Sleep to Your Heart's Content

By Michael Grandner, PhD

If you have heart disease or heart disease risk, you probably work on improving health and quality of life by managing diet and exercise. You may even take advantage of the benefits of meditation, yoga, tai-chi and social engagement. But are you also focusing on sleep and circadian health? Your circadian rhythm is the pattern of your physical, mental and behavioral daily cycle. Sleep plays many important roles in health maintenance and disease prevention. Adding a focus on sleep may improve your daytime function and quality of life.

Sleep is a fundamental part of human biology. Just as the whole body benefits from the oxygen we breathe and the food we eat, it benefits from sleep. Circadian rhythms are important as well, since many body systems, including metabolism, brain function and others, rely on maintenance of normal 24-hour rhythms to function well. Many studies have shown that lack of sleep or disturbance of the 24-hour cycle can lead to health problems.

In addition to heart health, sleep is closely linked with mood, ability to handle stress, risk for depression, ability to be clear-headed during the day, memory, concentration and many other brain functions. It is tied to energy level, focus, and even productivity. Although our society often sees sleep as unproductive time, that is a misguided perspective. Sleep is important to maintaining health, productivity and quality of life.

The American Heart Association recommends adults should strive for at least seven hours of sleep per night. But it’s not only time sleeping, but sleep quality that matters. To improve sleep quality, first make sure you’re sleeping at the right time. The human body was built to sleep at night; getting restful, restorative sleep during the day is difficult. Also, make sure you are sleeping enough. While many adults get seven hours a night, many others cannot. It’s true that not everybody needs a full seven hours, but it can be difficult to tell if you are getting enough high-quality sleep. One way to assess your sleep habits is to think about how you feel during the day. If you have trouble staying awake, especially while you are doing something, that’s a clear sign something is problematic with your sleep. Another sign is if you fall asleep right away at bedtime – it should take a few minutes. If you fall asleep as soon as your head hits the pillow, it’s a sign that you stayed up too long.

Even if you are getting enough hours of sleep, you may still be sleepy. This could be a sign of poor sleep quality, possibly caused by insomnia, either mild or more severe. The more severe type is called insomnia disorder and likely requires treatment. If you regularly need at least 30 minutes to fall asleep at the beginning of the night or if you spend more than 30 minutes awake during the night trying to sleep, you may have an insomnia disorder. The good news is the recommended treatment is not medication (which can carry troubling side effects), but rather a re-training protocol called Cognitive Behavioral Therapy for Insomnia (CBTI). Insomnia is recognized increasingly as a risk factor for obesity, heart disease and diabetes. If you have insomnia, you should consider treatment.

Sleep apnea is another common sleep disorder among both men and women and becomes more common as we get older. Untreated sleep apnea is serious, since it can lead to high blood pressure, weight gain, diabetes, heart attack and stroke. Sleep apnea involves difficulty breathing during the night and is best treated without medications. The main signs of sleep apnea are loud snoring, periods when you stop breathing while sleeping and extreme tiredness during the day.

Besides getting evaluated for sleep disorders, follow these tips to improve your sleep:

  • The bed should be for sleep (and sex) only. That means that you should not be spending time in bed awake. This includes laying in bed watching TV or doing other things. If you cannot sleep, get out of bed and try again later. The main risk factor for developing chronic insomnia is staying in bed tossing and turning. Get out of bed for a while and then try again to sleep.
  • Keep a regular sleep schedule. Regularity can help promote healthful sleep. It’s just like what happens if you eat lunch at the same time every day -- your body knows when to be hungry. Sleeping at a regular time helps promote a regular sleep pattern.
  • Get good bright light in the morning and avoid bright light in the evening. This helps promote a healthful circadian rhythm by promoting a strong “daytime” signal in the morning and a strong “nighttime” signal at night.

Surprisingly, you may want to make some time for a nap. A brief nap (about 20 minutes) during the day can reduce fatigue and improve mental and physical performance. A longer nap can even replace some nighttime sleep, though you need to be careful; you want to make sure you don’t wake up during “deep” sleep. If you’ve ever wakened from a nap and felt terrible, you possibly woke up during this deep-sleep stage. The solution is to either take a shorter nap (and avoid dropping into deep sleep) or allow yourself a couple of hours to go through a full cycle.

Dr. Grandner is director of the UA Sleep and Health Research Program and assistant professor in the UA Department of Psychiatry in the University of Arizona College of Medicine - Tucson. He is board certified in behavioral sleep medicine and treats patients with sleep disorders at the Behavioral Sleep Medicine Clinic at Banner - University Meddical Center Tucson, 1501 N. Campbell Ave. For appointments, call 520-874-7543. For more information about his clinic and research, visit

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