The Link Between Insomnia and Heart Failure Risk
Lee Surkin, MD, FACC, FCCP, FASNC
Lee A. Surkin, MD is triple board certified in sleep medicine, cardiovascular disease and nuclear cardiology and has over 22 years of practice experience. His undergraduate degree in biology was done at Brandeis University followed by a masters degree in human nutrition at Columbia University. He graduated with his MD from Hahnemann University in Philadelphia and did his internal medicine and cardiology training at Yale University. Dr. Surkin has been in private practice in eastern NC where he founded a cardiology practice followed by a sleep medicine practice followed by a medical weight loss practice and merged all into a multi-specialty group that places a strong emphasis on wellness and prevention. Dr. Surkin also founded a sleep medicine practice in NY where he sees patient utilizing telemedicine. Dr. Surkin was also one of the first sleep physicians in NC to offer home sleep apnea testing and has been on the cutting edge in offering new and innovative treatments across a broad spectrum of his areas of expertise. He is a national leader in advancing the recognition of the strong association between sleep disorders and cardiovascular disease and founder of the American Academy of Cardiovascular Sleep Medicine.
Did you know that insomnia can lead to heart health complications? Unfortunately, the truth is that this sleep disorder can increase the risk of heart disease, stroke, and heart failure, although it remains unclear whether insomnia causes these cardiovascular health issues or is merely linked with them. To learn more, continue reading below.
Insomnia is the most common sleep disorder affecting 10% to 15% of people worldwide characterized by difficulty falling, difficulty staying asleep, and/or waking up too early. A published study revealed that 44% of people with heart conditions experience insomnia frequently, also making it a common heart failure symptom (Bhaskar et al., 2016).
In addition, those who have all three insomnia symptoms, are at significantly higher risk, by more than three-fold, of heart failure. And, when it comes to the insomnia and heart failure connection, researchers came up with two theories: an underlying biological cause and the stress insomnia puts on the body takes a toll on heart health.
The Impact of Insomnia on Cardiovascular Health
Insomnia increases the risk of heart disease and stroke in people who suffer from these conditions (all considered precursors to heart failure):
- Hypertension (high blood pressure) – Blood pressure typically decreases approximately 10-20% during sleep (nocturnal dipping). So, if you cannot sleep, your blood pressure remains higher for longer than usual.
- Diabetes (Type 2) – This chronic disease impacts how glucose (sugar) is metabolized. As a result, blood vessels get damaged.
- Obesity – Weight gain is closely connected to lack of total and quality sleep since it affects the part of the brain responsible for controlling hunger and satiety.
Common Sleep Disorders in Heart Patients
There are several sleep disorders common in heart patients that negatively affect sleep and can aggravate existing insomnia and sleep deprivation. These include:
Obstructive Sleep Apnea
Up to 50% of heart failure patients suffer from obstructive sleep apnea, a sleep disorder characterized by breathing interruptions during sleep (Khattak et al., 2018). This condition can result in many sudden arousals per night, leading to chronic sleep deprivation. Sleep apnea typically worsens heart failure and worsened heart failure worsens sleep apnea. Therefore, it’s a vicious cycle. Treating sleep apnea has proven to improve sleep, quality of life, mood, blood pressure, cardiac ejection fraction, irregular heartbeats, and vascular parameters.
Nocturnal Movement Disorders
When compared to the general population, heart failure patients are at a higher risk of developing two types of nocturnal movement disorders that negatively affect sleep. These include:
- Restless Legs Syndrome (RLS) – This sleep disorder is characterized by an urge to move the legs that usually occurs in the evenings typically described as a burning, twitching, and/or “creepy crawling” sensation which can be relieved by moving the legs. As a consequence, these movements make falling asleep difficult.
- Periodic Limb Movements of Sleep (PLMS) – Similar to RLS, this disorder is also characterized by involuntary leg movements. However, it is different from RLS because these movements occur during sleep so the person may not even know they have the disorder. Still, it can disrupt sleep and lead to sleep deprivation. Statistically, 80% of individuals with RLS also have PLMS.
Final Thoughts
References
Khattak, H. K., Hayat, F., Pamboukian, S. V., Hahn, H. S., Schwartz, B. P., & Stein, P. K. (2018, June 1). Obstructive sleep apnea in heart failure: Review of prevalence, treatment with continuous positive airway pressure, and prognosis. Texas Heart Institute journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059510/#:~:text=The%20results%20of%20several%20studies,conditions
