Waking Up to Facts: Sleep Is Critical to Heart Health

There has been an awakening in America to the role sleep plays in overall health, and particularly in heart health. Sleep is not something only lazy people do. It’s not a need we can overcome by sheer willpower. To live, we need to breathe, we need to eat — and we need to sleep.

Recently, the American Heart Association added sleep to its list of essential components for promoting good health. For Harneet Walia, M.D., medical director of sleep medicine at Baptist Health Miami Cardiac & Vascular Institute, the recognition was long overdue.

Harneet Walia, M.D., medical director of Sleep Medicine and Continuous Improvement at Baptist Health Miami Cardiac & Vascular Institute.

“Sleep has always been sort of under the radar — underrated,” Dr. Walia says. “Sleep and sleep disorders have been underrecognized and undertreated. But now we do see more awareness about sleep — an awakening so to speak — toward these disorders from both patients and providers.”

Backed by extensive research on the importance of getting a good night’s rest, Miami Cardiac & Vascular Institute has focused on sleep for several years. “We offer a unique setting where sleep health is embedded as part of a comprehensive and holistic cardiac program. We are one of the very few,” Dr. Walia says. “When you talk about health, especially heart health, you have to consider diet, exercise, cholesterol. By the same token, you have to consider sleep.”

During American Heart Month and throughout the year, Dr. Walia hopes people will take notice of their sleep and how it affects health and well-being.  “I do see progress being made, but more needs to be done.”

Why Sleep Matters

All tissues in the human body contain molecular clocks that coordinate our biological systems, influencing blood sugar, appetite, heart rates, body temperature, gene expression, cell division, energy expenditure and other processes. The workings of these internal clocks are not fully understood, but they are driven by complex cues from inside and outside our bodies. Most notably, they synchronize to light and darkness.

In the short term, getting inadequate sleep can affect mood and concentration. Some people are willing to deal with a little crankiness in order to squeeze a few additional hours of awake-time out of their day.

But lack of sleep over the long term has been associated with a wide range of detrimental consequences affecting cardiovascular health, blood pressure, obesity, diabetes, mental health and immune function.

Just because you are able to get by with limited sleep, it doesn’t mean you should.

“Sometimes people do not recognize the consequences of sleep deprivation because they kind of get used to it,” Dr. Walia says. “It can have far-reaching consequences.”

Understanding Sleep Deprivation

It’s no mystery why sleep deprivation and low-quality sleep increase the risk of heart disease and other problems. All the mechanisms are familiar — insulin resistance, inflammation, higher rates of oxidative damage, higher levels of stress hormones, messing up hunger signaling in the brain. “Certainly there’s a connection — a strong connection,” Dr. Walia says.

There are many things that can influence the quality and quantity of sleep you get, from your personal habits to certain medical conditions such as restless leg syndrome and obstructive sleep apnea. 

People with obstructive sleep apnea can experience pauses or decreases in their breathing many times per hour while they sleep. Each such episode, caused when your airway becomes obstructed or collapses, may last from a few seconds to a few minutes. This pattern may repeat all night without you noticing it — but your body knows.

The disrupted intake of oxygen signals your brain to wake you in order to resume breathing. “The body’s fight-or-flight response is activated,” Dr. Walia explains. “Blood pressure spikes, your heart rate fluctuates and this creates stress.”

Obstructive sleep apnea is a risk factor for numerous cardiovascular diseases, including irregular heartbeats, hypertension, stroke, atherosclerosis (hardening of the arteries) and coronary heart disease. The more severe the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attacks, heart failure and strokes, research shows.

Addressing the Problem

CPAP — continuous positive airway pressure — is the most-often recommended treatment for people who have obstructive sleep apnea.

Using a mask, the CPAP machine pumps air into the back of your throat to keep your airway open while you sleep. Studies show that when used consistently, it is very successful.

“CPAP use can be challenging for some people, but it is important to stick with it,” says Dr. Walia, who has led numerous clinical trials and research on sleep-disordered breathing. Your physician can help you try out different masks, adjust the pressure on your machine and seek solutions to various problems such as dry mouth or inflamed sinuses. “We can troubleshoot the problems and overcome some of those challenges.”

CPAP doesn’t work for everyone, however. Other coexisting conditions may suggest a different approach. That’s why it’s important to address the situation with your physician. “CPAP is the gold standard, but there are other treatment options. The goal is to find the righttherapy to correct your individual sleep breathing disorder.”

Other solutions include mouth appliances that position the jaw so the airway stays open, and the widely advertised Inspire nerve stimulator device that is surgically implanted and operated by a remote to deliver electrical pulses that keep your airway open.

In addition, Dr. Walia is participating in a multi-site clinical trial testing a new, noninvasive device that is worn as a collar during sleep. The device, AerSleep II, is not yet available to the general public in the United States.

Deemed promising in preliminary studies, the device applies negative pressure on the outside of the neck with a battery-powered vacuum pump that holds the airway open during sleep. “It doesn’t require an external power source or connecting tubing,” Dr. Walia notes. “And the pump is completely silent because it operates at frequencies above the range of human hearing.”

The AerSleep II is being tested on patients who have moderate to severe sleep apnea and who do not tolerate CPAP well.

What to Do

If you have concerns about your ability to fall asleep or stay asleep, or you suspect that you might have sleep apnea, talk to your primary care physician or seek the advice of a sleep specialist, Dr. Walia says. Your health depends on it.

Addressing sleep issues is important — and complex, she says. “Sleep is not only sleep duration; there are many different facets to sleep health including sleep quality, sleep efficiency, daytime consequences related to sleep, your habits around sleep, and how sleep affects your quality of life. All these factors should be a part of the conversation.”