1. Sleep Apnea
There are two main types of sleep apnea: Obstructive sleep apnea (OSA) — the most common type — occurs when muscles in the back of the throat collapse too much during sleep, partially or completely blocking the airway. In central sleep apnea (CSA), the brain doesn’t send the necessary message to the muscles that control breathing. Both OSA and CSA interrupt nighttime breathing and contribute to daytime fatigue.
“Both conditions can result in a periodic drop in blood oxygen levels, which increase the adrenaline levels in the body and result in awakening,” says Rami Khayat, MD, a pulmonologist and sleep medicine expert with UCI Health in Orange, California, who works with cardiac patients. “And all these activities are detrimental to heart failure control.”
Get screened for sleep apnea. Since sleep apnea is so common among people with heart failure, screening for OSA is a good place to start. “Whenever one of my patients has heart failure, I always send them for a sleep evaluation, but it’s low-hanging fruit to improve heart failure by checking for sleep apnea,” Dr. Freeman says.
In cases of OSA, a continuous positive airway pressure (CPAP) machine or other treatment may be prescribed. “In some of the patients who have this [CPAP] treatment, we see improvement of the ejection fraction, which is the pumping function of the heart, and there’s even some data to support that arrhythmias may be decreased by this intervention as well,” says David Markham, MD, an associate professor of medicine at Emory University in Atlanta and an expert in advanced heart failure and transplant cardiology.
Over time, use of eXciteOSA can reduce snoring and other symptoms of mild OSA by preventing your tongue from collapsing backward and blocking your airway during sleep. You’ll wear the device for 20 minutes once a day (while you’re awake) for six weeks, then once a week after that.
Change your sleep position. If you have sleep apnea, side sleeping can also be beneficial for those who don’t tolerate CPAP, says Dr. Khayat. “In heart failure patients, lateral sleep positions — on the side, left or right — can often decrease sleep apnea.”
It’s controversial whether the left or right side is best, says Khayat. If you have an implanted defibrillator, sleep on the opposite side. Most defibrillators are implanted on the left side, so sleeping on the right side may feel more comfortable.
“If they don’t have an implant, sometimes the left side is more comfortable because, just like in pregnancy, it relieves the pressure off the inferior vena cava (IVC), the body’s largest vein, which is on the right,” says Khayat.
2. Insomnia
“If you have a chronic condition, often there’s a degree of concern or anxiety. Sometimes there’s concern over hospitalizations and medication schedules. Or there’s decreased activity. All of these things affect your ability to maintain sleep,” says Khayat.
Change the timing of your medication. If you’re taking diuretic medication and waking up frequently during the night to use the bathroom, the diuretic may be the cause. “Something most people don’t realize is that diuretics can last in the body for six hours,” Freeman says. “If you take it after 4 p.m. and go to bed at around 10 p.m., you’ll be up peeing all night.”
To increase your chances of getting the recommended seven hours of quality sleep, try taking your diuretic earlier in the day.
Seek help for depression and anxiety. If you feel depressed or anxious most of the day, nearly every day, for two consecutive weeks, tell your doctor. Medications are available for depression and anxiety disorders in people with heart failure, which may, in turn, help improve your sleep.
