People With Heart Failure Can Try to DREAM for Better Sleep

One of the most common symptoms of heart failure (HF) is sleep disturbance. The Centers for Disease Control and Prevention estimates that people with HF are 10 to 15 times more likely to report sleep disturbances than the general population.¹

Cycle of problems

What’s worse - sleep disturbances and HF antagonize one another. If you have HF, it’s likely to interfere with your sleep. On the other hand, if you have trouble sleeping, it’s likely to exacerbate your HF symptoms.

Anxiety and depression, two other common symptoms of HF, also contribute to the problem of disrupted sleep.

Sleep hygiene

The solution? Sleep hygiene. This broad strategy of techniques aims to achieve more and better sleep without resorting to medications.

The benefits are definitely worth pursuing. Solid, adequate sleep allows your heart to work more efficiently with less effort. Sleep also allows the body a chance to repair heart muscle and blood vessels.

The idea of sleep hygiene may seem too abstract. Leave it to cardiac nurses to demystify it by using the D.R.E.A.M. bundle to help HF patients get more sleep.

What does D.R.E.A.M. stand for?

Healthcare acronyms are nothing new. D.R.E.A.M. describes a bundle of phrases nurses employ to teach HF patients how to reduce their sleep disruptions.¹

• D = Determine underlying sleep condition
• R = Relaxation routine
• E = Eating and exercise
• A = Avoid stimulants
• M = Massage

D, determine underlying sleep condition

Did you know there are more than 80 sleep disorders that can be diagnosed?² From different types of insomnia to sleepwalking to circadian rhythm disruption to sleep-disordered breathing to restless legs and more, it’s important to remember that each disorder has its own unique cause and treatment.

Before any sleep problem can be treated, it requires identification. Screening for sleep problems at the clinic, or undergoing formal lab testing, maybe part of this important first step.

R, relaxation routine

Bedtime routines that include relaxation always benefit people with HF. A calm mind and body result in better sleep, which aids the heart muscle in working more efficiently.

Listening to soft music, reading, taking a warm bath, or practicing meditation are four pleasing ways to slow down at night. If sleeplessness persists, try asking your cardiologist about cognitive behavioral therapy for insomnia (CBT-i), which research shows to be effective for people with stable heart failure.³

E, eating and exercise

Timing is most critical here.

Eating a large meal or consuming excess beverages can stimulate digestion. This isn’t a problem during the day, but at night, it could cause sleeplessness. Try to consume your last meal 2 to 3 hours prior to bedtime to prevent problems.

Exercising greatly improves sleep by supporting your circadian rhythms, but only if it’s done during the day. Ideally, your best circadian reboot through exercise should happen in the morning. If you can’t do so then, exercise at least 2 to 3 hours before you go to bed.

A, avoid stimulants

People with HF should avoid four main kinds of stimulants before bed:

• Caffeine. Six hours after you’ve consumed caffeine, half of it still remains in your bloodstream. It may take 10 hours to completely metabolize it, so try to limit its consumption to the morning hours, if at all. (4)
• Alcohol. It’s popularly thought that alcohol—because it helps you fall asleep—makes a good “sleep aid.” The truth is, after your body metabolizes it, you experience a sleep-disrupting withdrawal effect. Not only that, but you may also find yourself using the bathroom more frequently at night. (5)
• Nicotine. Like alcohol, nicotine promises a moment of relaxation at bedtime, only to disrupt sleep in myriad unhelpful ways. (6)
• Electronics. These favorites in the 21st-century household can cause poor sleep. The blue spectrum light emitted by them can cause delays in the release of the sleep hormone, melatonin. On top of that, the content of a movie, television show, or video game may energize, rather than relax, leading to problems falling asleep.

M, massage

Not only does massage feel great, improve circulation, and elevate mood, but it’s a proven way to reduce so many of the negative things that can disrupt the sleep of someone living with HF, such as depression, anxiety, stress, and pain.

One study observing subjects with HF found that a single 20-minute massage every night before bed helped 93 percent of participants achieve improved sleep quality after only one week.¹

Give it a try

Now that you have a sense of what simple sleep hygiene looks like for people with HF in need of more and better sleep, why not give this strategy a try? If you struggle, ask your doctor — or even better, a cardiac nurse! — to help you D.R.E.A.M. so you, too, can sleep better.