When most people think of risk factors for heart disease and poor cardiovascular health, sleep doesn’t enter the picture. But mounting evidence shows that disruptions to daily sleep durations have a measurable effect on heart health.

Sleep Disorders are Cardiovascular Disorders

“I consider sleep disorders as cardiovascular disorders,” said Jonathan Fialkow, M.D., a preventive cardiologist with an interest in Sleep Medicine. This profound perspective on sleep is not all that surprising considering Dr. Fialkow is also a certified lipidologist by the American Board of Clinical Lipidology and serves as the medical director of the Chest Pain Center, Cardiac Rehabilitation and the Stress Lab at Miami Cardiac & Vascular Institute at Baptist Hospital.

“Sleep is a major, unrecognized factor in heart health and heart disease,” he said. “Getting the proper amount of uninterrupted sleep each day is just as important to heart health as is good nutrition and exercise.”

Sleep Duration and Cardiovascular Risk

Science supports what Dr. Fialkow believes. The Sleep Heart Health Study, published in 2006, found that sleep duration outside of the recommended 7 to 8 hours a day for adults is associated with an increased prevalence of high blood pressure, or hypertension. Subsequent observational studies, Dr. Fialkow says, show a correlation between sleep disturbances and common markers for cardiovascular risk, such as inflammation, elevated cholesterol levels and insulin resistance. These processes are known contributors to coronary artery disease, heart attack, stroke, diabetes and obesity.

“We’re not ready to say that sleep shortfalls cause cardiovascular disease,” he said. “But there’s no question that these markers of cardiovascular disease are present in people with known sleep disorders, like obstructive sleep apnea.” What science has yet to prove is whether sleep disturbances cause these elevated markers of cardiovascular disease or whether people with increased cardiovascular disease markers have disturbed sleep patterns.

In the meantime, the American Heart Association issued a scientific statement in 2016 that noted how short- and long-duration sleep and sleep disorders, such as sleep apnea and insomnia, are associated with “adverse cardiometabolic risk profiles and outcomes.” The statement also suggested that treatment of those disorders may provide clinical benefits, especially for high blood pressure.

Improving Heart Health With Sleep Treatment

Studies are currently underway to determine if by treating sleep disorders, doctors see a decrease in these cardiovascular risk factors. Dr. Fialkow predicts that the results of these studies could change the way sleep is viewed by cardiologists and the entire medical community.

“If studies underway show a significant decrease in cardiovascular risk when sleep apnea and insomnia are treated, sleep becomes an even more important lifestyle factor that we can address when trying to curb someone’s risk of developing cardiovascular disease,” he said.

Dr. Fialkow already assesses his patients’ sleep habits, including whether they have trouble falling asleep or staying asleep, whether they snore, whether their sleep is interrupted by frequent bathroom breaks, and whether they wake up feeling rested. If no clear signs point to a true sleep disorder, but the patient complains of often feeling tired, he recommends lifestyle changes to offer relief. These include:

• Maintaining a consistent bedtime and wake-up time daily.
• Reducing exposure to light, especially the blue light of electronics, at least one hour before bedtime.
• Keeping a cool, dark sleep environment.
• Avoiding caffeine and alcohol.

If Dr. Fialkow suspects sleep apnea, insomnia or another sleep disorder may be interrupting the recommended sleep duration of 7 to 8 hours, he advises that the patient undergo a sleep study, followed by the proper treatment. He doesn’t usually prescribe medications that induce sleep, because there’s growing evidence that these may not fully replicate the physiological process of sleep and how it helps the body reset for the next day.

The Sleep-Heart Health Connection

“There’s still so much that we don’t know about sleep’s benefit to our health, but science is starting to reveal that the lack of good sleep we’re seeing in modern society negatively impacts our overall health,” Dr. Fialkow said. “If we can prevent cardiovascular disease by paying closer attention to our sleep, I know many people, including me, who will sleep much better at night.”