Ask the Doctors September 2018 Issue

Ask The Doctors: September 2018

Q: I have never been a good sleeper. Is insomnia bad for the heart? Should I be worried?

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Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

A:Studies support the notion that less than seven hours or more than nine hours of sleep are associated with coronary heart disease (CHD).Poor sleep is linked to weight gain, diabetes, high blood pressure and increased sympathetic activity—all factors that may explain this relationship.

In one major sleep study, men who slept fewer than six or more than nine hours had a 1.7-fold higher death rate than those who slept seven to eight hours. Another study of more than 71,000 women found those who slept less than five or more than nine hours had a 1.82- and 1.57-fold higher risk of developing CHD, respectively.

Sleep apnea has been linked to several heart conditions, including atrial fibrillation, sudden death, high blood pressure and heart failure. However, a 2017 study showed that even when accounting for risk factors that included sleep apnea, sleep disturbances such as poor-quality sleep, short-duration sleep, difficulty staying asleep and use of sleeping pills were associated with an up to 70 percent higher likelihood of CHD and 45 percent increased risk of stroke.

It appears that getting seven to eight hours of sleep a night is best. However, the National Sleep Foundation reports that only one-third of U.S. adults get eight hours of sleep a night, and up to one-third get six hours or less.

You can improve your sleep habits by getting regular exercise, avoiding daytime naps, avoiding caffeine and powering down electronics before bed. Maintain a strict sleep schedule, which means going to bed and getting up at the same time every day. If you’re overweight, snore or have been told you stop breathing during sleep, see a sleep specialist and be evaluated for sleep apnea. Otherwise, if you have insomnia or other type of sleep problem, avoid rushing to use over-the-counter sleep aids. Work with your health provider to determine the cause and discuss remedies.

Q: I hear that alcohol may actually help protect my heart. Is there any truth to this?

A: It seems to depend on the quantity of alcohol and underlying heath conditions. Alcohol may be beneficial by raising good HDL cholesterol levels and reducing blood clotting. Epidemiologic studies provide evidence of a lower risk of CHD with moderate alcohol consumption, defined as one drink a day for women and two for men. A drink is 12 ounces (oz.) of beer, 5 oz. of wine or 1.5 oz. of liquor, which is roughly 14 to 15 grams (g) of alcohol.

A study in the British Medical Journal of more than 32,500 individuals without CHD found the lowest risk of CHD occurred in those consuming 15 to 30 g of alcohol a day. In contrast, an increase in stroke was seen with every additional 12 g of alcohol consumed daily.

Don’t forget alcohol consumption puts you at increased risk of dependency and accidents, and may cause adverse effects such as weight gain, diabetes, elevated triglycerides, high blood pressure, ulcers and some cancers.Excessive and binge drinking are associated with a higher risk of cardiomyopathy (weakened heart muscle).

If you don’t drink already, your heart health is not a reason to start. It would be better to eat a healthy diet and exercise regularly, which provide the same beneficial effects potentially tied to moderate alcohol consumption without the adverse ones. If you have conditions such as congestive heart failure, cardiomyopathy, high blood pressure, diabetes, high triglyceride levels, a history of stroke or heart rhythm irregularities, it is best to avoid or limit alcohol use. Otherwise, if you enjoy alcohol in moderation, it is not likely to harm your heart, but should not be considered a treatment for heart disease.

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