CSA AND CONGESTIVE HEART FAILURE
About 40% of people with congestive heart failure also have a sleep-related breathing disorder called central sleep apnoea (CSA). In CSA there are repetitive episodes of interruptions in breathing during sleep, just like in OSA.
However, in CSA the breathing passage remains open but the person stops making efforts to breathe. Frequent awakenings and drops in the level of oxygen in the blood also occur in CSA. The awakenings increase heart rate and blood pressure, which can worsen heart failure, in turn leading to more CSA and causing a vicious cycle that decreases heart function.
The first approach to treating CSA is to prevent it by treating the heart failure as thoroughly as possible. If CSA is still present, treatments are available to correct the CSA. Treatment of CSA can improve heart function as well as improve sleep quality.
SYMPTOMS OF CENTRAL SLEEP APNOEA
- Symptoms of congestive heart failure
- Shortness of breath
- Difficulty breathing while lying flat
- Restless sleep
- Waking up gasping or short of breath
- Witnessed episodes of stopped breathing while sleeping
- Unrefreshing sleep
- Snoring may be absent
During a stroke, the brain is damaged when the supply of blood and oxygen is reduced or cut off. Hypertension is the most common cause of stroke, and, as stated above, OSA can lead to the development of hypertension. In addition, OSA may cause strokes directly since blood flow to the brain is reduced and the level of oxygen drops during apnoeas.
Abnormal breathing patterns during sleep, especially OSA, are also more common immediately following a stroke. Other effects of OSA, such as excessive sleepiness from disrupted sleep and impaired thinking, may hamper a person’s recovery from a stroke.
EFFECTS OF HEART DISEASE ON SLEEP
As outlined above, sleep-related breathing disorders can directly cause heart disease. Yet, there are effects of heart disease on sleep that, though more subtle, are also important to address.
SHORTNESS OF BREATH
For instance, patients with congestive heart failure often report difficulty falling asleep or staying asleep because of the shortness of breath that often accompanies heart failure. This shortness of breath is often worse when the patient lies down because blood in the legs flows back into the heart and can overwhelm its ability to pump. Doctors call these symptoms orthopnea (shortness of breath when lying down) and paroxysmal nocturnal dyspnea (waking up from sleep short of breath). The patients who experience these symptoms may feel like they have insomnia since their sleep is interrupted.
In addition to experiencing these complications from heart disease, patients often worry about the long term consequences of a heart attack or chronic heart disease. Such anxiety, by itself, can lead to the development of chronic insomnia.
Taking into consideration all of these plus the direct relationship of numerous heart conditions with sleep-related breathing disorders, it is clear that people with heart conditions need to take special care and seek medical attention in order to ensure their ability to sleep well.
GOOD SLEEP – HEALTH HEART
Many things can be done to maintain a healthy heart:
- eat a nutritional diet
- maintain a healthy weight
- exercise regularly
- get regular medical check-ups
- AND get adequate amounts of good quality sleep.
If you have any kind of heart condition, it is I especially important to watch for signs that you may have a sleep related breathing disorder, such as OSA, which could stress your heart. People with OSA are often overweight and experience loud snoring, as well as trouble staying awake during the daytime.
WHEN SHOULD I SEE A HEALTH PROFESSIONAL?
If you already have hypertension or cardiovascular disease (coronary artery disease, angina pectoris, stroke), talk with your healthcare professional about whether or not you may have a sleep and breathing disorder, such as OSA or CSA.
It is also important that patients with congestive heart failure be monitored for CSA and other sleep disorders at a Sleep Disorders Centre. In contrast to people with OSA, those with heart failure and CSA are commonly thin and may not snore at all.