Want a Healthy Heart? It Starts With Better Sleep

Poor sleep doesn’t just affect your mood and your ability to get through the day. It can also impact your health and exacerbate existing conditions, according to Harneet Walia, M.D., medical director of Sleep Medicine and Continuous Improvement at Miami Cardiac & Vascular Institute. Sleep is crucial to the function of the heart, brain and other organs, she says, and many people aren’t getting the quantity – or quality – of sleep their bodies need.

“Sleep couldn’t be more relevant to other organ systems, particularly our cardiovascular system,” says Dr. Walia, who is part of the Cardiology Group at Miami Cardiac & Vascular Institute, where sleep health is a major part of their focus. “When people talk about maintaining or improving heart health, most often the focus is on diet and exercise. However, the link between sleep health and heart health has been highlighted both in the clinic and in a growing volume of research.”

Insufficient sleep linked to cardiovascular disease

Studies have shown that only one-third of all Americans get an adequate amount of sleep daily, which according to Dr. Walia is between seven to nine hours daily, depending on the person.

Common sleep disorders such as insomnia, insufficient sleep and restless leg syndrome have been linked to cardiovascular disease, she says.

Obstructive sleep apnea also a risk factor

Another sleep disorder – one that affects millions of Americans of all ages – is obstructive sleep apnea, or OSA, which is caused by a temporary collapse of the airways in the throat while sleeping. Those frequent and extended pauses in breathing, which are sometimes followed by a gasping or choking sensation as you awaken suddenly struggling for air, deprive your body of the oxygen it needs and leave you feeling tired and irritable during normal waking hours.

“We can actually measure the various physiological changes that occur in patients with sleep disorders,” Dr. Walia explains. “They include hypoxia (decreased oxygen levels); hypercapnia (excessive carbon dioxide in the bloodstream); changes in intrathoracic pressure; increased systemic inflammation, and increased activation of the sympathetic nervous system – meaning your body’s engine is always in high alert mode, just as when you’re faced with a dangerous or stressful situation. All of these can make you more prone to negative changes in your heart health.”

Roughly 34 percent of middle-aged men and 17 percent of middle-aged women meet the criteria for OSA, according to the American Heart Association (AHA), and there is a clear link between OSA and cardiovascular disease, they say. In a special statement released earlier last year, the AHA said in no uncertain terms that OSA worsens heart disease. Specifically, the AHA noted that:

• Between 40 and 80 percent of people in the U.S. with cardiovascular disease also have OSA, yet it is underrecognized and undertreated in cardiovascular practice.
• Sleep apnea can cause a negative feedback loop whereby it worsens cardiovascular conditions, which then worsen the sleep apnea.
• OSA affects 30 to 50 percent of people with high blood pressure and is a risk factor for atrial fibrillation.
• OSA is also associated with Type 2 diabetes, worse outcomes from heart failure and even sudden cardiac death.

“This statement from the AHA offers the highest level evidence to date of the link between sleep health and heart health,” says Dr. Walia.

Therapy for obstructive sleep apnea

Aside from modifying lifestyle behaviors and weight loss, one of the most common and effective treatments for OSA has been Continuous Positive Airway Pressure (CPAP) therapy. Patients wear a comfortable, custom-fitted mask connected to a small machine by their bedside that gently pushes air into the airway to keep it propped open while they sleep.

CPAP therapy isn’t for everyone, however. “Some patients don’t tolerate it,” Dr. Walia acknowledges, and some studies have found that only half of the patients who’ve been prescribed CPAP therapy actually use their device.

A study now underway at Miami Cardiac & Vascular Institute and several other sites is testing the efficacy of Continuous Negative External Pressure (CNEP) in treating OSA. A tiny device that generates negative pressure “pulls” airway tissues, keeping 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.”

New sleep disorder tied to pandemic

Treating OSA is important for reasons beyond one’s heart health, according to Dr. Walia. “People with OSA are more likely to be hospitalized with COVID-19 and to experience long-haul symptoms,” she says. Unfortunately, she adds, the pandemic has made it even harder for many people to get the sleep they need.

“We’re seeing a number of patients present with what some experts call ‘coronasomnia,’ ‘Covid-somnia,’ or difficulty sleeping due to the physical and emotional affects of the coronavirus pandemic,” she says. “Many people are feeling stress as a result of the pandemic, which translates into poor sleep and other health issues, or they’re experiencing long-haul symptoms of COVID-19 that can include OSA, insomnia and other sleep disorders.”

Dr. Walia says that if someone is having difficulty sleeping on a regular basis, for any reason, or have symptoms of daytime sleepiness/fatigue impairing their functionality they should see their primary care physician or consult with a sleep medicine specialist. “They can help identify any underlying conditions that may be affecting your sleep and your overall health, and recommend appropriate testing and treatment.”