How to Manage Sleep Problems Related to Heart Failure?

The medically approved recommendation is 7-9 hours of sleep for adults to live a healthy life with a healthy heart. Those with heart failure may find it tough to get a restful sleep.

A study in 2021 states 75% of people suffering from heart failure have a sleep disorder that includes sleep apnea, insomnia, awake through the night, and restless leg syndrome keeping them away from a peaceful slumber.

Disturbed sleep will not keep you refreshed, and you have daytime sleepiness, and a lack of energy can stress your heart, leading to heart failure.

Typical Sleep Orders Causing Heart Failure

Let us delve into the intricate interplay between sleep disorder and heart failure.

Sleep Apnea

Sleep disorders, such as sleep apnea, are untreated and can cause heart failure, and vice versa. Researchers found half of heart patients have sleep apnea.

Sleep apnea is of two types −

Obstructive Sleep Apnea (OSA)

It is the most common in which the muscles in the back of the throat collapse, blocking the airway, partially or totally.

Central Sleep Apnea (CSA)

Less commonly found in heart failure patients. It affects men with severe heart failure conditions. Heart failure patients can have one or both sleep disorder conditions. Both disorders blocks or affect nighttime breathing abilities and trigger daytime sleepiness and fatigue.

Both sleep disorder conditions lead to a gradual drop in oxygen levels, and adrenaline levels in the body rise, causing nighttime awakening. These conditions are conducive to causing heart failure.

Managing Sleep Apnea

Get your sleep apnea screened by a health expert. Researchers commonly found OSA in heart failure patients. So, begin by screening for OSA for sleep evaluation. OSA screening is the easiest to track and improve heart failure conditions.

Doctors recommend continuous positive airway pressure (CPAP) machines and other treatments for OSA. It improves the ejection function, which is the heart’s pumping function. CPAP intervention helps doctors decrease arrhythmias. It helps treat atrial fibrillation, another heart rhythm disorder, to maintain a normal heart rhythm.

Phrenic nerve stimulation (PNS) is a new treatment option for CSA that uses an implantable device to stimulate the phrenic nerve. The FDA has approved only one Phrenic nerve stimulation device called Remede System, manufactured by Respicardia Inc.

Remede system is the only PNS device to treat sleep apnea. It can effectively treat mild-to-severe sleep apnea in patients with heart failure and other heart diseases to improve the quality of life. PNS device treatment is safe.

You can tolerate wearing a CPAP machine under a doctor’s supervision if you have a mild OSA. It helps you with daytime therapy and snoring. The CPAP mouthpiece produces an electrical signal for the tongue to strengthen the back of the throat muscle tone.

With time, it reduces snoring and other signs of moderate OSA by stopping the tongue from bending backward and blocking the airway during sleep. Doctors recommend wearing the device for 20 minutes daily when awake for six weeks and once a week after the condition improves.

Sleep Position Modification

Sleep apnea can improve by sleeping sideways. If you cannot tolerate APAP, heart failure patients sleeping laterally on either side can reduce sleep apnea. Those having a defibrillator implanted sleeping on the opposite side are comfortable.

If you have no implants, sleeping on your left side is more comfortable, depending on the patient’s health condition, personal preferences, and comfort.

Insomnia-caused Heart Failure

When you toss and turn instead of a solid shut-eye, it could be insomnia. 23-73% of patients with heart failure suffered from insomnia. Insomnia is when the patient cannot fall and stay asleep or wake up early.

Patients with insomnia do not get adequate restorative sleep at least once a month. Anxiety, stress, overthinking, medication, and an abnormal breathing pattern called Cheyne-Stokes respiration can cause insomnia.

Managing Insomnia Effectively

Alter the time of your medication. Diuretic medication can wake you up multiple times in the night for peeing. Adjust the time of medicines earlier in the day with a doctor’s approval. Seek help if you have acute anxiety or depression. It can come in the way of your sleep.

Antidepressant and anti-anxiety medications can help people with heart failure, but they are habit-building, so consult your doctor before administering medications. If tolerated for a short time, these medications can improve your sleep.

Psychotherapy or cognitive-behavioral therapy (CBT) is another option for people with heart failure, depression, and anxiety coming in the way to a good 7-9 hours of uninterrupted sleep. CBT helps steer clear of negative thoughts that trigger anxiety and depression.

Orthopnea Sleep Disorder for Heart Failure Patients

Patients with heart failure may experience orthopnea when they feel breathlessness while lying. It is also because of paroxysmal nocturnal dyspnea, experiencing shortness of breath waking the patients up after 1-2 hours of sleep. It is a symptom that your body holds fluid that is congesting your lungs.

Managing Orthopnea Effectively to Sleep

If you need more pillows for a comfortable sleeping position, take your weight to see if you have held fluid. If your weight rises 2-3 pounds in a day or 5-6 pounds in a week, it is because of water retention by your body.

Orthopnea or its symptoms are a good reason that calls for a doctor. It may require a chest x-ray to see if you have fluid in the lungs. Diuretic medications can help here to prevent hospitalization. You may try elevating your bead head. a


Many other conditions like periodic limb movement disorder (PLMD) can prevent good sleep at night for heart failure patients experiencing restless legs syndrome caused by increased nerve traffic in the legs and arms. It leads to twitching legs and arms involuntarily while sleeping, disrupting a fresh sleep. Consult a doctor to reduce PLMD. It can reduce heart failure or heart disease risk.

Updated on: 28-Apr-2023


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