Sleep problems are common in people living with pulmonary arterial hypertension (PAH). One member of myPHteam shared, “It can be a bit overwhelming. Feeling tired, not sleeping well, and all the other symptoms that make up this disease.”

Another said, “My sleep is totally out of whack. Sometimes I sleep, and sometimes I don’t.”

Since sleep is essential for your health, it’s important to understand the connection between PAH and sleep. That way, you can get the right treatment, sleep better, manage your PAH symptoms, and slow disease progression (worsening).

How Is PAH Connected to Sleep and Sleep Problems?

Research has found that people with pulmonary arterial hypertension are likely to experience problems sleeping, including poor sleep quality and sleep disorders. If you’re living with PAH, it’s important to pay attention to how you’re sleeping and discuss any issues with your healthcare provider.

Some scientists also believe that sleep apnea — a type of sleep disorder — may contribute to the development of PAH in some people. This idea is still debated, but if you have sleep apnea, talk to your doctor about whether it could affect your risk of other health conditions like PAH.

Pulmonary Arterial Hypertension and Poor Sleep

PAH can interfere with sleep in several ways. Even if you have PAH, you may not have all of these symptoms, but knowing about them can help you spot problems early.

Shortness of Breath

Feeling short of breath — like you can’t get enough air, no matter how hard you try — is a common PAH symptom. Even if you don’t notice shortness of breath at night, it could still be disturbing your sleep. Studies show that people who struggle with shortness of breath during the day have a higher chance of sleeping poorly at night. If you’re often short of breath during your waking hours, talk to your doctor about how your breathing might be affecting your sleep, too.

People who are short of breath during the day have a higher chance of sleeping poorly at night.

Nocturnal Hypoxemia

Some people living with PAH might not get enough oxygen at night. This is called nocturnal hypoxemia. As many as 89 percent of people with PAH may experience nocturnal hypoxemia at some point in their lifetime.

Nocturnal hypoxemia can be caused by sleep apnea or other conditions. If you’re not getting enough oxygen at night, you might wake up frequently or find that you don’t feel rested when you wake up, even if you feel like you slept well.

Pulmonary Arterial Hypertension and Sleep Disorders

Pulmonary arterial hypertension is also connected to several sleep disorders.

Sleep Apnea

If you’re diagnosed with sleep apnea, it means your breathing repeatedly stops and starts throughout the night. There are two main types of sleep apnea:

• Obstructive sleep apnea (OSA) — OSA happens when throat muscles relax and block your airway.
• Central sleep apnea (CSA) — CSA happens when your brain doesn’t send proper signals to your body to keep breathing.

It’s unknown how many people with PAH also have sleep apnea. In one study, 71 percent of those with a PAH diagnosis had some form of sleep disordered breathing, a category that includes both types of sleep apnea as well as other sleep problems.

Sleep apnea can lead to high blood pressure and heart problems, both of which can affect PAH symptoms. While some researchers consider sleep apnea a cause of PAH, this connection isn’t fully proven. More research is needed to understand the connection between sleep apnea and PAH.

Restless Legs Syndrome

Restless legs syndrome (RLS) causes overwhelming urges to move your legs due to uncomfortable feelings. Moving them usually brings some relief, even if just for a short time.

People with PAH may be more likely to experience restless legs syndrome. Even if you aren’t dealing with other problems like sleep apnea or shortness of breath at night, RLS can make it hard to get restful sleep.

People with PAH may be more likely to experience restless legs syndrome, which can disrupt your sleep.

Insomnia

Insomnia is when you struggle to fall or stay asleep, or when you wake up too early and can’t get back to sleep. One study found that 13 percent of people living with PAH also experience insomnia.

Insomnia can happen on its own, or it may be caused by conditions like shortness of breath while sleeping or sleep apnea. For example, if you don’t have enough oxygen or you feel short of breath, it may be hard to fall asleep, stay asleep, or go back to sleep. Similarly, if you keep having to move your legs to relieve your discomfort, it may be hard to relax into sleep.

Insomnia may also be connected to stress, irregular sleep schedules, poor sleeping habits, certain medications, and more. If you experience problems falling or staying asleep, talk to your healthcare provider. They can help identify the underlying causes and get you the treatment you need.

Treating Sleep Problems Associated With Pulmonary Arterial Hypertension

Addressing sleep issues does more than improve rest when you’re living with PAH — it can also help you feel better and improve your quality of life. That’s why it’s important to talk to your doctor about sleep troubles, as they can evaluate you for specific conditions and recommend tailored treatments. Your treatment plan may include some of the following.

Managing PAH

Since PAH symptoms often disrupt sleep, treating the condition often helps you feel and sleep better. There is a variety of medications your healthcare provider may prescribe. They will choose the best PAH medication or combination of medications for you, based on your test results and needs.

Treating Sleep Apnea

If you have sleep apnea, your cardiology team may give you a continuous positive airway pressure (CPAP) machine. The CPAP machine helps keep your airway open at night so nothing gets in the way of the flow of oxygen. Many people living with PAH find this treatment helpful. One myPHteam member noted, “Most people I know end up on a CPAP machine to assist in breathing.”

CPAP therapy only helps with obstructive sleep apnea. If you have central sleep apnea, where your breathing signals from the brain aren’t being sent to your body properly, you may need another type of treatment. Your doctor can help you find an option that will help.

“Most people I know end up on a CPAP machine to assist in breathing.” — A myPHteam member

Using Oxygen Therapy

Supplemental oxygen may help you breathe better at night, which can also help with central sleep apnea. This type of therapy helps maintain your oxygen levels so you don’t feel like you’re short of breath.

Improving Your Sleep Hygiene

If you and your doctor find that your bedtime habits are contributing to your sleep problems, they may suggest you improve your sleep hygiene. This means having a healthier set of habits around sleep. Key sleep hygiene factors include:

• Sleep and wake times
• The temperature and darkness of your bedroom
• What activities you do (including eating and drinking) close to bedtime
• How you structure your day

Improving your sleep hygiene can make it easier to fall asleep, stay asleep, and go back to sleep if you wake up in the night.

Seeing a Sleep Specialist

If you need additional help sleeping, your doctor may send you to a sleep specialist. They can help figure out what is preventing a good night’s rest. Then, they can help you create a personalized plan to help you sleep better. They’ll monitor your progress until your sleep improves and you’re getting the rest you need. If possible, look for a sleep specialist who works with people with PAH regularly.

Talk With Others Who Understand

On myPHteam, more than 84,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension, including pulmonary arterial hypertension.

Are you experiencing sleep issues related to PAH? How do you manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.