For many people, getting a good night’s sleep seems out of reach. Modern life leaves little time to wind down and can work against our natural drive to sleep. It’s estimated that 30 percent of adults have trouble falling asleep, staying asleep, or waking too early. This jumps to more than 45 percent in people with heart disease. When these sleep issues happen most nights for at least three months and start to cause daytime difficulties, a person may have insomnia.

Sleepless nights are not just a night-time problem. Insomnia ups the risk for a range of mental health problems including depression, anxiety, and suicide. Insomnia is also linked with more healthcare visits, sick days, and accidents. Research studies that track people over time have shown insomnia increases the risk of developing heart disease and related health problems like hypertension and diabetes. Despite potential health effects, insomnia often goes unrecognized and untreated.

Why is Insomnia Related to Heart Health?

Sleep is clearly central to good health. So, why do so many people with health issues have trouble sleeping? The link between cardiovascular disease and insomnia is complicated (and not fully understood). A poor night’s sleep can make it hard to exercise, eat well, and otherwise follow a heart-healthy lifestyle. There are biological explanations, too. Insomnia is considered a condition of hyper-arousal. The body’s fight-or-flight response—which involves stress hormones like cortisol, activation of our sympathetic nervous system, and inflammation—is turned into high gear. Over long periods of time, this not only impairs sleep but leads to wear and tear on our hearts and blood vessels.

Insomnia can also start after the diagnosis of a heart problem. The stress of diagnosis, hospitalization, and treatment can lead to trouble sleeping. Issues like pain or medication side effect can impair sleep quality. Getting older can play a role, too. Increased age is a risk factor for both heart disease and insomnia. Co-occurring physical health problems, such as prostate issues, or menopause may also get in the way of a good night’s sleep.

40% of people with heart disease have trouble falling asleep, staying asleep, or waking too early

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What Causes Insomnia to Stick Around?

For most people, sleep improves after the stress of their cardiac event subsides (or after they complete cardiac rehabilitation). Patients return to work, adjust to their new medications, and resume normal life. For others however, a bout of poor sleep can become a long-standing problem or get progressively worse; this is where perpetuating factors come into play. For example, when someone isn’t sleeping well, it’s natural to try harder to get some sleep. One might go to bed extra early, linger in bed awake for several hours in the morning, or cancel daytime activities to rest. Unfortunately, these well-intentioned behaviors can actually worsen sleep.

This may seem counter-intuitive: if you give yourself more opportunity to sleep, why won’t your sleep problems go away? First, too much inactivity during the day and too much time in bed awake kills our sleep drive. Sleep drive is the pressure to sleep that builds up as your time awake increases. Second, our circadian rhythm does not like irregular schedules like waking or sleeping at different times each day. Third, our brain comes to link our bedroom with wakefulness via conditioned arousal. Here, the mind learns the bedroom is a place to be awake and worry about the events of the day (whereas the goal is to link the bedroom with only sleep and sex).

How Can I Get a Good Night’s Sleep?

The good news is insomnia is highly treatable. If your sleep problems just started, there’s a good chance they’ll improve once you tackle your precipitating stressors. If your sleep problem is sticking around for more than a few months, cognitive behavioural therapy for insomnia (CBT-I) can help. CBT-I is a psychological (non-drug) therapy recommended as the first-line treatment for insomnia. About 75 to 80 percent of people with insomnia benefit from CBT-I. Your provider will recommend thought-related approaches and behavioral strategies, such as limiting the amount of time you spend in bed awake and countering sleep-related worry.

Research shows CBT-I is just as effective as sleep medications in the short-term and is more effective in the long-term. Indeed, just like alcohol, most sleep medications can actually change sleep architecture so sleep is less restorative. They also come with side effects. Exercise also helps with sleep and is beneficial for your heart, too.

Finally, sleep apnea is a problem that often happens alongside insomnia and heart disease. Sleep apnea is very important to treat, and is linked with worse heart health outcomes. This condition involves episodes where breathing stops and starts during sleep. You can take a screening quiz and find sleep apnea treatment resources.

Good sleep is within reach! Talk to your psychologist, doctor, or other healthcare professional about help available in your area.