When patients come to me with a complaint of insomnia, their biggest issue is that they feel fatigued, on edge, moody or unwell. Those complaints are worrisome quality-of-life-issues; however, I know that persistent insomnia can have other serious health consequences. Chronic insomnia is associated with an increased risk of hypertension, diabetes, obesity, anxiety, depressed mood and an increased use of alcohol. Research published in the European Journal of Preventive Cardiology suggests a link between insomnia and heart attack and stroke risk.
The American Sleep Association estimates that 50-70 million adults in the U.S. have insomnia. When it comes to sleep deprivation statistics, 37 percent of 20-39 year olds report short sleep duration, and 40 percent of 40-59 year olds report short sleep duration. Some medical conditions can cause insomnia: chronic obstructive pulmonary disease (COPD), gastro-esophageal regurgitation disease (GERD), and congestive heart failure. Drugs including ACE inhibitors, beta blockers and SSRIs can also interfere with sleep.
Heart disease is the number one killer of men and women, accounting for more than 800,000 deaths yearly in the U.S. About 2,200 Americans die of heart disease each day, an average of one death every 40 seconds. The American Heart Association estimates that 92.1 million American adults currently live with some type of heart disease or the after-effects of stroke. A link between these two conditions – insomnia and heart disease – is alarming, given these current statistics.
In 2006 The National Academies of Sciences Engineering Medicine released Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, a book that explored the many aspects of sleep disorders and the health implications that chronic sleep deprivation causes. Cardiovascular diseases including hypertension made the list of worrisome health outcomes. This latest March 2017 meta-analysis of previous studies aimed to see if there were clear links and associations between insomnia symptoms (including difficulty initiating sleep, staying asleep, early morning awakening, or poor quality sleep) and the risk of cardio-cerebral vascular events, namely heart attack or stroke.
The researchers looked at 15 studies, involving a total of 160,867 subjects. The studies had examined a link between insomnia and incidence of death from acute heart attack, coronary heart disease, heart failure, stroke or a combination of events. The studies included follow-ups that ranged from three to almost 30 years. Among the subjects there were 11,702 “adverse health events.” The researchers found compelling links between insomnia due to difficulty initiating sleep, difficulty maintaining sleep or poor quality sleep and a higher risk of heart events and stroke. Insomnia due to early morning awakenings did not show similar strong links.
The researchers postulate that individuals who suffer with chronic insomnia may experience metabolic changes that impact endocrine function. The net effect may be increased sympathetic nerve activation which results in elevated blood pressure. The researchers also posited that insomnia can increase levels of pro-inflammatory and inflammatory cytokines. Elevated levels of inflammation are associated with heart disease and stroke risk.
The researchers noted that women seemed to have higher levels of heart events and strokes compared to men, especially if they experienced non-restorative sleep, though the difference was not statistically significant. Still, the researchers suggest that insomnia may be more risky for women. It’s also established that women tend to suffer more from insomnia due to differences in genetics, sex hormone levels, stress and their reaction to stress. Perimenopause and menopause are typically times when insomnia rates are elevated.
As a sleep expert, I routinely ask my patients about their sleep habits and sleep complaints, knowing how common sleep disturbances are in the general population and because I know the negative health outcomes linked to persistent insomnia. This study suggests how important it is for all clinicians, especially general practitioners who regularly see patients, to ask patients about their sleep habits. It also suggests how crucial deep, restorative sleep is to ones’ health. If you already have family history or other risk factors for serious heart disease or a stroke, you should seek help from a sleep specialist if you struggle with insomnia. As a patient, you can proactively bring up the subject of “sleep difficulties” if your healthcare practitioner doesn’t.
Many of us suffer from insomnia because of common daily practices that interfere with getting a good night’s sleep. A quick reminder of tips to help you sleep better:
- Keep a sleep journal so you track any issues that may be contributing to insomnia.
- Go to sleep at the same time every night and wake up at the same time daily.
- Use the bed only for sleep and intimate activities.
- Keep the room cool and dark.
- Disconnect from all tech devices and TV/electronics at least 90 minutes before bedtime.
- Avoid caffeine after 2 PM.
- Don’t eat or exercise close to bedtime.
- Relax and unwind before going to bed; deep breathing, soft music, a warm shower, reading in a comfortable chair can all help
- Try using some of the newer sleep apps to track and improve your sleep habits.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.