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In medical school, I had a job working nights as a technician in a sleep lab and though I took the job for some extra cash and some quiet time to study, I ended up with an affinity for cardiology. As patients were monitored with polysomnography through a supposedly restful period, alarms sounded through the night indicating arrhythmias, apneic periods, and dream disturbances. I was reminded of those days recently when I saw a new study in the Journal of the American College of Cardiology , correlating reduced sleep duration with the development of atherosclerosis, hardening and narrowing of the arteries, which can restrict blood flow.
The link between sleep disorders and heart disease is hardly new. In the 19th Century the Cheyne-Stokes pattern of central sleep apnea was described in patients with advanced heart failure. Modern sleep medicine has shown that obstructive sleep apnea is a risk factor for hypertension, heart attack, and stroke. Arrhythmia is so closely tied to apnea that a diagnosis of atrial fibrillation now mandates treatment of sleep disorder before considering other therapies. Sudden death during sleep —labeled by prior generations as “natural causes” on death certificates — may have a basis in apnea or in genetic conditions such as long QT syndrome.
New dangers are always being added to the long list of the problem that have a root in sleep deprivation: we speculate that sleep is an evolutionary adaptation to detoxify the central nervous system, with disruption of this process provoking dementia. The question is not how much sleep one should have but rather what medicine can do for those who cannot get enough.
A full night of sleep after initiating Bilevel Positive Airway Pressure (BiPAP) can alleviate chronic fatigue; palpitations and episodes of atrial fibrillation occur less frequently; and doses of medications needed to treat other conditions can be reduced. Insomnia independent of a cardiopulmonary problem may improve when patients are pointed towards the following principles of Sleep Hygiene* – practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness:
*Source: SleepEducation.org (American Academy of Sleep Medicine)
That human sleep patterns have changed in the modern world is beyond dispute — I type these words into an illuminated screen long after the sun has gone down — but the issue may go beyond just the missing hours of sleep. In the long dark nights of the pre-illuminated world, sleep was divided into two parts, leaving everyone a period of wakefulness in the middle of the night. This interval was used for meditation and self-reflection, a quiet conversation with a loved one, prayer, and other relaxing activities. When we discuss the lifestyle changes that are now a mainstay of cardiac intervention, we should include both restful sleep and a period of a mindfulness along with our recommendations for healthful meals, regular exercise, and stress reduction. I encourage my patients to consider rethinking not just their days, but their nights as well.