Good sleep can be tough to come by when you have a heart condition—nearly three-quarters of people with heart failure in particular say they have trouble getting quality rest.1 And, as you might’ve guessed, crappy sleep itself can contribute to heart problems. One 2020 study of nearly 409,000 people found that those who slept fewer than seven hours per night, or who struggled with insomnia or serious daytime fatigue, had a higher risk of developing heart failure than participants who didn’t have those issues.2 There’s also a link between high blood pressure (which raises the risk of heart failure and stroke) and lack of quality sleep.3

Okay, so we get that there’s a strong heart-sleep connection, but why? Richard Wright, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF that scientists are still trying to sort out what’s behind the link between bad sleep and heart failure—but hormones seem like one likely culprit. “We know that hormones that regulate sleep, like melatonin, are disrupted when you have heart failure,” he says.4

At the same time: “Heart disease shares similar risk factors with common sleep disorders, creating a lot of overlap,” Yonatan Greenstein, MD, associate professor of pulmonary and critical care medicine at Rutgers New Jersey Medical School, tells SELF. Those shared risk factors include having type 2 diabetes or high blood pressure. “That could be driving heart disease or making it worse,” he says.

If you’ve got a heart condition, taking steps to save your sleep isn’t just important for your comfort (though that’s really important!)—it can improve your overall health, per the Centers for Disease Control and Prevention (CDC). Here’s what could be causing crummy rest with a heart problem, and what to do next.

Watch out for signs of sleep apnea.

If you struggle to stay awake during the day, someone has complained about your snoring, or you wake up in the middle of the night gasping to catch your breath, there’s a possibility you have sleep apnea, a condition that causes you to stop and start breathing throughout the night. It can affect up to 80% of people with heart-related problems like high blood pressure, heart failure, and atrial fibrillation (an irregular, fast heartbeat).5 One possible reason: Sleep apnea can contribute to worsened left ventricular diastolic dysfunction, meaning the heart’s left ventricle stiffens. This puts extra strain on the organ, boosting someone’s heart rate and blood pressure—and increasing their risk of heart failure.

You should undergo a sleep evaluation to get diagnosed with sleep apnea—so stay alert for signs to flag to your doctor. (A few other symptoms can include a parched throat in the morning, headaches, or even mood changes throughout the day, per the Mayo Clinic.)

“Sleep apnea is usually one of the first things we think of if someone is having trouble sleeping,” W. Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine, tells SELF. “Luckily, there are a lot of ways we can combat it.” Treatment can include a special mouthguard to keep your throat open or a CPAP machine, which delivers air pressure down your throat through a mask you wear as you drift off. In more severe cases, a doctor might recommend surgery to remove throat tissue. (Depending on your unique symptoms, they can guide you on what approach is ideal.)

Tweak your sleeping position.

When you have heart failure, it’s common for fluid to build up in your lungs as you lie down—which you might not even realize when you’re back upright and going about your day, Sanjay D. Naik, MD, a cardiovascular disease specialist at NewYork-Presbyterian Westchester and ColumbiaDoctors, tells SELF. When you lie down at night, that fluid can inch toward your trachea (the tube that connects your voice box to your lungs) and upper lungs, which can make breathing a little difficult, Dr. Naik explains.

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