If you find yourself tossing and turning every night, you may have more to concern yourself with than simply fighting daytime sleepiness: Lack of sleep, or poor-quality sleep, may take a toll on your heart.

Adults over age 45 who sleep fewer than six hours a night are twice as likely to experience a stroke or heart attack as people who sleep six to eight hours nightly, regardless of age, weight, smoking or exercise habits, according to the Sleep Foundation.

The specific link between sleep and cardiovascular health remains unclear, but inadequate or dysfunctional sleep often aggravates underlying problems such as unhealthy glucose metabolism (which relates to diabetes risk) and higher-than-normal blood pressure.

What’s more, sleeplessness and cardiac trouble may be a two-way street.

“Sleep is a very complex sequence of events,” saysGeorge Ruiz, MD of Geisinger Health. “It’s more than just putting your head on a pillow, and not all sleep is created equal. Individuals who have sleep issues can develop problems with their heart and people with heart problems may develop problems with sleep, so it works both ways.”

Sleep and Cardiovascular Risk

Disorders such as sleep apnea, in which nighttime breathing is disrupted, play a major role in compromised heart health.

Without long, deep periods of quality sleep, substances responsible for lowering blood pressure and heart rate are not released by the body. Over time, this can lead to higher blood pressure during the day.

The obstruction and snoring associated with sleep apnea may or may not rouse the person, depending on the severity of the obstruction, explains Ruiz.

“This may wake the person up not to the point where they are conscious, but it prevents them from falling into deeper sleep. So they wake up feeling exhausted and never quite get to the replenishing effect of deep sleep.”

"This scenario also causes adrenaline levels to increase because the body thinks it’s being choked," Ruiz adds. The surges in stress hormones raise blood pressure, which can also raise pressure in the heart and in the blood vessels of the lungs (pulmonary hypertension), increasing the risk of cardiovascular disease.

“As a heart failure specialist, I check for sleep apnea because nearly 50% of those patients have problems with sleep because their heart’s not working well and the pressure in the heart is high,” says Ruiz.

In addition, obstructive sleep during the night results in a drop in oxygen, which triggers the restriction of blood vessels and can lead to high blood pressure, notesRami Khayat, MD, of Columbus, Ohio, who specializes in sleep-disordered breathing and cardiovascular disease.

“If you’re not getting six to nine hours of sleep, you already have a problem. Approximately 25% of people get less than six hours of sleep a night,” Khayat notes.

Sleeplessness can also promote obesity, which in turn is associated with heart problems. In one study, better sleep quality increased the chances that participants would lose weight by 33%.

Trying to Catch Up on Sleep

Sleeping in on weekends in an effort to “catch up” on deficient sleep during the week sounds good in theory, but doesn’t work in the long term, says Khayat.

“For example, if you require eight hours’ sleep a night but get by on seven hours during the week, you can’t make up for that time by sleeping more on weekends. It only counts for being refreshed on that day.”

Khayat adds that the problem is “long-term sleep deprivation. A bad week or one day here and there is not an issue. As long as you go back on a regular sleep rhythm it’s fine. Try to make up for it immediately and allow your body to recover.”

To calculate the amount of sleep you need, All Towfigh, MD, medical director atNew York Neurology and Sleep, suggests keeping a sleep log of all the snooze time you get over a two-week period and divide the total number of hours of sleep by the number of days.

“Waking up to an alarm clock,” he notes, “is usually a sign you’re waking up before your body is ready to wake up on its own.”

CPAP to the Rescue

Debra Wechter’s husband knew about her sleep apnea before she did.

“For years my husband told me I would start to fall asleep at night and invariably wake up choking myself snoring,” says Wechter, an engineer from Windsor, Massachusetts. “I didn’t know for sure until I was tested in a sleep study.”

The sleep lab diagnosed Wechter with a mild case of sleep apnea and her doctor prescribed a CPAP machine to help her breathe at night.

“I immediately noticed a difference,” she says. “I began dreaming and remembering my dreams, which indicated I was achieving stage five (REM) sleep, a level of sleep I was previously unable to reach due to sleep apnea.”

In addition to dreaming, Wechter felt more rested during the day and had more energy when working out.

Getting Better Sleep

If you snore or show other signs of apnea, it would be a good idea to visit a sleep lab for a full workup. But even if apnea isn’t causing your sleeplessness, there are steps you can take to make finding dreamland easier.

“If you’re not getting enough sleep, try going to bed earlier or changing your morning routine to one that allows you to get more sleep,” says Towfigh. “You should wake up feeling refreshed upon arising or within 15 minutes of waking, and have enough energy to get through your day without feeling listless or fatigued.”

To sleep more soundly, you should:

• Avoid napping, which can disturb your natural patterns of sleep and wakefulness.
• Keep regular bedtime routines and avoid emotionally upsetting discussions or activities at that time.
• Avoid drinking water within an hour or two of going to bed to avoid waking up for a bathroom visit.
• Cut back on caffeine during the day, which may keep you awake at night.
• Exercise earlier in the day, not immediately before sleep. Gentle practices such as yoga or tai chi are fine, as they promote relaxation; so does meditation.
• Avoid screen usage too close to bedtime. The blue light emitted by cellphones, computers and other devices resets your internal clock and signals your body that it’s time to wake up.
• Keep the thermostat down at night and consider trading your flannel PJs for lighter ones. Cooler temperatures promote better sleep.

“If you do these things and you still don’t wake up feeling refreshed, then there’s likely an issue with the quality [not quantity] of your sleep,” says Ruiz. 

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