Sleep Smart for a Healthy Heart

© 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

Table of Contents SLEEP IS GOOD MEDICINE

03

WHAT IS HEALTHY SLEEP?

04

SIGNS YOU NEED BETTER QUALITY SLEEP

05

SLEEP DISORDERS THAT AFFECT PEOPLE WITH HEART DISEASE

06

MORE ABOUT OBSTRUCTIVE SLEEP APNEA

07

THE CYCLE OF OBSTRUCTIVE SLEEP APNEA

08

OSA SEVERITY

09

OBSTRUCTIVE SLEEP APNEA MYTHS

10

DO I NEED A SLEEP STUDY?

11

CAN I GET A HOME SLEEP APNEA TEST?

12

WHAT IS PAP THERAPY?

13

IF YOU’VE ALREADY BEEN DIAGNOSED WITH SLEEP APNEA

14

HOURS OF SLEEP BY AGE

15

STRATEGIES FOR BETTER SLEEP

16

SPECIAL OFFER FOR SUMMIT ATTENDEES

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Author: Audrey Wells, MD Dr. Wells is a seasoned sleep medicine physician, obesity medicine physician, and professional mindset coach. She is on a mission to promote good sleep as good medicine.

Through Super Sleep MD, she offers a comprehensive library of self-directed courses, a group coaching program, and a private Facebook community.

There are free educational resources and more on her website SuperSleepMD.com.

Sleep is good medicine . . .

Healthy sleep is foundational to your mental and physical well-being. But did you know that your sleep can affect your risk for cardiovascular disease? If you already have heart problems, hypertension, or a history of stroke/TIA, healthy sleep can help to manage these conditions and prevent worsening or reoccurrence. In fact, there is a bidirectional relationship between heart and blood vessel disease and sleep.

Connections Between Cardiovascular Disease and Sleep Sleep affects your blood pressure. During sleep, your blood pressure experiences a nighttime drop called “nocturnal dipping.” This is a normal and healthy phenomenon in which blood pressure is lower by 10-20% compared to daytime blood pressure. People who have an untreated sleep disorder commonly lose the normal drop in blood pressure at night. In fact, blood pressure may spike with some conditions, such as sleep apnea.

Heart conditions are associated with sleep problems. Some types of heart conditions, such as heart failure, cause frequent nighttime awakenings and insomnia.

Similarly, hypertension (whether treated or untreated) is a risk factor for obstructive sleep apnea. Cardiac dysrhythmias such as atrial fibrillation are also associated with sleep-related breathing disorders. If you have heart or blood vessel disease, it is worthwhile to have a low threshold for sleep testing.

Low-quality sleep can make heart disease worse. Too little sleep, frequent sleep disruptions, and drops in blood oxygen levels occurring during sleep apnea put a strain on your cardiovascular system. Sleep loss is a known source of inflammation. Over time, the effects of chronic stress and inflammation compound, resulting in worsening heart and blood vessel disease.

Healthy and sufficient sleep is critical for reducing risk factors for long-term health issues.

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What is healthy sleep?

Sleep is vital for optimal brain function, body function, and overall wellness.

Many critical processes occur during sleep to regulate the immune system, nervous system, hormone production, memory, and mood. Deep, restful sleep is associated with a lower risk for chronic health conditions, including heart and blood vessel (cardiovascular) disease, dementia, diabetes, obesity, and depression. But what does healthy sleep mean, exactly?

There are 3 components to healthy sleep: Healthy sleep means getting enough sleep. You have a personal sleep requirement, and meeting your sleep need is necessary for you to feel your best. The vast majority of adults have a sleep requirement of 7-8 hours of sleep each night. Very few individuals can function normally on less than 6 hours of sleep, and detriments to health and functioning are observed with less than 7 hours of sleep.

Healthy sleep means getting highquality sleep. This means you have stable cycling of the different sleep stages and adequate amounts of deep (or slow-wave) and REM (dream) sleep.

An untreated sleep disorder or any source of frequent sleep interruption is a barrier to sleep quality.

Healthy sleep means your sleep period is timed consistently. You have a natural circadian rhythm, regulated by various internal and external factors. Your circadian rhythm influences every organ and system in your body. Light exposure is the primary signal for wakefulness, while darkness or dim light signals it is time for sleep.

Eating schedules, social activities, and exercise can also influence your body’s rhythms. The consistency of your sleep timing plays a vital role in getting healthy sleep.

Healthy sleep has so many benefits, and sleep is a significant lifestyle factor that affects your risk for heart disease, high blood pressure, and stroke. Prioritizing healthy sleep also reduces your risk of complications related to cardiovascular disease and helps keep medication use to a minimum.

Every night is a new chance to practice supporting your health with good sleep.

It’s never to late to sleep well!

Find Community Join the Super Sleep MD private Facebook group to find other people who want to uplevel their sleep.

JOIN TODAY!

Page 04 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

Signs you need better quality sleep Take action if you experience these symptoms: Sleeping less than 7 hours each night Repeatedly waking up during the night or having prolonged awakenings Not feeling rested even after uninterrupted sleeping An irregular sleep pattern, with more than an hour of variability in your bedtime or wake-up time Experiencing symptoms of sleep disorders or bedpartner reports symptoms Problems with weight management, blood glucose control, blood pressure control, or mood

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Two (Very) Common Sleep Disorders

Sleep disorders that affect people with heart disease Obstructive Sleep Apnea (OSA): Obstructive sleep apnea is a serious breathing disorder that occurs during sleep. Moderate to severe sleep apnea affects 1 in 5 women and 1 in 3 men.

OSA is estimated to affect about half (40-60%) of people with cardiovascular disease.

OSA has been associated with many different forms of cardiovascular disease, including hypertension, stroke, heart failure, coronary artery disease, and atrial fibrillation. Adults with OSA not only have an increased risk of developing heart disease but also have worse outcomes.

OSA is characterized by frequent interruptions in breathing during sleep due to the collapse of soft tissues in the airway. These breathing events cause drops in blood oxygen levels and sleep disruption throughout the night. While it is commonly associated with nighttime snoring and daytime sleepiness, symptoms may be subtle or absent.

Insomnia: This condition is defined by perceived difficulty with getting to sleep, staying asleep, or sleep quality (despite an adequate opportunity to sleep) coupled with subsequent daytime impairment.

Insomnia is chronic when the sleep problems last 3 months or more. Insomnia symptoms may result from another sleep disorder.

In the past decade, there has been increasing evidence associating insomnia with hypertension, coronary artery disease, and heart failure, as well as subclinical cardiovascular disease and cardiovascular disease mortality.

It's important to note that insomnia symptoms are frequently associated with depression or anxiety.

Depression and anxiety are also common among people dealing with chronic disease. Seeking effective treatment for sleep is likely to have a positive impact on multiple aspects of one’s health.

Page 06 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

More about Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea deserves special mention as a sleep disorder that affects those with cardiovascular disease (CVD). There is a bidirectional relationship: people with OSA are at risk for CVD, and people with CVD are at risk for OSA. Aging and obesity are shared risk factors for both OSA and CVD. OSA disrupts the body’s regulation of stress hormones and inflammatory mediators, predisposing one to develop dysfunction of the heart and blood vessels. Untreated OSA and cardiovascular disease are both chronic conditions that can antagonize each other. A person with untreated OSA is at high risk for accelerated CVD complications such as refractory high blood pressure, heart attack, stroke, weight gain (especially abdominal fat), kidney disease, and vascular dementia. Because about half of the people diagnosed with cardiovascular disease also have sleep apnea, the threshold for sleep apnea testing should be low.

It is estimated that 80% of people with OSA are undiagnosed. The more severe the OSA, the more stress and inflammation accelerate the risk for cardiovascular , metabolic, adn neurocognitive complications.

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A

Wake

Low blood oxygen

Open Airway

Normal blood oxygen

B

Sleep

Obstructed airway

The Cycle of Obstructive Sleep Apnea (OSA) The figure above shows a person’s open airway while lying down and breathing normally with an open airway (box A). For people with OSA, muscle relaxation during sleep causes the upper airway to collapse. This obstructions the air from getting to the lungs (box B), so blood oxygen levels drop. The brain becomes alarmed by low oxygen levels, so it has to wake up to re-engage the throat muscles to open the airway again.

This figure depicts one cycle (or one event) of obstructive sleep apnea. Notice that there are two effects with each obstructed airway event, which happens repeatedly throughout the night: Low blood oxygen. Drops in blood oxygen levels occur as a result of an obstructed airway Sleep disruption/Wake (but usually not to full consciousness). Brief arousals from sleep occur to open the airway in response to low oxygen levels

Page 08 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

Obstructive Sleep Apnea (OSA) Severity OSA severity is currently described by the number of airway obstructions per hour of sleep time, also known as the AHI (Apnea-Hypopnea Index).

Mild OSA means the AHI is 5-14 airway obstructions per hour of sleep Moderate OSA means the AHI is 15-29 airway obstructions per hour of sleep Severe OSA means the AHI is 30 or more times per hour of sleep A person with 15 airway obstructions per hour of sleep time (on the border between mild and moderate OSA) would have about a hundred obstructive sleep apnea events in 7 hours of sleep. This staggering statistic means that low blood oxygen levels and sleep disruption occur about 100 times per night. These events cause stress hormones and inflammatory mediators to be released in response to intermittent hypoxemia, sleep loss, and activation of the sympathetic (fight/flight/freeze) nervous system.

There is a strong correlation between untreated moderate or severe OSA and cardiovascular disease. The same is true when OSA is selectively worse during REM (dream) sleep, especially for women.

Health risks

SEVERE Sleep Apnea

MODERATE Sleep Apnea

MILD Sleep Apnea

Normal Breathing

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Obstructive Sleep Apnea Myths Myth: Only people with obesity get sleep apnea.

Fact: About 20% of people with sleep apnea have a normal body weight.

Myth: You can’t have sleep apnea if you don’t snore.

Fact: Snoring is not always perceived, and some people with very severe sleep apnea don’t make any noise because they have complete airway obstructions.

Myth: OSA is just a nuisance and doesn’t necessarily need to be treated.

Fact: OSA is a breathing disorder with serious consequences if left untreated, especially if moderate to severe or with significant worsening in REM sleep.

Myth: If you have OSA, you have to use CPAP. Fact: CPAP is considered first-line treatment for sleep apnea because it is more than 95% effective. But each individual gets to choose their sleep apnea treatment. PAP therapy is only effective when it is used. If a trial of CPAP is not wanted or not successful, there are other sleep apnea treatment options.

Page 10 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

Do I need a sleep study?

Healthy sleep is

healing.

But sleep apnea is a breathing disorder that puts you at risk for disease, weight gain, memory and concentration problems, and emotional dysregulation.

Consider a sleep evaluation if you have one or more of these symptoms: Nighttime

Daytime

Snoring Hard to get to sleep Frequent awakenings Stop breathing during sleep Wake up gasping for air Two or more bathroom trips at night

Wake up with a headache Tired, fatigued, or sleepy during the day Memory or concentration problems Increased appetite or weight gain Feeling sluggish or foggy Mood problems

Especially if you have one or more of these conditions: Diabetes or pre-diabetes

Heart attack

Overweight or obesity (BMI more than 30)

Heart failure

Diagnosed with high blood pressure

Stroke or TIA

Heart rhythm problem (such as AFIB)

Pulmonary hypertension

Angina, or heart pain

COPD or another chronic lung disease

Coronary artery disease

Acid reflux during sleep

A sleep study can help you find out if you've been missing an important piece in caring for your health.

Page 11 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

Can I get a Home Sleep Apnea Test?

Home sleep apnea testing (HSAT) has been on the rise over the last 10 years.

Since the pandemic, many more people have had a home sleep apnea test to look for problems with breathing during sleep. There are many different kinds of home sleep apnea tests.

Sleep testing is most often ordered after a clinic visit with a sleep specialist. The type of test recommended to you will be based on your symptoms, medical history, insurance, and other factors. To find an accredited sleep medicine center near you, go to sleepeducation.org.

Note that some insurance companies REQUIRE home sleep apnea testing as the initial diagnostic measure. Contacting your insurance company before your sleep clinic visit will help you determine if this is true in your case. You can also get information about the cost and coverage of testing and treatment options.

Like all medical tests, HSATs have advantages and disadvantages:

Advantages of HSAT Comfort and convenience of testing at home Fewer sensors applied (no scalp sensors) Lower cost compared to an in-lab sleep study More accessible (pick up or mail delivery) May have a shorter wait time for test Disadvantages of HSAT ONLY tests for sleep apnea (no other sleep conditions) Estimates sleep time Estimates sleep stages (deep sleep, REM) May underestimate sleep apnea severity May give a false negative result Ultimately, people who have a sleep evaluation establish a collaborative relationship with their sleep specialist. Let your provider know if you have a strong preference for sleep testing, and move forward with your goal of healthy sleep in mind.

Page 12 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

What is PAP Therapy?

PAP stands for Positive Airway Pressure. The two most common forms of PAP Therapy are CPAP (C for Continuous airflow and one prescribed setting) and AutoPAP (Auto-adjusting airflow within a prescribed range of settings).

The Positive Airway Pressure is generated by a machine that delivers the pressurized air to your upper airway through a mask worn on your face. The air pressure supports your airway in an open position so you can breathe normally during sleep. This ensures normal blood oxygen levels because your airway stays open. Without drops in blood oxygen levels, you can stay asleep and have normal and healthy sleep cycling.

OSA is an entirely treatable condition. Research studies have demonstrated that when OSA is fully treated with CPAP, measurements of cardiovascular disease, metabolic disease (diabetes and pre-diabetes), neurologic functioning, and quality of life can improve significantly. Improvements can be expected to occur after about three months of treatment for those who use PAP therapy nightly and often correlate with using PAP throughout the night (greater than 6 hours of use). 

Common treatments for sleep apnea CPAP or AutoPAP machine (gold standard) Oral Appliance Therapy Weight loss Surgical procedures

Aside from improving health measures, sleep apnea treatment can significantly improve your sleep quality, duration, and timing--allowing you to get healthy and enjoyable sleep again. People often notice an energy boost and better memory, concentration, and mood during the day. Driving safety improves. All of these benefits underscore the importance of healthy sleep to your longevity and day-today wellbeing.

Page 13 © 2024 Super Sleep MD

All rights reserved. All information presented on this guide is for informational purposes only and is not

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

If you've already been diagnosed with sleep apnea, you may have a CPAP machine.

Are you using CPAP regularly and throughout the night?

CPAP treats sleep apnea,

Effects of Sleep Apnea:

but only when you're using it.

Deprives your heart and brain of oxygen Activates a stress response

If you've run into problems with

Disrupts sleep cycles

sleep apnea treatment, it's time to push the RESET button!

Increases hunger hormones Interferes with blood sugar control

Visit SuperSleepMD.com

Increases inflammation

To continue progress with sleep apnea treatment, follow the Click on the links to start!

Super Sleep Plan: Get SUPPORT in the private Facebook group

EDUCATE yourself with virtual courses

EMPOWER yourself with group coaching sessions

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2

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Sleep patterns naturally shift over a lifespan. As we age, changes in our body's physiology and external factors influence our sleep. This causes changes in the quality and quantity of sleep we get.

Here are some common ways that sleep can change with normal aging: 1. Decreased sleep quality: Older adults spend more time in light sleep and less time in deep, restorative sleep.

2. Changes in circadian rhythm: Older adults may experience changes in their natural sleep-wake cycle, causing them to feel sleepy earlier in the evening and wake up earlier in the morning.

3. Increased sleep fragmentation: Older adults often experience more frequent awakenings during the night.

4. Increased daytime sleepiness: Older adults may feel more tired during the day due to changes in their sleep patterns and sleep quality.

5. Increased prevalence of sleep disorders: Older adults are more likely to experience sleep disorders such as sleep apnea, insomnia, restless leg syndrome, and periodic limb movement disorder.

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Strategies for better sleep Set a schedule

Prioritize your sleep time, keeping a regular wake-up time and going to bed when you feel sleepy. Consider tracking your sleep with a wearable device.

Get bright light in the morning, preferably by spending at least 15 minutes outdoors in the sunlight.

Turn down the lights in the evening. Light in the evening suppresses your own body's production of melatonin.

Avoid looking at electronic screens at night, especially between 11 pm and 4 am. Use a red filter setting on your phone.

Naps are okay, but limit napping to less than 30 minutes and before 3 pm.

Take care of your physical body with a combination of aerobic exercise, strength training, balance maneuvers, and stretching. Exercise helps sleep quality!

Follow a daytime schedule with socializing, regular meals, and activities.

Create a contrast between day and night.

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Evaluate & Treat

Treat underlying sleep conditions.

Insomnia responds well to guided behavioral therapy, which is a safer approach compared to routinely using medications. Note that untreated sleep apnea causes breathing problems and sleep problems.

Review your medications and supplements with your prescribing physician to determine if any may be causing agitation or awakenings. Be aware that supplements often contain caffeine or other stimulants.

Caffeine, tobacco, and alcohol (especially within 6 hours of bedtime), have negative effects on sleep. Take care to limit caffeine intake to the morning hours.

Stop eating at least 3 hours before bedtime to allow adequate time for digestion and to preserve sleep quality.

YOUR NEXT STEP. . .

Visit SuperSleepMD.com to access Super Sleep Resources Free membership Self-paced courses Regular additions to content Group visit package with Dr. Wells

SAVE 15% by entering HEARTSLEEP24 Exclusive, limited-time pricing for Reversing Heart Disease Summit attendees.

DON'T SUFFER THROUGH ANOTHER SLEEPLESS NIGHT!

INSIDE THE SUPER SLEEP MD PROGRAM Understand the root causes of your sleep problems so you can solve your tiredness Access to credible and science-backed information from a sleep medicine physician Get comfortable with CPAP treatment for sleep apnea, or choose an alternative so you can get all the healthy sleep you deserve Take advantage of personalized attention in group video visits for faster results Don't wait to experience your best night's sleep EVER! Join the private Super Sleep MD Facebook group community focused on sleep apnea treatment support.

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