How does sleep affect blood pressure. What is nocturnal dipping. Can lack of sleep lead to hypertension. How does obstructive sleep apnea impact cardiovascular health. What are effective strategies for improving sleep quality.

The Nocturnal Dipping Phenomenon: A Key Indicator of Cardiovascular Health

Nocturnal dipping is a natural and essential physiological process that occurs during sleep. It refers to the decrease in blood pressure that typically happens when we’re asleep. This phenomenon is crucial for maintaining cardiovascular health and reducing the risk of heart disease and stroke.

During nocturnal dipping, both systolic (the top number) and diastolic (the bottom number) blood pressure readings can drop by up to 20% compared to daytime levels. This reduction allows the cardiovascular system to rest and recuperate, playing a vital role in overall heart health.

Why is nocturnal dipping important?

Research has shown that individuals who don’t experience this natural nighttime drop in blood pressure face a higher risk of cardiovascular complications. The absence of nocturnal dipping, also known as non-dipping, is associated with an increased likelihood of developing heart disease and stroke. This underscores the importance of maintaining healthy sleep patterns and monitoring nighttime blood pressure levels.

The Impact of Sleep Deprivation on Blood Pressure and Overall Health

While an occasional night of poor sleep may not have lasting effects on your health, chronic sleep deprivation can lead to a cascade of negative health outcomes. Insufficient sleep has been linked to various health issues, including an increased risk of obesity, diabetes, and cardiovascular problems.

How does lack of sleep affect blood pressure?

Numerous studies have established a strong correlation between inadequate sleep and elevated blood pressure. Consistently sleeping less than five hours per night, experiencing insomnia, or dealing with frequently interrupted sleep can all contribute to higher blood pressure readings. Interestingly, this effect appears to be more pronounced in women and middle-aged individuals.

The mechanisms behind this relationship are complex and multifaceted. Sleep deprivation can lead to increased stress hormone production, activation of the sympathetic nervous system, and inflammation, all of which can contribute to hypertension.

Shift Work and Its Effects on Blood Pressure Regulation

For many individuals, shift work is an unavoidable reality of modern life. However, the disruption to natural sleep-wake cycles caused by irregular work schedules can have significant implications for cardiovascular health.

How does shift work impact blood pressure?

Research has shown that shift workers are at a higher risk of developing various health problems, including obesity, high cholesterol, and diabetes. These conditions are known risk factors for hypertension. Additionally, the constant disruption of circadian rhythms can directly affect blood pressure regulation, potentially leading to elevated readings.

Shift workers often struggle to maintain consistent sleep patterns, which can result in chronic sleep deprivation. This, in turn, can trigger the same physiological responses associated with inadequate sleep, such as increased stress hormone production and activation of the sympathetic nervous system.

Obstructive Sleep Apnea: A Hidden Threat to Cardiovascular Health

Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by repeated episodes of partial or complete airway obstruction during sleep. This condition not only disrupts sleep quality but also poses significant risks to cardiovascular health.

What is the connection between OSA and hypertension?

Studies have shown that approximately half of all individuals diagnosed with OSA also have high blood pressure. The relationship between OSA and hypertension is bidirectional, meaning that each condition can exacerbate the other. OSA can lead to hypertension through various mechanisms, including:

• Intermittent hypoxia (low oxygen levels)
• Increased sympathetic nervous system activity
• Oxidative stress
• Inflammation
• Endothelial dysfunction

Moreover, people with OSA are at an increased risk of developing other cardiovascular complications, such as type 2 diabetes, atrial fibrillation, stroke, and heart attacks.

Risk Factors and Treatment Options for Obstructive Sleep Apnea

Understanding the risk factors associated with OSA is crucial for early detection and prevention. While some risk factors are beyond our control, others can be modified through lifestyle changes.

Who is at risk for developing OSA?

Several factors can increase an individual’s likelihood of developing obstructive sleep apnea:

• Obesity: Excess weight, particularly around the neck and throat, can put pressure on the airways
• Age: OSA is more common in individuals over 40
• Gender: Men are more likely to develop OSA than women
• Family history: Genetic factors can play a role in OSA development
• Smoking and alcohol consumption: These habits can contribute to airway inflammation and muscle relaxation
• Certain medications: Some drugs can affect breathing patterns during sleep

How is OSA treated?

Treatment for OSA typically involves a multifaceted approach, which may include:

1. Continuous Positive Airway Pressure (CPAP) therapy: This is often the first-line treatment for moderate to severe OSA
2. Lifestyle modifications: Weight loss, smoking cessation, and reducing alcohol intake can significantly improve OSA symptoms
3. Positional therapy: Using special devices to encourage side sleeping can help reduce airway obstruction
4. Oral appliances: Custom-made devices can help keep the airway open during sleep
5. Surgery: In some cases, surgical interventions may be necessary to address anatomical issues contributing to OSA

Strategies for Improving Sleep Quality and Duration

Ensuring adequate sleep is crucial for maintaining optimal blood pressure levels and overall health. While individual sleep needs may vary, most adults require around eight hours of quality sleep per night.

How can you improve your sleep habits?

Implementing good sleep hygiene practices can significantly enhance both the quality and quantity of your sleep:

• Establish a consistent sleep schedule: Go to bed and wake up at the same time every day, even on weekends
• Create a relaxing bedtime routine: Engage in calming activities like reading, gentle stretching, or meditation before bed
• Optimize your sleep environment: Ensure your bedroom is dark, quiet, and cool
• Limit screen time before bed: The blue light emitted by electronic devices can interfere with melatonin production
• Avoid caffeine, alcohol, and large meals close to bedtime
• Exercise regularly, but not too close to bedtime
• Manage stress through relaxation techniques or mindfulness practices

The Role of Ambulatory Blood Pressure Monitoring in Assessing Cardiovascular Risk

Ambulatory Blood Pressure Monitoring (ABPM) has emerged as a valuable tool for assessing cardiovascular risk and predicting potential health outcomes. This method involves wearing a portable blood pressure monitor for 24 hours or more, providing a comprehensive picture of blood pressure fluctuations throughout the day and night.

Why is ABPM superior to traditional blood pressure measurements?

Several studies have demonstrated the advantages of ABPM over conventional clinic-based measurements:

1. Better prediction of cardiovascular events: The Ohasama study found that ABPM was more accurate in predicting stroke risk compared to screening blood pressure measurements in the general population.
2. Enhanced assessment of treatment efficacy: The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) showed that ABPM was superior in predicting cardiovascular events in treated hypertensive patients.
3. Identification of nocturnal blood pressure patterns: ABPM can detect abnormal nighttime blood pressure patterns, such as non-dipping or extreme dipping, which are associated with increased stroke risk, particularly in older hypertensive individuals.
4. Comprehensive risk assessment: The Dublin Outcome Study demonstrated that ABPM measurements were superior to clinic blood pressure readings in predicting mortality risk.

By providing a more accurate and comprehensive assessment of an individual’s blood pressure patterns, ABPM enables healthcare providers to make more informed decisions regarding diagnosis, treatment, and long-term management of hypertension.

The Interplay Between Sleep, Blood Pressure, and Cardiovascular Health

The relationship between sleep and cardiovascular health is complex and multifaceted. Adequate sleep is not only crucial for maintaining optimal blood pressure levels but also plays a vital role in overall cardiovascular well-being.

How does sleep affect cardiovascular health beyond blood pressure regulation?

Sleep influences various physiological processes that impact cardiovascular health:

• Inflammation: Chronic sleep deprivation can lead to increased levels of inflammatory markers, which are associated with cardiovascular disease.
• Glucose metabolism: Insufficient sleep can impair glucose tolerance and insulin sensitivity, increasing the risk of type 2 diabetes, a known risk factor for cardiovascular disease.
• Lipid metabolism: Poor sleep quality and duration can negatively affect lipid profiles, potentially leading to dyslipidemia.
• Autonomic nervous system function: Sleep plays a crucial role in maintaining the balance between the sympathetic and parasympathetic nervous systems, which is essential for cardiovascular health.
• Endothelial function: Adequate sleep is necessary for maintaining healthy endothelial function, which is crucial for proper blood vessel operation.

By addressing sleep issues and promoting healthy sleep habits, individuals can significantly reduce their risk of developing hypertension and other cardiovascular problems. Healthcare providers should consider incorporating sleep assessment and management into their overall approach to cardiovascular risk reduction and treatment.

As research continues to uncover the intricate connections between sleep, blood pressure, and cardiovascular health, it becomes increasingly clear that prioritizing quality sleep is an essential component of maintaining a healthy heart and circulatory system. By understanding the importance of nocturnal dipping, addressing sleep disorders like OSA, and implementing strategies to improve sleep quality, individuals can take proactive steps towards better cardiovascular health and overall well-being.

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 ,
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Good afternoon Obstructive sleep apnea syndrome (OSA.