How did you sleep last night?
The answer may say as much about your heart health as do factors such as weight, blood pressure, cholesterol and whether you smoke or have diabetes.
Even if you don't snore or have sleep apnea, not sleeping well most nights, even for a few weeks or months, can take its toll on your heart.
"Five, 10 years ago, I didn't talk about sleep problems with my patients," said Dr. Kevin Garner, chief of cardiology at St. Anthony's Hospital in St. Petersburg. "Now we've learned sleep apnea, chronic insomnia, disturbed and poor quality sleep all have a dramatic effect on the heart and have to be taken very, very seriously."
Chip Levick, a patient of Garner, snored for years but never thought much about it. "The kids always joked about it," said the 57-year-old St. Petersburg man. But a few years ago when he was in the hospital for surgery, doctors discovered Levick had atrial fibrillation, a dangerously abnormal heart beat.
"I didn't know I had it," he said. "I couldn't feel anything different, which is kind of scary."
Garner ordered a sleep study and found that Levick had severe sleep apnea. It wasn't the kind caused by an obstruction in the throat, but by a neurological problem in which the brain sometimes forgets to tell him to breath during sleep.
"That apnea caused significant changes in the heart that set him up for atrial fibrillation," said Garner. "Now, I routinely get sleep studies on A fib patients. Apnea is one of their primary health problems."
Most people know it's important to watch blood pressure and cholesterol, exercise, limit alcohol, maintain a healthy body weight, control diabetes and not smoke for optimal heart health. But even if you do all those things, poor sleep can be as an independent risk factor for heart disease.
Some experts believe getting the proper amount of good quality sleep is the most important controllable risk factor for heart disease prevention. "I think it should be number one. It's extremely important," said Dr. William Kohler, medical director of the Florida Sleep Institute in Spring Hill and a spokesman for the American Academy of Sleep Medicine.
"Lack of sleep or getting poor quality sleep can lead to high blood pressure, high blood sugar, high cholesterol, obesity, all these things that affect the heart."
Kohler said poor sleep affects every system in the body and can also be associated with cancer, depression, irritability, digestive disorders, learning and concentration problems. "We've taken sleep for granted for far too long," he said.
Without adequate sleep, the body — and the heart in particular — remains in a state of stress, as though it's constantly on high alert. That creates a chronic cascade of unhealthy metabolic changes and systemic inflammation that elevates blood pressure, cholesterol, and blood glucose.
"When that goes on for weeks and weeks or years and years," said Garner, "it essentially stimulates everything you don't want to go wrong with the heart. It has a big effect on heart disease risk and stroke."
The average amount of sleep most people need is eight hours a night. Some perform well on less — former Bucs coach Jon Gruden famously insisted he needed just four or five.
How do you know when you've had enough sleep? You should wake up feeling refreshed and ready to jump out of bed in the morning, with a positive attitude, the ability to think clearly and perform well at work. You shouldn't yawn a lot or feel that you need a nap.
"There's enormous variation in sleep needs," said Kohler. "Some very creative people only need a few hours a night. Others will need nine hours."
Shift workers are at particular risk for problems related to too little or poor quality sleep. He said they need to pay particular attention to practicing habits conducive to getting good sleep. Keep lights bright if possible at work at night; wear dark glasses when you drive home on sunny days; create a cool, dark, quiet place to sleep at home.
If you're not sure whether you're getting enough sleep, he suggests keeping a log and writing down how much you sleep, and how well you function during the day.
Just don't ignore sleep problems. Levick now uses a C-pap machine to prevent sleep apnea and takes medication to control high blood pressure and A fib.
He had trouble at first with the C-pap machine, but found success with one that fits the nose rather than using a mask.
"I now fall asleep almost immediately and I sleep very sound,'' he said.
Contact Irene Maher at firstname.lastname@example.org.