Around the time of menopause, many women discover they no longer sleep like they used to. Hot flashes cause many to awaken multiple times per night and have difficultly going back to sleep. Some women need to get up several times a night to urinate, due to declining levels of the hormone that allows the body to retain water. Others just can’t fall asleep at night, or find they awaken too early.
Both conditions—interrupted sleep or too little sleep—can affect your cardiovascular health in many ways. “Poor sleep can raise the risk of heart attack or stroke directly by impacting the health of the arteries, or indirectly by increasing risk factors that contribute to cardiovascular disease, such as causing blood pressure to rise. For unknown reasons, poor sleep has a more potent impact on women,” says Leslie Cho, MD, Director of the Women’s Cardiovascular Center at Cleveland Clinic.
Too Little Sleep
Sleep is needed for general maintenance. It’s during sleep that our body conducts repairs, releases hormones needed for tissue growth and revitalizes our immune system. That’s why lack of sleep disposes us to short-term health problems, such as colds and flu, as well as long-term health issues. We need a minimum of six to seven hours of sleep a night to stay healthy: Eight hours is ideal.
Regularly sleeping six hours a night or less increases the risk of having a heart attack or stroke, as well as dying from it. These risks are doubled by sleeping five hours a night or less. Too little sleep also increases the likelihood of developing diabetes and high blood pressure.
The good news is that adding an extra hour or two of sleep—raising the total to seven hours a night—substantially lowers cardiovascular risk.
When sleep is regularly interrupted three or more nights a week, the incidence of cardiovascular disease and two of its key risk factors, obesity and diabetes, rises. Interrupted sleep—defined as awakening more than twice a night—nearly doubles the risk of developing coronary artery disease or having a heart attack and raises the risk of stroke by 30 percent.
Restless legs syndrome (RLS) is one problem that can interrupt sleep. RLS causes creepy-crawly sensations in the legs before falling sleep and uncontrollable urges to move the legs at night.
Women with RLS are at increased risk of developing hypertension. Fortunately, multiple medications and non-medical therapies are available to treat RLS. “If the hypertension was caused by RLS, resolving the RLS should cause the patient’s blood pressure to drop back to baseline,” says Dr. Cho.
Snoring Can Be a Warning
It is not unusual for women to begin snoring after menopause begins. “It often starts when women become less active and begin gaining weight. Fat accumulates throughout the body, including in the back of the throat, where it may interfere with breathing at night,” Dr. Cho explains.
Women who snore lightly tend to experience a rise in blood pressure. Loud snoring is associated with an increased risk of heart attack and stroke.
Loud snoring punctuated by periods of silence, followed by gasping for air, is the hallmark of obstructive sleep apnea (OSA), a condition that tends to affect more women after menopause. In OSA, excess tissue at the back of the throat collapses during sleep, stopping the flow of oxygen to the lungs. This signals the brain to awaken you just enough to take a breath. The process, which can happen hundreds of times a night, stresses the heart and lung, elevates blood pressure and is one of the most common causes of atrial fibrillation. OSA also increases the risk of type 2 diabetes, coronary artery disease and, in women with severe OSA, stroke.
“Studies have shown that OSA affects the body’s autonomic responses that control blood pressure, heart rate and sweating, and that the impact is stronger in women than in men,” says Dr. Cho.
What You Can Do
Age-related sleep disorders aren’t inevitable: Many older women sleep very well. If you experience sleep interruptions during menopause, tell your gynecologist. She will weigh the benefits of a short course of hormone replacement therapy against your individual risks. If you awaken more than once or twice a night to urinate, ask about a medication to help you hold your water.
Insomnia can have multiple causes. Although sleeping pills may sometimes be helpful, they should never be used for more than a few days. “Sleep medications are not benign,” says Dr. Cho. “It’s more important that you practice good sleep hygiene, such as avoiding alcohol and caffeine in the evenings, keeping your bedroom cool and dark and turning off all electronic devices, particularly those that emit blue light.”
The signs of OSA in women may be subtle and easily overlooked. If your bed partner says you snore, or you are experiencing excessive sleepiness during the daytime, tell your internist. You may need a sleep test.
If you are under a cardiologist’s care, tell your doctor about your sleep habits. She may want to monitor your blood pressure and blood glucose levels more closely, and may want you to have periodic blood tests for inflammatory factors. Sleep disorders may raise your risk of a cardiovascular event, but this risk is modifiable. Treating the sleep disorder will lower your risk and help restore your quality of life,” says Dr. Cho.