Sometimes, sleep can feel like a bit of a nuisance—it’s often the first thing people give up when there isn’t enough time in the day. But growing evidence suggests that not getting enough sleep doesn’t just make you tired in the morning. Over the long term, it may endanger your heart.
A new paper in the Journal of the American Heart Association adds to this research by following about a million U.S. veterans over a couple of decades, asking whether those with both insomnia and sleep apnea, where breathing is interrupted during sleep, had a higher risk of heart problems.
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Indeed, compared to people with no sleep disorders, they had more than double the risk of developing high blood pressure and more than quadruple the risk of developing heart disease. While the study can’t establish why these correlations exist, the results add to the evidence that sleep has a role in maintaining our long-term health.
Dangerous disruptions
This study draws on a vast database of medical records of post-9/11 U.S. veterans who receive health care through the Department of Veteran Affairs, or VA. This information was promising material for probing the link between sleep disorders and the heart, says Allison Gaffey, a clinical health psychologist at the Yale School of Medicine and an author of the new paper. “We know that veterans have higher rates of sleep disorders” than the general population, she says. “This is driven by a variety of factors, including deployment-related stress, irregular sleep schedules, psychiatric comorbidities such as PTSD, depression, and anxiety, and then also physical injuries and chronic pain.” What’s more, veterans also have higher rates of heart disease, raising the question of whether dealing with the sleep problems might bring those numbers down.
When the researchers ran their analysis, they were surprised by how strong the connection was between heart problems and sleep disorders. The study population was fairly young; more than 40% were age 39 or under when they enrolled in the VA’s services. And both men and women with the sleep disorders were equally likely to see a spike in heart risk.
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“We have this mindset that cardiovascular disease occurs later in life, and we don’t have to think about heart health and heart prevention until that part of our life,” Gaffey says. “However, the foundation for our cardiovascular health really begins far earlier than is recognized, and these findings really suggest that sleep disruption can influence cardiovascular risk much earlier than we typically think.”
Getting to the root of the problem
The results are consistent with what other studies have found, says Peter Catcheside, a sleep and respiratory physiologist at Flinders University in Australia who was not involved in the work. The research also raises the question of how to handle treating the pair of sleep disorders.
The gold standard treatment for obstructive sleep apnea is wearing a positive airway pressure, or CPAP, machine for sleep. For insomnia, it’s a form of cognitive behavioral therapy, CBT-I, that helps get sleep back on track. Neither is a trivial undertaking. Would it be better to treat one first?
“It’s quite complicated as to which one you deal with first,” says Catcheside, who co-authored a study in 2019 on this question; however, that work found that providing CBT-I first before moving to CPAP was more effective than going the other way. Catcheside emphasizes that understanding the underlying cause of each of the disorders in a given individual can make all the difference in addressing their health. Some people who have sleep apnea, for instance, might be diagnosed with insomnia as well. But a closer look could reveal that it’s the apnea that’s waking them up repeatedly and making it hard to reach deeper stages of sleep, and if the apnea is treated the insomnia disappears.
Getting to the bottom of why someone isn’t sleeping well, as complicated as that might be, may pay real dividends, Gaffey says: “Sleep isn’t just about feeling tired. It’s really about your long term cardiovascular future…it’s an active, restorative biological process, and that chronic disruption of sleep has measurable consequences downstream.”
She hopes future work will delve more into the question of whether treating these disorders early can change the cardiovascular health outlook, both for veterans and civilians. “A key message is this: Don’t normalize persistent sleep problems,” she says. If several nights a week you have a lot of trouble falling asleep or staying asleep, if you are often tired in the day, see someone about it. You might end up changing your life for the better.
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