouth, nose or throat – Chronic snorers often wake up with dry mouth, nose or throat. This can lead to irritation in the throat (sore throat) as well as drying of the mucus membranes in the nose and mouth. When this happens you become more susceptible to infections, colds and flu.
- Day-time fatigue – Similar to sleep apnea, having your airways partially blocked means that you are struggling for air. This can prevent you from fully experiencing REM sleep (the deepest most restful sleep).
- Headache – When the airways are blocked, less oxygen is getting to the organs, with less oxygen, carbon dioxide builds up in the blood. This buildup of carbon dioxide can cause “morning headaches” that usually subside with time.
- Early sign of sleep apnea – While not everyone with sleep apnea snores, loud snoring along with gasping for air is a warning sign that you should not ignore. If you or your partner notice this, please talk to your doctor immediately.
- Emotional health – Don’t underestimate the effect snoring has on your emotional health. If your not getting restful sleep you’re more likely to be moody, irritable and even depressed. This is also true for your sleeping partner if your snoring interrupts their sleep.
Sleep and Heart Health: Tips, Treatments and Cures
As discussed earlier, we are just now beginning to understand the bidirectional nature of sleep and heart health. What we use to think caused sleep issues, obesity, heart disease and poor diet, may actually be the consequences of, not the symptoms of, sleep disturbances. So with that in mind, what can you do to treat or even cure your sleep issues?
Lose weight – Losing weight is one of the best things for your heart health and your health in general. And while some people with heart issues and sleep apnea may actually be “cured” by losing weight, even if you aren’t, both conditions can be improved by weight loss. Now I know that I just said that it may be that it’s actually the sleep disturbance that causes weight gain, so how should you address it?
Treat both conditions (sleep disturbance and obesity) using a two pronged approach. Because both issues feed off each other, it’s much easier, and you will get quicker results by treating both issues at the same time. Use anti-snoring/sleep apnea devices to get better sleep and reduce fatigue, and use diet and exercise to lose weight. When you’re not tired all the time and craving high sugar, high carbohydrate foods, it’s much easier to stick to a diet and exercise routine.
Lower your blood pressure – Known as the “silent killer” because you often times don’t have symptoms until something major happens. Lowering your blood pressure will reduce your risk of developing heart disease, congestive heart failure, stroke, kidney disease and more.
By treating your snoring or sleep apnea, you can prevent the release of the stress hormones that cause your blood pressure to go up. It’s important to do this early, as the damage done by high blood pressure can be permanent if not treated early. If you still have high blood pressure even after snoring/sleep apnea treatment, you may need medicine to control it. Talk to your doctor.
Congestive Heart Failure Patents – People with congestive heart failure often times have trouble sleeping. They can wake up short of breath and gasping for air. This is often times due to fluid that builds up in the lungs at night. It’s especially important for people with CHF to treat any snoring or sleep apnea symptoms.
The link between sleep and heart health is turning out to be more complex than we originally thought. The good news is that the better we understand this connection, the better we’ll get at treating both conditions. And by using treatment options that address both issues at the same time, we can see better results in a shorter time frame. If you have any questions, comments or concerns, we are more than happy to answer them below.
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