Insomnia - often caused by heart disease

Going to the toilet at night with right heart failure

With right heart failure, blood builds up in the leg veins - the blood vessels that carry blood from the body towards the heart. Fluid then seeps through the bulging veins into the surrounding tissue, causing the legs to swell (oedema). At night, when the legs assume a horizontal position when lying down and are therefore relieved, the fluid flows back into the vessels and reaches the bladder. This causes the urge to urinate at night (nocturia), which disturbs sleep - especially if the bathroom has to be visited more frequently.

Left heart failure dictates lying position

If the left side of the heart is affected by the insufficiency, blood builds up in the pulmonary vessels, causing shortness of breath (dyspnoea), especially during exertion. However, shortness of breath can also be caused by obesity, insufficient exercise or, for example, chronic obstructive pulmonary disease (COPD), which may mask the presence of heart failure in those affected.
If, on the other hand, sufferers frequently toss and turn in bed at night or have the feeling that they need to elevate their upper body in order to sleep without coughing, pain or shortness of breath, it is advisable to consult a doctor, because: While the healthy heart is adjusted to the stronger blood flow from the body when lying down, this places a strain on the left side of the heart with heart failure, which pumps the blood into the systemic circulation. This is all the greater if the affected person is lying on the left side of the body. For a quieter night, lying on the right side of the body is therefore recommended.

Obstructive sleep apnoea interrupts sleep phases

People with heart failure often also experience breathing disorders at night, known as sleep apnoea - obstructive sleep apnoea is the most common form. It is characterized by snoring and nocturnal mouth breathing. During the course of the night, the pharynx repeatedly narrows, which means that an adequate supply of oxygen is no longer possible during these periods. The lack of oxygen in the brain triggers a stress reaction with hormone release, which disturbs sleep several times a night. Mouth breathing also dries out the mucous membranes and provokes night-time coughing fits. These regular interruptions to sleep encourage the development of high blood pressure (hypertension).

Heart valve disease - cause of insomnia?

Other heart diseases that can cause disturbed sleep are various heart valve defects, such as narrowing (stenosis) or leakage (insufficiency) of the aortic or mitral valves. If these conditions are advanced, you may experience shortness of breath or a chesty cough even when lying down - both of which are disruptive to healthy sleep.
If mitral valve regurgitation has been diagnosed, for example, it can be treated with the MitraClip™ as part of a minimally invasive procedure. This is a clip that is advanced via a catheter through the leg vein from the groin to the right atrium and through the cardiac septum to the left atrium. Here, the MitraClip™ supports the diseased heart valve by bringing the leaflets together so that the valve closes tightly again. This gentle procedure could have a positive effect on sleep disorders.
If the aortic valve is narrowed (aortic valve stenosis), it can be replaced using a gentle, minimally invasive procedure. The TAVI procedure (transcatheter aortic valve implantation) is suitable for people who

• live with concomitant diseases,
• have a medium to high surgical risk,
• are of advanced age or
• are frail.

In this procedure, the surgeon does not replace the defective aortic valve, but replaces it with a biological aortic valve made of animal tissue (such as the Navitor™ valve) folded into a fine tubular metal mesh. This is advanced into the heart via the inguinal artery to the defective aortic valve using a catheter. As soon as the new aortic valve is correctly positioned, it immediately takes over the function of the old one. The symptoms often subside after the procedure, meaning that sleep disorders can also improve.

Restful sleep is important for heart health. However, if this is already compromised, a diseased heart can in turn be the cause of problems falling asleep and sleeping through the night and further damage the heart. Although the urge to urinate at night, coughing fits or shortness of breath can occur for various reasons, they regularly disturb your night's sleep and should be investigated by a doctor.

With the practical symptom check, you can quickly test whether you have symptoms and limitations that indicate heart failure. With the help of a total of 12 questions, the symptom check creates an individual health profile for you, which you can also print out and bring with you to your next visit to the practice.