Sleep and CVD: A Complicated Rest
There has been a long history of studying the benefits that adequate sleep has on one’s general well-being, but what does that mean for one’s cardiovascular health? This has been a question that has been studied for decades. While the results consistently point to the benefits of sleep on both one’s general and cardiovascular health, determining a specific cause-and-effect relationship becomes more complicated, as cardiovascular disease (CVD) is so common and exists on a spectrum. However, there is an impact and some aspects of sleep health that one should be aware of if they have or are concerned about CVD.
Please grab a cup of tea and a pillow as we delve into this question.
The benefits of adequate sleep are widely documented in terms of its impact on general health. The article Get Enough Sleep by the Office of Disease Prevention and Health Promotion lists how in general, people who sleep enough “get sick less often, stay at a healthy weight, lower your risk for serious health problems, like diabetes and heart disease, reduce stress, improve your mood, and get along better with people, think more clearly, form long-term memories, and do better in school and at work and make good decisions and avoid injuries — for example, drowsy drivers cause thousands of car accidents every year” (Office of Disease Prevention and Health Promotion, 2024). So, there are general benefits to one’s overall health that should be considered. However, what actually counts as “enough sleep?”
The article continues, noting how “most adults need 7 or more hours of sleep each night” (Office of Disease Prevention and Health Promotion, 2024). However, to account for those who experience congenital heart disease (CHD), other age groups also must be addressed, as CVD can appear even congenitally. In cases like this, the heart issues last for the entire life of the individual. For example, “teens (age 13 to 17 years) need to sleep between 8 and 10 hours each night” (Office of Disease Prevention and Health Promotion, 2024). While “school-aged children (age 6 to 12 years) need to sleep between 9 and 12 hours each night” (Office of Disease Prevention and Health Promotion, 2024). Even younger, “preschoolers (age 3 to 5 years) need to sleep between 10 and 13 hours a day, including naps. Toddlers (age 1 to 2 years) need to sleep between 11 and 14 hours a day, including naps. Babies (age 4 to 12 months) need to sleep between 12 and 16 hours a day, including naps” (Office of Disease Prevention and Health Promotion, 2024), and even “newborns (age 0 to 3 months) need to sleep between 14 and 17 hours a day” (Office of Disease Prevention and Health Promotion, 2024). Therefore, sleep is not only crucial for maintaining one’s health as an adult, but also in the development of children. However, another factor that needs to be addressed is how well one keeps to a sleep schedule and sleeps through the allotted time period. While this is ideal, it is not always possible; however, the benefits are worth noting.
A lack of adequate, unbroken rest can increase the risk of developing heart disease. As the article, , Sleep Disturbances and Their Relationship to Cardiovascular Disease by Stuart F. Quan, MD, discusses, how “there is now increasing evidence that reductions and increases in sleep duration, as well as various sleep disorders, including obstructive sleep apnea and insomnia, may be causal factors in the development of cardiovascular disease” (Quan, 2009). However, he also points out that sleep disturbances can be a matter of a chicken-or-the-egg situation, as they can cause CVD, but CVD can also cause sleep disturbances. For example, “CVD may be a causal factor in producing these sleep disturbances (ie, reverse causality). For example, it has been demonstrated that insomnia symptoms are more prevalent in patients with congestive heart failure. Moreover, incident insomnia has been shown to occur more frequently in those with several other chronic medical conditions. Thus, it is likely that for some persons, sleep disturbances are exacerbated or caused by comorbid medical conditions” (Quan, 2009). Considering this aspect, he concludes that, “There is substantial evidence linking abnormalities in sleep duration and several sleep disorders with CVD.” He continues, noting in more detail that, “recent data indicate that this condition may be an important risk factor for the development of hypertension, CVD, and subsequent earlier mortality. For other conditions such as insomnia and restless legs syndrome, strong associations are present. Still, verification that they are primary risk factors can be determined only in longitudinal cohort studies” (Quan, 2009). However, “whether or not they are primary risk factors for CVD, it also is likely that sleep disturbances occur more commonly in those with some types of CVD” (Quan, 2009). Therefore, if you have CVD, you are more likely to have sleep disturbances as well. But why?
Symptomatically, aspects of heart disease, like high blood pressure and a weakening of the physical organ, can impact one’s ability to breathe correctly and to function as needed. This is addressed in the article, Do Your Heart a Favor - Get More Sleep published by JohnsHopkinsMedicine.org. The article states that people who have the physical symptoms of heart disease, such as, “high blood pressure, coronary artery disease, heart failure or a history of stroke, tend to sleep more poorly, especially due to sleep apnea, a condition in which an airway temporarily collapses repeatedly during sleep, depriving the body of oxygen” (www.hopkinsmedicine.org, n.d.). This means that the physical symptoms and medical problems connected to them can impact whether and for how long one can stay asleep.
While this is true, and the symptoms cause the sleep deprivation, that is not the complete story. As mentioned before with the “chicken-or-the-egg” situation, if one looks more closely at the symptoms, it evolves into a cyclical system of cause and effect regarding sleep deprivation and CVD symptoms. For example, cardiac symptoms can lead to sleep deprivation, which in turn can cause additional symptoms to emerge or worsen. For example, the article "Sleep Plays An Important Role In Heart Health" by the American Heart Association provides further detail. Especially how “poor sleep can cause major cardiovascular disease risk factors, including obesity, high blood pressure, and diabetes. Insufficient or irregular sleep can negatively influence diet, stress, and other lifestyle factors that can raise the risk of cardiovascular disease. Excessive daytime sleepiness, which is a symptom of many sleep disorders, including hypersomnia, can lead to a greater risk of cardiovascular disease. Sleep deprivation and sleep disorders have also been linked to increased inflammation in your body, which can also elevate your risk of cardiovascular issues. Poor sleep and sleep disorders can cause depression and other mental health issues, which can hurt your heart health” (American Heart Association, 2023). So, in summary, the physical symptoms cause poor sleep, for physical reasons, but can also impact other factors like weight and mental health, leading to the development of other conditions like obesity and depression, which are both documented to simultaneously be causes and results of CVD.
As the article mentioned, emotional and psychological factors also play a role in sleep deprivation and CVD. The article, The Relationships Between Coping Mechanisms, Depression, Anxiety, and Sleep Disorders in Cardiovascular Patients by Andreea Mustață, centers on this connection between emotions and sleep problems in addition to physical symptoms. She discusses how “the link between emotional disorders, such as depression and anxiety, and cardiovascular disorders is well known, as depression is a risk factor in patients with coronary heart disease in terms of mortality, comorbidities, decreased quality of life, early retirement, reduced treatment compliance and anxiety is also correlated with cardiovascular risk” (Mustață, 2021). It should also be noted that, “emotional disorders are related to cardiovascular risk through inflammatory processes, but also through disorders of the HPA axis and of the autonomic nervous system” (Mustață, 2021), and, therefore impact one’s heart health in two separate ways. “Thus, there is strong evidence to support the importance of psychological factors in cardio-metabolic processes, biological, psychological and cognitive responses to chronic stress playing an important role in cardiovascular disease and they can act both as a trigger and as an independent factor influencing cardiac rehabilitation outcomes" (Mustață, 2021). Also, “regarding sleep disorders, in a large longitudinal study, insomnia is an independent risk factor for cardiovascular diseases, such as ischemic heart disease or ischemic stroke” (Mustață, 2021). Additionally, stress can be a key factor that connects all of these pieces. As I discussed in previous articles, stress, depression, and anxiety are all connected to cardiovascular health. As this article points out, the presence or a lack of these factors influences the level of ease with which one can drift off and stay asleep to achieve the prescribed number of necessary hours. The more stress, depression, and anxiety are managed, regardless of how severe the CVD symptoms, the more likely the individual is to reap the general benefits of a good night’s rest.
Another factor that can impact one’s ability to sleep if they have CVD, which is somewhat more uncommon, is whether or not they have mechanical devices such as pacemakers and/or mechanical heart valves. The mere presence of these devices often creates stress.
Furthermore, knowing that there are foreign objects inside you, which keep you alive, and even hearing them with each “tick” of your heart (as mechanical heart valves do) can be unsettling. This adds another layer of physical and psychological stress to the heart and mind that can impact one’s ability to fall and stay asleep.
Personally, I have critical congenital heart disease and have experienced difficulty sleeping for as long as I can remember. I had four open-heart surgeries before the age of 7, along with countless procedures, three pacemakers, and two mechanical heart valves. So… my inability to sleep soundly due to physical and psychological factors that have impacted me over the past three decades is understandable.
This has been especially obvious since I was seven, when I received my mechanical heart valves. These devices have been well documented to potentially negatively impact one’s mental health. However, while I know the mechanical heart valves are a contributing factor, I attribute my sleep problems to a slew of other heart-related issues as well. For example, the anxiety due to hearing the ticking and the stress of having a critical heart disease itself is nerve-wracking, but also on top of it, knowing that the stress of the condition is also putting you at risk of making it worse by not getting enough sleep is a cycle that can lead to only aggravating the issue.
However, when I was growing up, it was assumed that I was being obstinate if I could not sleep. As if lying awake and staring at the ceiling was the equivalent of my refusing to go to bed. Unfortunately, I was unable to sleep due to the incessant sound coming from my chest that echoed in my ears, and I still find it challenging to do so.
However, over the years, I realized that symptoms of CVD have made me a night owl. I accepted and embraced it, as I get my best work done at night. As a result, I try to schedule my work so that I can sleep in the following day, if possible. I also have a few other ways of managing my sleep to try to get 7+ hours, even if it is difficult to do so due to aspects of my CVD.
While I adapted, this does not mean that I don’t need and/or could not benefit from a full night’s sleep, though. The relationship between the heart and adequate sleep has been undeniably proven. On the opposite end, the relationship between poor sleep and poor heart health has also been extensively studied. However, if you have CVD, attaining the required amount of sleep can be difficult for a growing list of potential reasons.
The degree to which this is a problem shifts from person to person depending on their age, gender, and medical history. Therefore, while there is a trend of people with CVD not getting enough sleep, this does not necessarily mean that this should be used as an excuse for the behavior, as it can potentially only worsen it. The benefits to one’s heart and overall health outweigh the drawbacks of letting the symptoms prevail. So, while it is difficult, it is worth the effort to try to achieve those 7+ hours of sleep if you have CVD. Your heart and health will thank you for it.
This is why my next article will focus on how to get more sleep if you have CVD.
Tune in next Sunday for more!
Sweet Dreams!
Keep ticking, everybody!
Reference List:
American Heart Association (2023). Sleep Plays An Important Role In Heart Health. [online] www.heart.org. Available at: https://www.heart.org/en/health-topics/sleep-disorders/sleep-and-heart-health.
Mustață, A. (2021). The Relationships Between Coping Mechanisms, Depression, Anxiety, and Sleep Disorders In Cardiovascular Patients. Depression... 37 Journal of Evidence-Based Psychotherapies, [online] 21(1), pp.37–56. Available at: https://jebp.psychotherapy.ro/wp-content/uploads/2022/01/3-PUBLISHED.pdf [Accessed 13 Sep. 2025].
Office of Disease Prevention and Health Promotion (2024). Get Enough Sleep - MyHealthfinder | health.gov. [online] Health.gov. Available at: https://odphp.health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleep.
Quan, S.F. (2009). Sleep Disturbances and Their Relationship to Cardiovascular Disease. American Journal of Lifestyle Medicine, 3(1_suppl), pp.55S59S. doi:https://doi.org/10.1177/1559827609331709.
www.hopkinsmedicine.org. (n.d.). Do Your Heart a Favor - Get More Sleep. [online] Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/do-your-heart-a-favor-get-more-sleep.
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