Blood Pressure UK

Getting enough sleep helps keep your mind and body healthy, and could be important for your blood pressure too.

Does your blood pressure change while you sleep?

When you’re asleep your blood pressure is generally lower than while you’re awake. This is totally normal and is known as nocturnal dipping. The drop in both your systolic (the top number) and diastolic (bottom number) blood pressure can be up to 20% lower than your readings in the day time.

People who don’t have lower blood pressure while they sleep have been shown to be at higher risk of heart disease and stroke.

How can lack of sleep affect your health?

A night of bad sleep can affect your mood and concentration the next day, but it won’t affect your overall health. But a regular lack of sleep can have a bigger effect. In the long run, you’re more likely to become overweight or obese and develop problems including high blood pressure, diabetes and heart disease.  

How can lack of sleep affect your blood pressure?
Many studies have shown people who have trouble sleeping are more likely to have high blood pressure. Sleeping less than five hours a night, insomnia and interrupted sleep all appear to raise blood pressure. This effect seems to be stronger in women than in men, and during middle-age.  

How can shift work affect your blood pressure? 
Shift work can be very disruptive to your sleep patterns and how much sleep you get. There is research linking shift work to health problems including being overweight, high cholesterol and diabetes, and it could raise your blood pressure too.

What is Obstructive Sleep Apnoea (OSA)?

Obstructive Sleep Apnoea (OSA) is a condition which interrupts sleep because it causes difficulty breathing. 

With OSA, the walls of the throat relax during sleep, blocking your airways so you can’t breathe for a short period of time. The lack of oxygen wakes you up or brings you into a lighter sleep so that your airways can open up and your breathing can return to normal. These episodes can happen throughout the night, affecting your sleep.

People with OSA are more likely to develop high blood pressure – it’s estimated that half of people with OSA have high blood pressure. It also means you’re more likely to develop type 2 diabetes, atrial fibrillation, a stroke or a heart attack. 

What causes OSA?
OSA is most common in people who are very overweight as this can put a strain on the throat muscles. It’s more common in men than women and tends to affect people over 40. Your lifestyle, any medicines you’re taking and your genes can all play a role too. 

Losing weight if you need to, stopping smoking and drinking less alcohol can all help to lower your risk of developing OSA.

Treating OSA
The signs and symptoms of OSA can include snoring and laboured breathing, as well as interrupted breathing and gasping for breath. You might not know you have it – it’s often noticed by a partner. Visit your GP if you think you might have OSA as it can be treated. 

Find out more from NHS Choices.

How can you get enough sleep?

Most people need about eight hours of sleep a night, but everybody’s different. Lack of sleep can be caused by problems such as sleep apnoea, but it’s usually due to unhelpful sleeping habits and routines. 

There is lots of advice available to help you get enough sleep, for example, figuring out how much sleep you need and working out a regular routine and sticking to it. Winding down before bed can help, for example with a warm bath or writing down anything that’s on your mind so you can deal with it the next day.

The NHS has more information and ideas for getting a good night’s sleep.  Read more about meditation to improve sleep from BeMindful.co.uk.

Sleep and Hypertension – PMC

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how poor-quality sleep and high blood pressure are related – UniMedica

Sleep is one of the most important components of good health and well-being for every person. Without proper sleep, all processes in the body quickly fail, which means that mood worsens, various diseases arise and progress. In this article, you will find out what effect nighttime sleep has on blood pressure, and what is the relationship between poor quality sleep and arterial hypertension.

Poor quality sleep contributes to increased blood pressure and the occurrence of arterial hypertension

It is important to remember that sleep and wakefulness always go hand in hand. This means that if sleep is disturbed, a full-fledged, healthy wakefulness is also impossible, because the body simply does not have enough strength for normal life. An increase in blood pressure (BP) is one of the first disorders that results from poor quality sleep at night. Late progression of the disease can lead to arterial hypertension.

What is hypertension?

Arterial hypertension (AH) is a persistent increase in blood pressure in hypertension (95% of cases) or secondary hypertension.

Today, arterial hypertension remains a significant problem for both medicine and society, because it is a risk factor for the occurrence of pathologies such as heart attack or stroke, resulting in a high mortality rate.

The following methods are used in the treatment of hypertension:

• non-drug treatment, i.e. drug-free;
• drug treatment, that is, with the use of medicines.

Effects, symptoms and complications of arterial hypertension

But it should be remembered that any disease is easier and more cost-effective to prevent than to treat, so much attention is paid to the prevention and early diagnosis of hypertension. Since this pathology can be corrected, the patient’s compliance with the doctor’s recommendations and maintaining a healthy lifestyle, including, of course, full sleep, leads to a sharp decrease in the number of complications and reduces the likelihood of disease progression.

Proper functioning of the autonomic nervous system, which is responsible for the functioning of organs, endocrine glands and blood vessels, is directly dependent on the quality of sleep. As with other physiological parameters, poor sleep affects blood pressure, leading to episodes of high blood pressure. A frequent increase in blood pressure increases the risk of developing arterial hypertension.

“Dipping” effect is a decrease in blood pressure during sleep, which is an important physiological process.

Why is sleep so important for the body?

In contrast to the time when a person is awake, during sleep there is a decrease in blood pressure, also known as the “dipping” effect. There are two types of blood pressure reduction during sleep:

• reduction of blood pressure up to 20 percent, which is the physiological norm for humans;
• less than 10 percent decrease in blood pressure, or “non-dipping”, which is a physiological disorder.

Due to insufficient reduction in blood pressure during sleep, the likelihood of developing cardiovascular complications increases. This picture is present in most secondary arterial hypertension in diabetes mellitus, kidney damage and obstructive sleep apnea syndrome. Accordingly, multicenter medical studies and observations demonstrate that lowering blood pressure during sleep helps to relax the body and gives it time to recover, while the “non-dipping” effect leads to the emergence, development and even progression of the patient’s diseases. In addition, it has a serious impact on the risk of sudden death due to cardiovascular disorders.

Cardiovascular disorders are a formidable complication of arterial hypertension.

It is important to note that there is a direct relationship between the amount of sleep and the risk of developing hypertension itself. Thus, it has been proven that people who sleep less than 5 hours a day for a long time are much more likely to be diagnosed with hypertension and comorbidities.
Accordingly, adherence to an adequate sleep and wakefulness regimen is an important element in the prevention of hypertension, as well as an effective method of non-drug therapy in its treatment.

Insomnia, what is it and why is it dangerous? Patients complain of difficulty falling asleep, sleep interruption and insufficient sleep duration, poor overall sleep quality, and fatigue upon waking. Despite the fact that such people usually have time for a good rest, they cannot get enough sleep.

Insomnia leads to an increase in the level of catecholamines, special signal substances of the body, and activation of the sympathetic nervous system, which provokes an increase in blood pressure. Chronic sleep disorders affect the increase in night and daytime pressure, thereby doubling the chances of developing arterial hypertension in a patient. In addition, if a person has already been diagnosed with hypertension, insomnia will contribute to its progression and lead to a decrease in the effectiveness of drug therapy.

Insomnia (insomnia) contributes to both the appearance of arterial hypertension and its progression.

Other sleep disorders and their impact on hypertension

In addition to insomnia, other types of sleep disorders, such as restless legs syndrome and periodic limb movement syndrome during sleep, have an important impact on arterial hypertension.

Both syndromes are sensorimotor disorders and are characterized by unpleasant sensations in the limbs and their periodic movements that interfere with falling asleep and lead to a deterioration in the quality of sleep. In addition, it is reliably known that at the time of uncontrolled movements of the limbs, an episodic increase in blood pressure occurs, which means that both provokes the development of hypertension and aggravates its course if the disease has already been diagnosed.

Sleep apnea reduces blood oxygen saturation and causes fluctuations in systemic blood pressure

Obstructive sleep apnea syndrome (OSAS) is another serious sleep disorder characterized by repeated episodes of obstruction, or narrowing, of the upper airways. These episodes are often accompanied by a decrease in blood oxygen and cause fluctuations in systemic blood pressure, and therefore lead to sleep disturbance.

It is important to note that a characteristic symptom of OSAS is the absence of a normal decrease in blood pressure during sleep, or even its increase during the night. Therefore, the correct and timely correction of apnea is so important, which not only prevents nocturnal rises in blood pressure, but in some patients leads to its independent decrease, including during the daytime, without additional therapy.

Thus, sufficient and high-quality night sleep has a direct impact on both the risk of occurrence and further progression of arterial hypertension caused by a persistent increase in blood pressure. Timely correction of the patient’s sleep disorders will help him avoid the formidable complications associated with increased blood pressure.

Snoring, sleep apnea – association with arterial hypertension

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Snoring (ronchopathy) is a violation of breathing during sleep, caused by the vibration of the soft tissues of the nasopharynx and larynx, accompanied by a low-frequency rattling sound.

The key pathophysiological process of snoring is a short-term cessation of breathing and impaired ventilation – apnea. Such stops, depending on the severity of the pathology, can be from 30 to 500 per night.

Why people snore

There can be several reasons leading to snoring:

• difficulty in nasal breathing. Which, in turn, can be caused by allergic rhinitis, chronic sinusitis, nasal polyps, deviated septum, including as a result of trauma, which prevents normal breathing through the nose.

• Features of the structure of the facial skeleton. Most often it is a small from birth, displaced back lower jaw.

• In some cases, snoring occurs due to a long uvula or too large tonsils.

• Obesity. The more excess weight, the more pronounced the fat layer in the walls of the pharynx and the narrower the upper respiratory tract.

• Hypothyroidism is a disease of the thyroid gland, accompanied by a decrease in the production of its hormones, which leads to chronic swelling of the mucous membranes and contributes to obesity,

• Changes in the hormonal background of the body. For example, many women begin to snore during menopause, when the production of female sex hormones decreases.

• Age-related changes in tissues with a decrease in the tone of the muscles of the pharynx.

Snoring with pauses in breathing during sleep (or, scientifically, ronchopathy with obstructive sleep apnea syndrome) is a widespread disease and its statistics have a pronounced upward trend. Snoring is most common among middle-aged and older males. At the age of 30-35, 40% of men and 20% of women snore.

Why snoring is bad

Perhaps, snoring is the only human health problem that is complained about in the first place not by the culprit himself, but by his close circle. Over time, the domestic situation can escalate, moving from light “kicks in the side” at night and joking in the morning to serious quarrels, scandals and even divorces. In the UK, 10% of divorces are due to snoring. There it is the official reason why the court can dissolve the marriage.

However, few people think that snoring is not only a social problem, but also a medical one, leading to serious complications in the functioning of the body: chronic oxygen deficiency, sleep and wakefulness disturbances, cyclic fluctuations in heart rate, fluctuations in blood pressure, increased influence of the sympathetic nervous system (constant stress for the body), the development of irreversible structural changes with the formation of cardiovascular diseases, and even the development of sudden death

It has now been proven that obstructive sleep apnea syndrome (OSAS) is a risk factor for arterial hypertension, since 50% of patients with sleep apnea have high blood pressure. An inverse relationship was also noted – in 30% of patients with hypertension, obstructive sleep apnea syndrome is observed. A clear relationship has been established between the syndrome of obstructive sleep apnea and the development of hypertensive crises, cerebrovascular accidents, strokes and heart attacks in the early morning hours. In a report by the United States Joint National Committee on the Prevention, Diagnosis, and Treatment of Hypertension, sleep apnea ranks first among all causes of secondary arterial hypertension.

During normal sleep, there is a decrease in blood pressure by 10-20% compared to wakefulness. Apnea leads to oxygen starvation and frequent micro-awakenings (night stress). All this increases the tone of the sympathetic nervous system, in other words, in response to the stress occurring in the body, adrenaline is released. And adrenaline in the blood is a spasm of blood vessels and an increase in blood pressure.

In addition to the activation of the sympathetic nervous system, compensatory mechanisms are involved in the pathogenetic chain, activated by a lack of oxygen in the body (hypoxia) during respiratory arrest. The fact is that in patients with sleep apnea, during respiratory stops, oxygen does not enter the lungs. An increase in blood pressure causes more blood to pass through the lungs, and, accordingly, the chances of taking in more oxygen increase. However, if the pause in breathing is prolonged, then less and less oxygen remains in the lungs and the body needs to increase blood pressure more and more. As soon as breathing resumes and the oxygen content in the blood is restored, a decrease in blood pressure occurs. But, during the night, in patients with obstructive sleep apnea syndrome, there are several hundred stops of breathing, and since in most cases they follow one after another, the blood pressure does not have time to return to its original level. There is a gradual increase in blood pressure during the night, and sometimes even a hypertensive crisis develops at night or in the early morning hours.

Main signs of obstructive sleep apnea:

• loud snoring and periodic pauses in breathing during sleep, most often this is combined with overweight;

• restless sleep with frequent awakenings;

• feeling tired, tired in the morning, frequent headaches after waking up

• during the day there is excruciating drowsiness, absent-mindedness, irritability;

• arterial hypertension, especially at night and in the morning.

Initially, arterial hypertension in a patient with obstructive sleep apnea occurs only at night and in the morning, but if left untreated, it can spread to the period of wakefulness. Thus, if a person snores loudly, and then wakes up in the morning or even in the middle of the night with high blood pressure, and the pills prescribed by doctors do not help well, then you should think about whether obstructive sleep apnea is to blame for all this.

It is in such cases that the question of how to treat snoring and sleep apnea is most relevant. Often, only the correct and effective treatment of sleep apnea by a doctor will allow you to bring your blood pressure back to normal and avoid both hypertension itself and its terrible complications.

Diagnostics

Cardiorespiratory monitoring is prescribed for patients with suspected OSA.

With cardio-respiratory monitoring, parameters of respiration and heart function are recorded during a night’s sleep. The respiratory sensor allows you to diagnose the frequency and duration of respiratory arrests. The pulse oximetry sensor measures the level of oxygen saturation in the blood. Electrocardiogram sensors establish the relationship between breathing disorders that occur during sleep and disorders of the heart.

Determining the severity of apnea is necessary for choosing a treatment method

Treatment

Depending on the severity of OSAS, various treatments may be recommended:

• Surgical intervention. This approach to the treatment of snoring and sleep apnea is the most radical and aims to increase the lumen and strengthen the walls of the upper respiratory tract. You can count on success only with the correct determination of the applicability of this method in each specific case. Candidates for such treatment should be selected

• Mouth applicators. The principle of their action is to push the lower jaw forward a little while sleeping, preventing blockage of the pharynx and its excessive vibration. The oral applicator can be considered as an alternative to surgery for relatively mild sleep apnea. But do not think that it is worth buying an affordable mouth guard at a pharmacy around the corner, and in the same moment you will be guaranteed a healthy sleep. You don’t buy glasses without first consulting with an optometrist, do you? Here, too, the correct mouth applicators are made by the dentist to order according to the individual measurements of the patient.

• CPAP therapy or positive pressure breathing during sleep. The air entering through a special mask pumps up the throat like a car tire pump, the upper respiratory tract expands, snoring and apnea disappear. However, the cost of the CPAP machine is quite high and this method of treatment is not used to eliminate simple snoring.

It is important to repeat once again that the choice of a way to deal with snoring should not be done on your own, but together with a specialist after consultation and a properly conducted examination.

Literature

Khasanov U. S., Sharipov S. S. Ronchopathy: a modern view on the pathogenesis of the disease // Young scientist. – 2016. – No. 14. — S. 243-247.

Grinchuk V. I., Elizarova L. N. Oxygen supply of the body in men with ronchopathy. Bulletin of Otorhinolaryngology, 2007. – No. 6. – P. 43–47.

Elizarova LN Treatment of ronchopathy // Bulletin of Otorhinolaryngology. – 2006. – No. 1. – S. 35–38.

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Answers to patients’ questions

Good afternoon I would like to solve the problem of snoring during…

Platonov Alexander Viktorovich ,
Functional diagnostics doctor

Good afternoon Obstructive sleep apnea syndrome (OSA.