A new study found that women who are experiencing poor sleep or having sleeping problems are more at risk of dying from cardiovascular disease – nearly twice that of peers of a similar age.
Being restless in bed can be caused by a host of problems, say scientists, from noise or light pollution to snoring.
Unconscious wakefulness, also known as cortical arousal, is a normal part of our shut-eye.
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It occurs spontaneously and is part of the body’s ability to respond to potentially dangerous situations – such as breathing becoming obstructed.
Pain, limb movements, trauma and temperature are triggers.
Now a clear link between the frequency and duration of the phenomenon and fatal illnesses has been established.
Women are particularly prone. Men’s risk of death from a cardiovascular condition increased by just over a quarter.
Study lead author Professor Dominik Linz, a cardiologist at Maastricht University in The Netherlands, said:
“A common trigger for nocturnal arousals is obstructive sleep apnoea when breathing stops and the arousal system ensures the activation of our body to change our sleep position and to reopen the upper airway.
“Another cause of arousals can be ‘noise pollution’ during the night by, for example, night-time aircraft noise.
“Depending on the strength of the arousal, a person might become consciously aware of the environment, but often that is not the case.
“Typically, people will feel exhausted and tired in the morning because of their sleep fragmentation but will not be aware of the individual arousals.”
The findings published in the European Heart Journal are based on 8,000 over 40s in the US.
They wore sleep monitors and were tracked for an average of six to eleven years – making it one of the most thorough investigations of its kind.
Previous research has shown having either too little or too much sleep is associated with increased risks of death from cardiovascular or other causes.
But it was not known if there was also a connection with the number of arousals and their duration, called the ‘arousal burden‘ – until now.
Women with an arousal burden of more than 6.5 percent had a 13 percent risk of dying from cardiovascular disease – nearly twice that of peers of a similar age.
They were also around 50 percent more likely to die from any cause – with rates rising from 21 percent in the general population to 31.5 percent.
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This was after taking into account other factors that could affect the results such as total sleep duration, age, medical history, BMI (body mass index) and smoking habits.
Men with an arousal burden accounting for more than 8.5 percent of their night’s sleep had up to 30 percent more risk of dying from heart disease or any cause.
Prof Linz said:
“It’s unclear why there is a difference between men and women in the associations but there are some potential explanations.
“The triggers causing an arousal or the body’s response to arousal may differ in women compared to men.
“This may explain the relatively higher risk of cardiovascular death in women.
“Women and men may have different compensatory mechanisms for coping with the detrimental effects of arousal.
“Women may have a higher arousal threshold and so this may result in a higher trigger burden in women compared to men.”
Older age, BMI, and the severity of sleep apnoea – a condition where the airways become blocked causing snoring – increase arousal burdens.
Prof Linz said:
“While age cannot be changed, BMI and sleep apnoea can be modified and may represent an interesting target to reduce arousal burdens.
“Whether this will translate into lower risks of dying from cardiovascular disease warrants further study.
“For me as a physician, a high arousal burden helps to identify patients who may be at higher risk of cardiovascular disease.
“We need to advise our patients to take care of their sleep and practice good sleep ‘hygiene’. Measures to minimize noise pollution during the night, lose weight and treat sleep apnoea could also help to reduce the arousal burden.”
Regular poor sleep is known to increase the risk of serious medical conditions including obesity, heart disease and diabetes.
Co-lead author Prof Mathias Baumert, of Adelaide University, said:
“In order to include assessment of arousal burdens into routine strategies for reducing the risk of cardiovascular disease, we need easily scalable, widely accessible, and affordable techniques to estimate the duration and fragmentation of sleep and to detect arousals.
“Wearable devices for measuring the activity and changes in breathing patterns may provide important information.”
The NHS says a solid night’s sleep is essential for long and healthy life. Failure to get the recommended seven to eight hours shortens life expectancy.
Professor Borja Ibanez, of the National Center of Cadiovascular Research in Madrid who was not involved in the study, said disruption of the body clock fuels fat accumulation in arteries.
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This can form into clots that cut off blood supply to vital organs – triggering a heart attack or stroke.
Prof Ibanez added:
“Many knowledge gaps on the relationship between sleep and CVD (cardiovascular disease) remain to be studied in the coming years.
“This study provides solid evidence supporting the importance of sleep quality for better cardiovascular health.
“Further evidence combining comprehensive sleep evaluation with biological sampling and long-term follow-ups will be desirable.
“What remains to be determined is whether an intervention aiming at improving sleep quality is able to reduce the incidence of cardiovascular events and mortality. While awaiting these trials, we wish you sweet dreams.”