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How Sleep Apnea Affects The Heart -- Poor-Quality Sleep And Heart Disease Are Connected

Sedona, Arizona

January 22, 2021

I am sharing my story in case it can help you.

After my cardiac arrest, my cardiologist suggested that I get checked out for sleep apnea. My partner confirmed that I sometimes sounded like I was gasping for air in my sleep. Eventually I did get checked out. UVa, it turns out, has one of the only overnight sleep study centers in Virginia. I was diagnosed with mild sleep apnea; my results indicated that I had on average seven "events" per hour (anything less than five is considered normal). As a result I am now the proud owner of a CPAP machine.

Back in the fall, I started waking up with headaches and not having a lot of energy. Those are a couple of the classic symptoms of sleep apnea. (They also are classic symptoms of sleeping in the back of your truck,I thought.) So one night in my tent, I plugged my CPAP into one of my batteries to see if it would help. It helped in a way I had not expected. The CPAP keeps stats on your sleep and it indicated I was having a lot more "events" per hour than indicated in my sleep study. I used it again the next few nights with the same result.

What really "woke" me up (pun intended) that I needed to check in with my sleep doctor was that I noticed my mood was slipping. And indeed, there is a correlation between sleep apnea and being Eeyore.

Fortunately in Charlottesville we have a world-class sleep specialist - Chris Winter. Why not go to the best, right? When I see him soon, hopefully he'll be able to help me get back to having a restful night's sleep.

Punchline - sleep apnea is much more than just not sleeping well. If you snore, gasp for air, wake up with headaches and/or just don't feel your best, it might be worth talking to your doctor. There are home sleep tests you can do to access whether you might have sleep apnea. Don't be like me and assume that only overweight folks are at risk for sleep apnea.

The following article is from Harvard Health, February 2013:

We've all heard stories about super snorers, whose snorts and snores rattle windows and awaken the neighbors. Many of these people suffer from sleep apnea. In this condition, the airway becomes blocked, or the muscles that control breathing stop moving. Either way, breathing stops... and then resumes with a gasp. In the worst cases, this can happen hundreds of times every night.

Because sleep apnea sufferers are constantly awakened, they have poor-quality sleep and feel exhausted all day. They may also suffer from poor cardiovascular health. The sleep disorder is found in 47% to 83% of people with cardiovascular disease, 35% of people with high blood pressure, and 12% to 53% of people with heart failure, atrial fibrillation (a heart rhythm abnormality), and stroke. Researchers estimate that untreated sleep apnea may raise the risk of dying from heart disease by up to five times.

Sleep apnea In sleep apnea, the airway often collapses, blocking airflow. The person awakens hundreds of times a night gasping for air. The body releases a stress hormone which, over time, may raise blood pressure and contribute to heart problems.

Obstructive sleep apnea (or OSA)—the most common form of sleep apnea—is caused when the upper airway collapses or becomes blocked during sleep. People who are obese or overweight have excess fat in their throats that can contribute to the problem, but some people with OSA are slender.

"Over time, OSA exposes the heart and circulation to harmful stimuli that may cause or contribute to the progression of most cardiovascular diseases," explains Dr. Atul Malhotra, associate professor at Harvard Medical School and sleep specialist at Brigham and Women's Hospital.

It works like this: When you stop breathing, your oxygen level drops. The body responds by releasing epinephrine (also called adrenaline), a stress hormone. When this happens over and over, adrenaline levels remain high. This can lead to high blood pressure.

Fortunately, several effective treatments for OSA are available. A bedside machine that provides a constant stream of air through a face mask can prevent the back of the throat from collapsing and obstructing airflow. Called continuous positive airway pressure (or CPAP), it's the treatment of choice for OSA. Although some people have trouble adjusting to the mask, many others call it "transformative," and say they never felt so good. Early research suggests that treating OSA with CPAP may improve heart function and lower the risk of cardiovascular complications.

Custom-made mouthpieces are also available. These devices pull the jaw forward to help keep the airway open. Disposable devices that adhere to the nostrils and pressurize the airways are in development.

For some people, losing weight, eliminating alcohol use, or stopping the use of medications that relax the muscles can improve sleep.

"The best treatment for an individual may ultimately depend on the underlying cause of the sleep apnea as determined by an expert in sleep disorders," says Dr. Malhotra.

Heart disease affects sleep

A different form of sleep apnea, called central sleep apnea (or CSA), is often found in people with conditions that cause them to retain sodium and water, such as heart failure. Doctors suspect that some of the excess fluid enters the lungs at night, causing these individuals to awaken feeling short of breath.

"CSA appears to occur due to an unstable respiratory control system, and is probably a consequence, rather than a cause, of heart failure," Dr. Malhotra explains.

Men, older adults, and people with atrial fibrillation, are also at increased risk for CSA. CSA is treated through closer management of the underlying disease that is causing the problem.

Could you have sleep apnea?

An unusual breathing pattern or loud snoring often leads to a diagnosis of sleep apnea. Yet excessive daytime sleepiness—an equally common symptom—may be overlooked, misdiagnosed, or downplayed.

"It's not normal for older people or people with cardiovascular disease to be sleepy all the time," says Dr. Malhotra. "If you are lying in bed all day, falling asleep at inappropriate times, and have no energy, talk to your doctor about getting a sleep study. You may have a treatable condition."

Not all snorers have sleep apnea, and other possible symptoms of it can be caused by a variety of health problems. The surest way to diagnose sleep apnea is with an overnight sleep study conducted in a sleep clinic. Throughout the night, information from electrodes placed on the head and chest are sent silently to a central station, where it is interpreted by sleep experts. Home monitoring devices are now on the market, but how well they work is an open question.

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Jan 24, 2021

And I suspect your heart is happier! I agree the CPAP does keep by nasal passages clear. 😁


Jan 24, 2021

As I believe I referred to in my Christmas letter, I have had sleep apnea for decades. Two, two-and-a-half years ago I got a CPAP machine. I do not think the quality of my sleep has improved, nor has it improved the ease with which I can fall asleep when at rest at a desk, for instance. BUT I have not had a single night where I could not breath clearly through my nose, and no colds or respiratory problems (even though I live in a mold-infested basement) in all that time!!! I credit that good health to being forced to breathe filtered air through my nose 6.5 to 7 hours a day.

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