Known culprits include sleep apnea, orthopnea, and periodic limb movement disorder.
“If you wake up feeling not refreshed or you have daytime sleepiness or if you need to curtail your daytime activity because of lack of energy, these could be signs that there’s something going on during sleep,” says Rami Khayat, MD, a pulmonologist and sleep medicine expert at The Ohio State University Wexler Medical Center, who works predominantly with cardiac patients.
Find out more about each type of sleep disturbance that can be associated with heart failure and what to do about it so you can get a good night’s sleep.
1. Sleep Apnea
Sleep apnea is present in up to 70 percent of heart failure patients, says Dr. Khayat.
There are two types of sleep apnea: obstructive sleep apnea (OSA), the most common type where the muscles in the back of the throat collapse too much during sleep, partially or completely blocking the airway. Less common central sleep apnea (CSA) tends to affect those with more severe cases of heart failure, and men in particular, says Khayat. “In some heart failure cases, you can have one or the other, or both,” says David Markham, MD, associate professor of medicine at Emory University and an expert in advanced heart failure and transplant cardiology. Both OSA and CSA interrupt nighttime breathing and contribute to daytime fatigue.
“Both conditions can result in a periodic drop in blood oxygen levels, which increase the adrenaline levels in the body and result in awakening,” says Khayat. “And all of these activities are detrimental to heart failure control.”
Many people with heart failure also experience orthopnea, a feeling of breathlessness while lying down, or paroxysmal nocturnal dyspnea, shortness of breath that wakes them up after one or two hours of sleep, says Dr. Markham. “These are related to ventricular pressure and volume overload,” he says. Both conditions improve upon sitting or standing.
3. Periodic limb movement disorder (PLMD)
In PLMD, increased nerve traffic in the legs and arms causes them to twitch involuntarily while you sleep, which may awaken you, says Khayat. “A person wouldn’t remember these twitches because they are very brief episodes. But they can disrupt sleep and you can wake up feeling not refreshed or just tired.”
Insomnia, which often goes hand in hand with chronic conditions, may also be to blame. “If you have a chronic condition, often there’s a degree of concern or anxiety. Sometimes there’s concern over hospitalizations, medication schedules. Or there’s decreased activity. All of these things affect your ability to maintain sleep,” says Khayat.
Better Sleep Positioning
According to Markham, most people with heart failure figure out their best sleep position through trial and error. Here are 5 things to try if you have heart failure and are struggling to get a good night’s sleep.
1. Get screened for sleep apnea. In cases of OSA, a continuous positive airway pressure (CPAP) machine or other treatment may be prescribed. “In some of the patients who have this (CPAP) treatment, we see improvement of the ejection fraction, which is the pumping function of the heart, and there’s even some data to support that arrhythmias may be decreased by this intervention as well,” says Markham.
2. Sleep on your side. If you have sleep apnea, side sleeping can be beneficial for those who don’t tolerate CPAP, says Khayat. “In heart failure patients, lateral sleep positions on the side, left or right, can often decrease sleep apnea.”
A bit of controversy surrounds whether the left or right side is best, says Khayat. If you have an implanted defibrillator, sleep on the opposite side. Most defibrillators are implanted on the left side, so sleeping on the right side may feel more comfortable.
“If they don’t have an implant, sometimes the left side is more comfortable because, just like in pregnancy, it relieves the pressure off the IVC, the body’s largest vein, which is on the right,” says Khayat.
3. Elevate the head of your bed. “Some people need more pillows or need to elevate the head of the bed just in order to sleep,” says Markham. Sleeping on an incline can reduce the anatomical and volume overload of lung congestion, including orthopnea and paroxysmal nocturnal dyspnea.
4. Elevate your feet. If you have edema in your legs or feet, you may find it comfortable to put pillows under your legs to reduce the swelling, says Markham. Wearing compression socks at night may also help.
5. Avoid sleeping flat on your back, unless you have a CPAP machine. “Once the patient gets on CPAP, they can sleep in any position they want because the machine prevents sleep apnea,” says Khayat.
Regardless of sleep position, if you want to get a better night's sleep with heart failure or any chronic condition, the main focus should be on good sleep hygiene, says Khayat. He recommends maintaining a regular sleep and wake time, avoiding alcohol and caffeine before bedtime — both of which can disrupt sleep — and staying off electronic devices several hours prior to sleep, which can make it more difficult to fall asleep.
If your doctor okays it, Khayat also suggests those with heart failure get daily brisk exercise. “A cardiovascular routine that lasts 20 or 30 minutes about four to five hours before bedtime helps in improving their sleep consolidation, their ability to generate sleep and to stay asleep,” he says.
BETTER HEALTH & BEYOND Editorial Team
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