Women's Heart Advisor July 2014 Issue

Ask The Doctors Women's Edition: July 2014

Q. Iíve always struggled with poor sleep, but since my diagnosis of coronary artery disease last year my insomnia has become worse. Is this because of my heart disease, and how can I improve my sleep?


A. Researchers are just beginning to understand the connection between poor sleep and heart disease, but there is growing evidence for the hypothesis that insomnia is associated with an increased risk for cardiovascular disease. Insomnia is also linked with hypertension and elevated resting heart rateótwo conditions both known to lead to cardiovascular disease. Insomnia is defined both as difficulty falling asleep and the inability to sleep through the night.

Insomnia symptoms in middle age are strongly associated with the subsequent development of heart failure, according to a large Norwegian cohort study published in European Heart Journal (March 2013). The study, which reviewed over 54,000 men and women, linked insomnia symptoms and heart failure, even in subjects who had never experienced a coronary event.

While more research is necessary to demonstrate a definitive connection between poor sleep and heart disease, insomnia is known to have a negative effect on overall health. Because of this, itís important to take steps to improve sleep, including sticking to a sleep schedule, avoiding a heavy meal and nicotine, caffeine and alcohol before bed, limiting daytime naps and including daily exercise.

Cleveland Clinicís Wellness Institute and Sleep Disorders Center can also offer additional help through an interactive, online six-week program called GO! to Sleep.

Designed to be most beneficial for people who are experiencing psychophysiological insomnia (insomnia that is associated with excessive worrying, often focused on not being able to sleep), the GO! to Sleep (GoTS) program was designed as a treatment alternative that provides daily recommendations and tips to help improve sleep.
Patients with chronic insomnia (at least six months) or insomnia that is comorbid with other conditions will also benefit, particularly if they have yet to adopt sleep-friendly habits and consistent sleep patterns.

Proof of the programís effectiveness was recently presented in a study completed by Cleveland Clinic at the 28th Annual Meeting of the Associated Professional Sleep Societies (June 2014). At six-week follow up of 30 of 51 randomized GoTS participants, the research showed a significant improvement in insomnia compared to the control group.

Further investigation is underway in a joint project by Cleveland Clinic and Brigham and Womenís Hospital to study the GoTS online sleep programís effect on individuals with coronary artery disease. The study will determine if the program improves their sleep, in addition to improving symptoms of cardiovascular disease.

For more information about the GO! to Sleep program at Cleveland Clinic, visit ClevelandClinicWellness.com or call the Sleep Center at 216.444.2165, or toll free at 866.588.2264.

Q. Iíve been told that I should begin taking a beta-blocker medication to help manage my new diagnosis of heart failure. Which beta-blocker is most helpful for my condition?

A. A beta-blocker is vital for people with heart failureóeven if they do not have symptoms. Beta-blocker medications improve the heartís ability to relax, decrease the production of harmful substances produced by the body in response to heart failure, and slow the heart rate. Over time, a beta-blocker may improve the heartís pumping ability.

Two recently published studies found that carvedilol (Coreg) to be the most effective beta-blocker to treat heart failure. It has better outcomes in patients with heart failure and acute myocardial infarction. In the Carvedilol or Metoprolol European Trial (COMET), survival appears to be better for patients who took carvedilol (25 milligrams twice daily) than with immediate release metoprolol tartrate (50 milligrams twice daily). Additional evidence of carvedilolís positive impact on heart failure was published in the American Journal of Cardiology. The meta-analysis showed that carvedilol, as compared against other beta-blockers including atenolol, bisoprolol, metoprolol and nebivolol, significantly reduced all-cause mortality in systolic heart failure patients.

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