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Sleep Problems and Pulmonary Hypertension

Updated on October 27, 2021
Medically reviewed by
Allen J. Blaivas, D.O.
Article written by
J. Christy McKibben, LPN

Pulmonary hypertension (PH) is one type of high blood pressure affecting the arteries in the right side of the heart and the lungs. One common symptom of PH is difficulty sleeping. Many people with PH report having trouble falling and staying asleep — as one myPHteam member wrote, “I am lucky if I get four to five hours of sleep at night, and I have sometimes gone all night with no sleep.”

PH may occur alongside several sleep disorders, including insomnia and obstructive sleep apnea (OSA). These disorders can interfere with your ability to get a good night’s sleep. It is important to understand the connection between sleep problems and PH, including why they occur and how they can be managed.

What Is Pulmonary Hypertension?

PH refers to hypertension (high blood pressure) in the arteries that carry blood from the right side of the heart to the lungs (pulmonary arteries). PH occurs when the pulmonary arteries narrow and harden, making it harder for blood to flow through them. High pulmonary artery pressure forces the heart to work harder to pump blood through the arteries, causing it to weaken.

PH may also occur in association with other diseases, including lung disease and heart disease. After a while, PH may lead to right heart failure.

What Causes Sleep Problems in Pulmonary Hypertension?

Sleep problems in PH are usually caused by insomnia or obstructive sleep apnea.

Insomnia

Insomnia is a very common sleep disorder. People who have insomnia cannot stay asleep, fall asleep, or get quality, restful sleep. Over time, a lack of quality sleep may lead to some health problems such as hypertension, diabetes, and weight gain or obesity.

Symptoms of insomnia may include:

  • Feeling fatigued during the day
  • Waking up during the night
  • Having a hard time falling asleep at night or getting back to sleep if you’ve woken up
  • Problems with memory or concentration
  • Depressed or irritable mood

One study found that 13 percent of people with pulmonary arterial hypertension, a type of PH, had clinical insomnia.

Obstructive Sleep Apnea

OSA can be a very serious sleep disorder. There are a few kinds of sleep apnea, and OSA is the most common. Apnea refers to a 10-second or longer pause in breathing. In OSA, a person’s breathing starts and stops repeatedly during sleep. It generally occurs when the throat muscles relax, blocking the airways.

The resulting halt in breathing causes oxygen desaturation (a drop in blood oxygen levels). A low level of oxygen in your blood is called hypoxemia, and an oxygen saturation level below 90 percent is typically considered harmful.

In many cases, a bed partner or someone else in the home recognizes the signs of OSA. Many people who have OSA aren’t initially aware of it, and they have no complaints about their sleep. Eventually, however, severe OSA can cause considerable sleep disruptions. It can also lead to insomnia and leave a person feeling fatigued or sleepy throughout the day.

PH frequently occurs alongside OSA. Some research on the prevalence of PH in OSA has found that between 17 percent and 53 percent of people with sleep apnea develop pulmonary hypertension, as well. OSA is commonly linked with left ventricular dysfunction, in particular. This dysfunction can interfere with pumping blood to the rest of the body.

PH and OSA share two common risk factors: aging (which cannot be controlled) and obesity (which often can be controlled). Untreated sleep apnea or other types of sleep-disordered breathing may contribute to the development or progression of PH, as well. PH often improves when OSA is treated. The more serious the PH case is, the better the response to continuous positive airway pressure (CPAP) will be — a therapy for OSA that helps keep the airways open during sleep.

The Impact of Sleep Problems on Those With PH

Our bodies rely on getting enough high-quality sleep to function normally. Living with sleep disorders like OSA and insomnia can interfere with a person’s ability to get quality sleep, leaving them exhausted or moody during the day.

As one member explained, “I have chronic insomnia. The only thing that helps me is Lunesta. I know some really don’t understand because they don’t have it. However, not being able to sleep soundly and sleep in a pattern is awful.”

Some members share their difficulties with waking up during the night: “I sleep two hours,” wrote one member, “then I’m awake. Get back to sleep, then awake another two-hour window. It goes on all night.” Another member wrote, “Insomnia is a regular occurrence for me. I got up at 12:45 a.m. Slept again from 3 to 4:20 a.m. Have been up ever since.”

One member shared the anxiety they experience in tandem with insomnia: “I also have recurrent insomnia, and it seems my anxiety goes high at night. I don’t know if I’m afraid I’m going to stop breathing or what.” Another member shared these sentiments: “My problem is staying asleep. I get anxiety at night,” they said.

Managing Sleep Problems With PH

Members of myPHteam have shared a great deal of information about what living with sleep problems and PH is like. Here are some of their recommendations along with expert tips to help you get a better night’s sleep with PH.

Continuous Positive Airway Pressure

CPAP is a treatment for sleep apnea. CPAP machines work by delivering positive air pressure to help keep the airways open while the user sleeps. When you use the CPAP machine, you wear a mask or other device over your nose and mouth (or just your nose). A tube connected to the machine’s motor delivers air pressure to the mask to help support breathing.

Many myPHteam members use CPAP machines to treat their sleep apnea and help them sleep better at night. “That first night of sleep with my CPAP machine was years ago,” wrote one member, “and I still remember how good it was and how much better I felt.”

Another member shared, “I have been on a CPAP machine for a few weeks after being diagnosed with moderate sleep apnea. I have noticed a remarkable difference. I’m now sleeping practically through the night without interruptions.”

Note that not everyone feels the benefits of a CPAP machine right away. “It took me the better part of the first year to get used to the CPAP and have the results of using it,” a member commented. “I was more tired and felt more sick. You and your body just have to acclimate to it to achieve the desired results.”

Melatonin

Many myPHteam members say that they take melatonin, a natural sleep aid, to help induce sleep before bed. One member shared, “I take 10 milligrams before I go to bed along with 50 milligrams of trazodone [an antidepressant used for poor sleep].”

Sleep Medications

Many members have shared that their doctors have prescribed them trazodone to help combat insomnia. This medication is typically used to treat depression and anxiety, but it can also be used to help manage difficulty sleeping. However, recent guidelines by the American Academy of Sleep Medicine do not support its use for insomnia. Consult your doctor if you have questions about taking trazodone.

Other members report success with eszopiclone (sold as Lunesta). Several other options are also available, so talk to your doctor if you think medication may be the right approach for you.

Saline Nasal Spray

For people with OSA, saline nasal spray may be used to keep the nasal passages open while sleeping. It’s important to ask your doctor before using over-the-counter decongestants or other treatments and remedies.

Sleep Positioning

A member of myPHteam shared this tip: “Sometimes, the position of your jaw slows down the airflow at the back of the throat. You might want to put a couple of pillows under your mattress to elevate your upper body just a little bit to increase the airflow when you fall asleep. I had to buy a small pillow to put beside my head so it wouldn’t turn to the left or right and slow my airflow.”

Try sleeping on your stomach or side if you can, rather than on your back. Sleeping on your back may cause the soft palate and tongue to rest against the back of the throat and block the airway.

Some mouthpieces push the lower jaw forward while sleeping to help keep the jaw in the right position to facilitate breathing. You can speak with your doctor to see if a mouthpiece might work for you.

Exercise

If you’re obese or overweight, losing weight can often help relieve airway constriction, improve OSA, and improve your overall quality of life. Exercise might also boost energy to reduce any sleepiness you have during the day. Strength training, aerobics, and yoga may help your condition if you’re able to do these activities regularly.

Stress Relief

Not everyone with PH has sleep apnea. For some myPHteam members, the biggest contributor to insomnia is stress. Meditation, deep breathing, and other calming activities may help if worry is keeping you up. You might also want to consider talking with a counselor or therapist who can help with any challenging emotions or anxieties.

Keep a Sleep Diary

It’s a great idea to keep a sleep journal to help your health care provider uncover the potential causes of your sleep problems. In this journal, you can record your sleep patterns, including:

  • How many hours of sleep you get
  • What time you go to bed
  • How many times you wake up during the night
  • Any naps you take
  • How you feel throughout your day

Don’t forget to write down symptoms you’re having (even if they seem to be unrelated), what you are eating, how much you are exercising, and any major life changes or stressors.

Find Your Team

On myPHteam, the social network for people with pulmonary hypertension, more than 46,000 members come together to ask questions, give advice, and share their stories with those who understand life with PH.

What treatments have you tried for your sleep problems? Share your experiences and thoughts in the comments below or by posting on myPHteam.

All updates must be accompanied by text or a picture.
Allen J. Blaivas, D.O. is certified by the American Board of Internal Medicine in Critical Care Medicine, Pulmonary Disease, and Sleep Medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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