Sleep Struggles After Heart Surgery, Solved
Heart surgery can save—and improve—your life. The most common procedure, coronary artery bypass, restores your blood flow to normal, which in turn relieves chest pain, known as angina, and protects you against heart attacks. Once your heart can adequately pump oxygen-rich blood again, you’ll have more energy to get active. But there’s a common catch that can undermine how you feel: sleep problems. About 50% of people who have heart surgery struggle to get a good night’s sleep in the weeks, and sometimes months, following the procedure. Rest easy—there’s plenty you can do.
Why do people have trouble sleeping after heart surgery?
In the short term, while you’re still in the hospital, you’ll be dealing with physical discomfort and pain as you heal, as well as the after-effects of anesthesia, all of which can throw off your sleep schedule, says Lawrence Chan, M.D., a sleep medicine physician at The Ohio State University Wexner Medical Center in Columbus. Interruptions due to noises, light, and the care you receive in the I.C.U. also make it harder to sleep soundly.
Do you sleep better once you return home?
You’re finally out of the hospital and in your own home, your own bed. All good, right? Not necessarily. Sleep disturbances can continue while you're on the mend. For example, if you’re used to sleeping on your stomach or your side, you may struggle to sleep on your back and in a more upright position, a requirement to protect your sutures. Other issues: Lingering pain from the surgery as well as changes to your daily routine can also make it tougher to drift off at night.
Can worrying about your heart actually keep you awake?
Your emotions can make sleep difficult, too, says Guy Mintz, M.D., director of Cardiovascular Health & Lipidology at Sandra Atlas Bass Heart Hospital in Manhasset, NY. “You can have a large degree of anxiety after heart surgery,” says Dr. Mintz. “Common worries: ‘Am I going to have a heart attack? Is my heart very fragile?’” Such thoughts can intrude on your sleep, and your anxiety may make you prone to acid reflux, another enemy of sleep, he adds. Acid reflux causes heartburn and can be worse when lying down, according to the Cleveland Clinic.
Can sleep apnea cause post-surgery problems?
Dr. Chan says it’s critical to identify and treat underlying sleep problems. A common one? Obstructive sleep apnea (OSA), which interrupts your breathing for brief spells throughout the night. It also harms the heart. In fact, a JAMA study found that severe OSA increased the risk of heart attack, stroke, and other cardiac complications in the month following major non-cardiac surgery. Treating it effectively, therefore, may not only improve your sleep, it just may protect your heart health, too. “I recommend ongoing treatment of OSA before and after heart surgery,” says Dr. Chan.
What kind of techniques work to improve post-op sleep?
You have a lot of options, and that’s a good thing. As Dr. Mintz points out, everyone’s different, and what may work for someone else may not work for you. Still, researchers have found that a few methods consistently rise to the top: relaxation techniques like massage; education on how to reduce anxiety and truly relax; and the use of certain devices, like earplugs, sleep masks, and white noise machines, all tools Dr. Mintz agrees can be helpful.
Can regular exercise after heart surgery help, too?
In July 2020, researchers reported that a 30- to 45-minute walk helped heart surgery patients sleep better that night. Dr. Mintz sees the benefits of walking among his post-surgery patients. The exercise is good not only for their heart but also for their anxiety. “Walking shows you that your heart’s not as delicate as you thought it was, and that’s a relief.” But ease into it, and build up your stamina slowly. Consider walking around the house twice a day at first, Dr. Mintz advises. Then venture around the block and, eventually, further afield.
Should you join a cardiac-rehabilitation program?
If your insurance covers cardiac rehab, sign yourself up. Not only will you get an individualized exercise program that could help you sleep better, you’ll also find camaraderie among others in the program. This helps you feel less alone and goes a long way towards reducing anxiety, which in turn improves sleep, say Dr. Mintz. (Bonus: Recent research suggests that cardiac rehab can ease the severity of sleep apnea, too.) However, he adds, many cardiac rehab programs have been suspended during the pandemic, so it may be difficult to find one until it’s fully under control.
Are there things you should avoid to protect your sleep?
Does your regular, pre-surgery routine include a cup or two of java each day? Indulging post-op may disturb your sleep, says Dr. Mintz. “Be cognizant that caffeine should be avoided in the first week or so after surgery.” During this healing time, skip coffee, tea, chocolate and caffeinated sodas, too. The same goes for naps. Falling asleep in the daytime messes with your body’s sleep schedule, and you may find yourself wide awake at bedtime. Rest for short spells when you need to, but be sure not to drift off for long, and never past mid-afternoon.
Can you stress yourself out of restorative ZZZs?
You couldn’t sleep one night. Then, you worry about whether you’ll sleep the next night—which keep you up again. “You develop anxiety over your inability to sleep,” says Dr. Mintz. Break that cycle with relaxation techniques like meditation, cognitive behavioral therapy (CBT), guided imagery, and/or deep breathing, all of which help curb the production of stress hormones like cortisol and adrenaline. The result: a calmer mind and body. You may have to experiment to see which techniques benefit you the most, and you may require a little practice, so you may not get immediate results. Don’t give up!
How can you prepare for the best possible night's sleep?
Make your bedroom a slumber sanctuary with these tips (if you've heard them before it's because they work)! Wear a sleep mask to block out excess light, and use earplugs to dull ambient noises that can keep you awake. Set your thermostat to 65 degrees Fahrenheit. Hit the hay at the same time each night to train your body when to expect sleep. Turn off blue-lit screens a few hours before bedtime such as your computer or cell phone. And if you don’t drift off within 20 minutes, try reading or getting out of bed and stretching for a spell. Then try again!
When should you alert your doctor about poor sleep?
Lost sleep takes a toll, both on your quality of life and your heart health. If insomnia continues to be an issue three to four weeks after your surgery, talk to your doctor. But don’t wait even that long if you feel like your sleeplessness is having a significant impact on your daily life, says Dr. Chan. “It makes sense to check in with your primary care provider,” he says, who may recommend you see a sleep specialist to protect your heart’s recovery process. Sweet dreams!
- Heart Surgery: National Heart, Lung, and Blood Institute. (n.d.). “Heart Surgery.” nhlbi.nih.gov/health-topics/heart-surgery
- Sleep After Heart Surgery (1): Revista Latino-Americana de Enfermagem. (2017). “Non-pharmacological interventions to promote the sleep of patients after cardiac surgery: a systematic review.” ncbi.nlm.nih.gov/pmc/articles/PMC5599071
- Sleep After Heart Surgery (2): National Sleep Foundation. (n.d.). “2 Ways Surgery Impacts Your Sleep.” sleep.org/3-ways-surgery-impacts-your-sleep
- Sleep Apnea and Surgery: The Journal of the American Medical Association. (2019). “Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery.” jamanetwork.com/journals/jama/article-abstract/2733209
- Sleep Apnea and Cardiac Rehab: Journal of Clinical Sleep Medicine. (2018). “Obstructive Sleep Apnea in Cardiac Rehabilitation Patients.” ncbi.nlm.nih.gov/pmc/articles/PMC6040801/
- Sleep and Stress: National Sleep Foundation. (2020). “Stress and Insomnia.” sleepfoundation.org/articles/stress-and-insomnia
- Sleep Hygiene: National Sleep Foundation. (2020). “Sleep Hygiene.” sleepfoundation.org/articles/sleep-hygiene