Dealing with insomnia
Does your heart or circulatory condition keep you awake at night? You’re not alone. Rachael Healy offers tips that could help.
John Burden, 71, was diagnosed with angina in 2000 and with atrial fibrillation a few years later. He’s had three heart attacks, followed by bypass surgery and ablation procedures. But it wasn’t until the onset of heart failure in 2013 that John began having issues with sleep.
“Around the time I was diagnosed with heart failure, one of the symptoms was waking up and experiencing breathlessness during the night,” he says. “That was my first real sleeping problem. They put me on furosemide [a diuretic], which was like magic. But what I have experienced in the past few years is that I go to sleep quite easily, but I will wake in the night. The problem is getting back to sleep.”
Sleep issues are particularly common among people with heart and circulatory diseases, with as many as 44 per cent of heart patients experiencing them. There can be many different reasons, ranging from the breathlessness John experienced (which is often worse at night), to trouble getting comfortable after heart surgery (it’s fine to sleep in any position that works for you). A 2011 review of studies showed that up to 50 per cent of heart surgery patients experience sleep disturbance for two to six months after the procedure. Certain medications, such as beta blockers, can also make it harder to sleep, as can worries about your health and what lies ahead.
Professor Nicole Tang is Principal Investigator at the University of Warwick Sleep and Pain Laboratory. Her team has discovered that people with health anxiety are more likely to experience sleep issues. This can also be tied in with the pain caused by health conditions. “If pain is making you feel depressed, you have a higher probability of developing sleep disturbances too,” she explains.
Change how you think about sleep
Dwelling on how you’ve slept can make things worse. “‘Sleep quality’ is totally down to the individual person’s perception of how well they have slept,” says Professor Tang. “When you’re not sleeping, you pay more attention to any symptoms and signs that indicate you haven’t been sleeping too well.”
This can be the case for John. “I do feel it when I haven’t had a good night’s sleep and it does make a difference to your day,” he says. “You wake up feeling tired and think: ‘Am I tired because I’ve got these heart conditions or am I tired because I haven’t had enough sleep?’”
It can be hard to forget about it but try finding ways to take your mind off your lack of sleep. You could try a good book, a phone call to a friend or anything else that works for you. Changing the way you think about sleep can help too. “We start with educating people about how sleep works,” says Professor Tang. “It helps to settle people’s nerves. For example, some people may not know that sleep goes in cycles. It cycles through deeper and shallower stages for good reason. Explaining how things work is helpful and people are able to adjust their expectations of sleep… so they don’t get too wound up by the fact that they did wake up a few times.”
When John wakes in the night, he uses a few strategies to change his mindset and get back to sleep. “Eventually I will read – the best thing is a book that is non-fiction and quite dense,” he says. “Sometimes I’ll get up and walk downstairs and potter about – that might change your mental state and be enough to break the spell.”
Improve your sleeping environment
Going to bed at regular times and having a relaxing sleeping environment can also help. “Turn off your computer about an hour before bed and make sure there is no TV or other screen in your bedroom,” says John. “But I have to say, it’s very difficult getting away from the computer at times!
“We don’t drink alcohol very much because, although it has a relaxing effect, it also manages to wake you up and you won’t necessarily feel great the next morning. And try not to eat just before you go to bed.”
On his GP’s recommendation, John has also started taking his nightly heart medications earlier, so that he doesn’t need to drink a glass of water immediately before bed. He then always empties his bladder immediately before sleeping. He now takes paracetamol in the evening too, to reduce pain that could wake him in the night (check with your GP first if you plan to do this regularly.)
Professor Tang helps patients establish healthier sleeping schedules. Patients start by keeping a sleep diary for two weeks, recording when they sleep, rest and wake, medications they take and how they feel. They and their healthcare professional then identify patterns and make a plan.
“It’s almost changing their whole lifestyle to prioritise sleep, so they can watch out for their own health,” says Professor Tang. Some people need to make more time for sleep, whereas others are advised to spend less time in bed because spending hours waiting for sleep may only increase their anxiety. Either way, the goal is to reach the deeper stages of sleep and to feel refreshed upon waking.
It’s normal for a health condition, diagnosis or surgery to cause anxiety. Take all the time you need to think about your situation and talk it over with loved ones or a professional. Doing that in the day can help you to leave it behind at night. “It takes some time to wind down and, if night is the only time you can contemplate things, you won’t be able to fall asleep,” Professor Tang says. “You have to give yourself permission to think about things during the day. Prioritise sleep; protect a zone for facilitating sleep.”
What can you do?
As the causes and patterns of sleep disturbance vary from person to person, a detailed sleep diary can be useful. Keep one for a fortnight, then take it to your GP.
There can be a psychological element to insomnia, which often gets worse over time as people start to associate trying to get to sleep with anxiety and frustration. A variety of CBT (cognitive behaviour therapy) designed for insomnia (CBT-i) can help. Speak to your GP or refer yourself through IAPT (Improving Access to Psychological Therapies).
Studies have shown that relaxation techniques, including progressive muscle relaxation (relaxing then contracting muscles in sequence) and audio-guided meditation, helped improve sleep. You can try our guided podcast. If you are offered the chance to attend cardiac rehabilitation, these classes may be able to offer you advice on relaxation techniques.
Sleeping pills are usually only recommended for short-term use. Professor Tang says that although they work for some people, for others the side effects and longterm risks outweigh the benefits. Your sleep diary can help show if there is correlation between nights you take pills and ‘good sleep’.