Risk of heart disease rises when women have difficulty sleeping

Women who experience sleep difficulties are at greater risk of developing cardiovascular disease than men, writes Peta Bee
Risk of heart disease rises when women have difficulty sleeping

Depressed woman awake in the night, she is touching her forehead and suffering from insomnia

SO much is at stake with a poor night’s sleep. Stress and fatigue worsen, we become anxious and tetchy, tired and more prone to stress.

But for women, there is the added concern that when sleep is fitful or disturbed their risk of heart disease might rise. Cardiologists from the Columbia University Medical Centre say that poor sleep is associated with higher cardiovascular risk for women than for men.

The research team, headed by Brooke Aggarwal, assistant professor of medical sciences, tracked the sleep patterns (including drop-off time and insomnia) and the diet habits of 500 women aged 22-76.

The results, published in the Journal of the American Heart Association, showed that women with the worst sleep also had poor diets and consumed food with higher sugar content, a risk factor for obesity and associated conditions, including type 2 diabetes and heart disease.

Women who took the longest to fall asleep also had the highest calorie intake, and women with the most severe insomnia consumed the least amount of healthy fats — nuts, seeds, avocados and wholegrains, etc — which are considered beneficial for the heart.

While insomnia can affect anyone, a study exploring gender differences in sleep during Covid-19, conducted last year by researchers at the University of Oxford, found that women are 58% more likely to have sleep difficulties than men.

Aggarwal says that the gender difference is partly linked to the burden of emotional responsibility often shouldered by women. Women feel under more emotional pressure at work and home, which can affect sleep, and that hormonal and lifestyle factors predispose them to insomnia.

“Women have higher chances of developing sleep disorders compared to men,” says Motty Varghese, a sleep physiologist at the Sleep Therapy Centre in Dublin.

“This is partly because of the hormonal influences of menstrual cycles, pregnancy, and the menopause can have on altering sleep architecture, as well as responsibilities that women often take on with childcare and family care.”

Hot flushes, palpitations, and restless legs are common symptoms of the menopause that contribute to insomnia for 50% of women in their 40s, 50s, and older, according to research published earlier this year in the journal Sleep Breath.

“The loss of reproductive hormones from perimenopause onwards often manifests as sleep fragmentation, due to hot flushes and other symptoms,” says Varghese.

“Post-menopausal women have an increased prevalence of sleep apnoea symptoms, which include breathing problems and snoring, while sleep issues precipitated by the menopause can also lead to anxiety, which can result in the development of insomnia, if not addressed.”

Studies have also shown that women are often kept awake by male partners’ snoring.

Mid-life changes in sleep are universal, says Kevin Morgan, emeritus professor of psychology at Loughborough University’s Clinical Sleep Research Unit.

“Some people just have a predetermined personality type that makes them predisposed to insomnia that can rear its head at any stage of adulthood, in response to stresses, which can include work, and financial and lifestyle factors.”

Many women, Morgan says, do not realise that they are predisposed to sleep problems until they have a baby or are menopausal. “At these life stages, their sleep patterns might head on a new trajectory. The menopause is particularly challenging to the sleep patterns of many women, who, if predisposed to insomnia, don’t come out of it easily.”

Aggarwal says the relationship between female sleep patterns and heart health is complex. What is likely happening, she says, is that “women are making unhealthy food choices and overeating” when they are sleep-deprived, which contributes to a higher risk of heart disease.

“Poor sleep is considered a risk factor for many aspects of poor health,” Varghese says. “And the more women dwell on the risks, the greater the anxiety and the worse sleep can become, so it is a bad cycle to get into.”

So, what can we do to improve their sleep? Here are six health hacks to help you nod off and stay asleep:

1. Avoid the nightcap (and even the chamomile tea)

If you have problems waking up, then a glass or mug of any fluid — alcohol, cocoa, chamomile tea — within a couple of hours of bedtime is almost guaranteed to make matters worse.

“The anti-diuretic hormones that regulate fluid balance and are pumped out at night decrease from mid-life, so our ability to retain fluid diminishes,” Morgan says. “Stick to any habit that works and don’t introduce new ones.”

2. You can try going to bed later but always get up at the same time

Why we wake up more during the night in mid-life is thought to be associated with the impact of ageing on two main drivers of sleep. There’s the homeostatic driver, governed by the time we spend awake, and the circadian driver, which is controlled by our internal body clock. “If you want to amplify the homeostatic pressure of sleep, you simply go to bed earlier or later and don’t spend time napping in the day,” Morgan says.

“But the real magic comes from a circadian standpoint, and if we want to keep our sleep anchored, we should always get up at exactly the same time, regardless of our bedtime, to ensure your body clock stays in tune.”

Start delaying your rise time each morning or have a lie-in at the weekend and you’ll quickly disrupt your sleep routine.

3. Try cognitive tricks

Meditation, relaxation techniques, cognitive behavioural therapy for insomnia (CBT-I), and a guided habit-changing programme can be highly effective in helping mid-lifers sleep better.

One review of 20 published studies, in the journal Annals of Internal Medicine, concluded that CBT-I helped people with chronic insomnia drop off 19 minutes sooner, spend 26 minutes less time awake in the middle of the night, and increased total sleep time by eight minutes. Even simple cognitive distraction techniques, such as attempting to count backwards in sevens from 1,000, can slow a racing mind.

4. Apply the 15-20 rule if you wake up at 3am

If you are predisposed to insomnia, you’ll probably have a style of thinking that kicks in at 2-3am when you might be awakened by the slightest noise.

The worst thing you can do is to lie there worrying. Try applying one of the CBT-I techniques, called the 15-20 rule.

If you are lying in bed trying to sleep and are still awake 15-20 minutes later, you should get out of bed, and go and do a quiet activity, such as reading or knitting, until you feel sleepy again and want to go back to bed.

“Habitually lying there, trying unsuccessfully to get back to sleep, means you are just learning to hate your bed and reinforcing the belief that you won’t sleep,” Morgan says.

5. Don’t use a sleep tracker

Most sleep scientists are not fans of sleep trackers, at least for those prone to insomnia. “Worried sleepers buy into trackers to learn about their sleep attributes, including stages of sleep,” Morgan says.

By far his biggest bugbear with trackers is that there is not much you can do with the sleep data other than go to bed earlier to attempt a longer sleep duration if you need it. “A tracker just provides feedback,” he says. “There’s nothing you can do to change the components of sleep and we can’t will ourselves to sleep more deeply.”

6. Expect to sleep up to 20 minutes less in your 50s than you did in your 30s

Our total sleep time declines linearly with age, with one study suggesting a loss of up to 10 minutes per decade. As we age, we also spend more time in light sleep than deep sleep.

In addition, the time spent in rapid eye movement (REM) sleep drops subtly and slow-wave sleep (SWS), another deep-sleep stage considered important for memory consolidation and emotion regulation, also declines by about 2% per decade.

“Don’t stress too much, as long as you are getting somewhere near seven to nine hours total sleep,” Varghese says.

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