Herbie Murray
Sleep issues are a common problem for people with heart disease. Research has shown that up to 44% of heart patients experience trouble sleeping. While sleeping pills can be effective in treating insomnia, they may not be suitable for heart patients. This is because they can have serious side effects and may increase the risk of cardiovascular events in heart patients. For instance, a study from Japan found that sleeping pills increased the risk of cardiovascular events in heart failure patients by eightfold. As such, it is important for heart patients to consult a doctor before taking any sleeping pills.
| Characteristics | Values |
|---|---|
| Risk of cardiovascular events in heart failure patients | 8 times greater risk |
| Side effects | Confusion, memory issues, balance problems, constipation or diarrhea, muscle weakness, digestive problems, worsening of snoring and sleep apnea, rebound insomnia, overdose risk, parasomnia |
| Recommended alternatives | Non-drug treatments, over-the-counter sleep aids (Benadryl Allergy®, Advil PM®, Tylenol PM®), changing sleeping environment, cognitive behavioral therapy (CBT), sleep diary |
| Drugs to consider for short-term treatment | Benzodiazepine hypnotics, non-benzodiazepine hypnotics, mirtazapine, nefazodone, trazodone |
| Drugs to consider for Non-24-Hour Sleep-Wake Syndrome | Tasimelteon |
| Drugs to avoid | Zolpidem, suvorexant |
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What You'll Learn
Sleeping pills and heart failure
Sleep issues are a common problem for people with heart disease. A study found that as many as 44% of heart patients have trouble sleeping, with up to 50% of heart surgery patients experiencing sleep disturbances for up to six months post-surgery.
While sleeping pills can be effective in treating insomnia, they are usually recommended for short-term use only. Sleeping pills can have side effects and long-term risks that may outweigh the benefits. Over-the-counter and prescription sleeping pills can cause constipation, diarrhoea, muscle weakness, digestive problems, worsened snoring and sleep apnea, and rebound insomnia. Additionally, certain sleeping pills may increase the risk of cardiovascular events in heart failure patients. A study from Japan found that sleeping pills increased the risk of cardiovascular events in heart failure patients by eightfold. Benzodiazepine hypnotics, a type of sleeping pill, may have cardiodepressant and respiratory depressant actions, which could further exacerbate sleep disordered breathing and lead to a worse prognosis.
For heart patients experiencing insomnia, it is recommended to try non-drug treatments first. Healthcare providers may suggest changing your sleeping environment or trying cognitive behavioural therapy (CBT). Keeping a sleep diary can also help identify patterns and make a plan for improving sleep. If sleep issues are affecting your quality of life and other methods have not helped, consult with your healthcare provider about the potential benefits and risks of taking sleeping pills. They may recommend trying over-the-counter sleep aids at a low dose for a short period, while monitoring for any side effects.
For heart patients with insomnia, treatment with mirtazapine, nefazodone, or trazodone may be preferred due to the chinidine-like effect of tricyclic antidepressants (TCA). Benzodiazepine hypnotics may be useful for short-time treatment, but non-benzodiazepine hypnotics offer more safety and comfort due to the reduced risk of drug dependence and rebound insomnia. If insomnia is part of a depressive syndrome, pharmacotherapeutic intervention with antidepressive sedative medication may be required.
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Side effects of sleeping pills
Sleeping pills can cause a range of side effects, and they are not recommended for long-term use. It is always best to consult a healthcare professional before taking any medication, especially if you are already taking other drugs or have existing health conditions.
Sleeping pills can cause constipation, diarrhoea, muscle weakness, and digestive problems such as gas, heartburn, and nausea. They can also worsen snoring and sleep apnea. Sleeping pills are considered habit-forming and can cause dependence, leading to rebound insomnia when trying to stop taking them. This can result in a worsening of insomnia and may take months to stop safely. Mixing sleeping pills with other sedatives or alcohol can lead to an overdose, which can be deadly.
Some prescription sleep medicines may cause parasomnia, a disruptive sleep disorder where individuals may sleepwalk, eat, take medications, talk, or even drive while still mostly asleep. Benzodiazepines, a common type of sleeping pill, can have cardiodepressant and respiratory depressant actions, which could exacerbate sleep disordered breathing and lead to a worse prognosis.
Older adults are more susceptible to the side effects of sleeping pills, as the drugs can stay in their bodies longer, causing confusion, memory issues, and balance problems, which increase the risk of falls and hip fractures. Drowsiness can persist into the day after taking sleeping pills, impacting an individual's ability to drive, work, or perform daily tasks.
It is important to note that sleeping pills are not recommended as a first-line treatment for sleep issues, especially for older adults and individuals with heart disease. Non-drug treatments, such as cognitive behavioural therapy (CBT), changing the sleeping environment, or keeping a sleep diary, are often suggested first.
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Over-the-counter sleep aids
Sleep issues are a common problem for people with heart disease. Studies show that as many as 44% of heart patients have trouble sleeping. This could be due to various reasons, such as shortness of breath or difficulty getting comfortable after heart surgery.
Before taking any over-the-counter sleep aids, it is important to consult a healthcare provider to discuss potential risks and side effects. Sleeping pills are generally not recommended for long-term use due to possible side effects and the risk of dependency. Older adults should be especially cautious as the drugs can stay in their bodies for longer, increasing the risk of falls and hip fractures.
Melatonin Supplements: Melatonin is a natural hormone produced by the brain in response to reduced light exposure, signalling that it is time to sleep. However, exposure to artificial light from electronic devices can prevent its release, disrupting sleep. Melatonin supplements are available over the counter and can help regulate sleep. It is important to consistently purchase the same brand of melatonin supplements as their dosages and ingredients may vary.
Diphenhydramine and Doxylamine: These are first-generation antihistamines with sedative effects that can help with short-term insomnia. They are found in many over-the-counter sleep aids, such as Nyquil, Unisom SleepTabs, and Medi-Sleep. However, caution should be exercised, especially for older adults, as chronic use can lead to a "residual sedative effect".
Valerian Root: Valerian is believed to interact with GABA, serotonin, and adenosine receptors, and is often used to treat insomnia and anxiety. While it is available as an over-the-counter dietary supplement, the evidence for its effectiveness in treating insomnia is inconclusive, and its composition may vary by brand. Pregnant and nursing women should refrain from taking valerian unless under medical supervision.
Natural Remedies: Some natural remedies, such as warm milk, chamomile tea, and tart cherry juice, are also recommended for improving sleep. While there is limited scientific proof of their effectiveness, they are generally considered safe to consume. Additionally, physical activity can enhance sleep quality, increasing the amount of slow-wave (deep) sleep.
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Non-drug treatments for sleep
Behavioural Changes
Behavioural changes and non-drug treatments can often be all that is needed to improve sleep. It is important to address any psychological elements that may be causing insomnia, as this can lead to associating bedtime with anxiety and frustration, making it even harder to fall asleep. Taking time during the day to contemplate and discuss worries with loved ones or professionals can help leave them behind at night. Keeping a sleep diary for two weeks and then reviewing it with a healthcare professional can help identify patterns and create a plan to improve sleep.
Sleep Hygiene
"Sleep hygiene" refers to creating an environment and habits that promote good sleep. This includes reducing exposure to light from smartphones, televisions, and other electronics before bed. Using a flashlight instead of turning on the lights if you need to get up during the night can help minimize visual disruption. It is also important to be consistent about when you sleep and wake up, as trying to catch up" on sleep during the weekends can negatively impact sleep quality.
Sleep Aids
Some natural sleep aids can be helpful, such as warm milk, chamomile tea, and tart cherry juice. Melatonin supplements can also be useful, especially if your sleep issues are due to exposure to unnatural light in the evening. However, it is important to note that melatonin supplements are unregulated, so the dosage and ingredients may vary between manufacturers. Always buy the same brand of melatonin to ensure consistency.
Pain Management
Pain can disrupt sleep, so it is important to address any pain issues. Taking pain medication in the evening, with the advice of a healthcare professional, can help reduce pain that may wake you up during the night.
Lifestyle Changes
Lifestyle changes can also improve sleep. For example, avoiding exercise within two hours of bedtime can help, as it can raise your core body temperature, signalling to your body that it's time to wake up. Reducing alcohol consumption can also improve sleep, as alcohol interferes with sleep quality.
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Benzodiazepine hypnotics
However, while they can be effective in treating insomnia, benzodiazepine hypnotics have been associated with several adverse side effects, particularly in heart patients. Research has shown that these hypnotics can increase heart rate during sleep and may have cardiodepressant and respiratory depressant actions. These actions could potentially exacerbate sleep disordered breathing and lead to a worse prognosis for heart patients.
Furthermore, a study presented at the Heart Failure Congress in 2014 found that sleeping pills increased the risk of cardiovascular events in heart failure patients by eightfold. While the study did not specifically focus on benzodiazepine hypnotics, the potential risks of sleeping pills for heart patients are concerning.
Another study published in the Journal of the American Heart Association found that the use of benzodiazepines was associated with a higher risk of rehospitalization for heart failure patients. This study also highlighted the unclear prognostic impact of benzodiazepines on patients with heart failure, suggesting that further research is needed to fully understand the mechanisms and risks involved.
Given the potential risks associated with benzodiazepine hypnotics and other sleeping pills, healthcare providers typically recommend trying non-drug treatments first for improving sleep. This is especially important for older adults, as sleeping pills can have longer-lasting effects and cause side effects such as confusion, memory issues, and balance problems. Some alternative methods to improve sleep include changing your sleeping environment, trying cognitive behavioural therapy (CBT), or keeping a sleep diary.
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Frequently asked questions
Sleeping pills are usually only recommended for short-term use, and patients with heart disease should be cautious and seek a physician's advice before taking them. Some sleeping pills that heart patients can take include Benadryl Allergy®, Advil PM® or Tylenol PM®. For short-time treatment, medication with benzodiazepine hypnotics may be useful. If insomnia is part of a depressive syndrome, pharmacotherapeutical intervention with antidepressive sedative medication is required.
Sleeping pills can have side effects like constipation, diarrhea, muscle weakness, digestive problems, worsening of snoring and sleep apnea, and drug dependence.
Yes, healthcare providers recommend trying other methods to improve sleep before resorting to sleeping pills. These include changing your sleeping environment, cognitive behavioral therapy (CBT), and keeping a sleep diary to track your sleep patterns.
Sleeping pills have been found to increase the risk of cardiovascular events in heart failure patients. Benzodiazepine hypnotics, in particular, may have cardiodepressant and respiratory depressant actions, which could lead to a worse prognosis.
Sleep issues are particularly common among people with heart and circulatory diseases, with up to 44% of heart patients experiencing them. This can be due to various reasons, such as breathlessness, discomfort after heart surgery, certain medications, and health anxiety.
