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Can you suffer a heart attack while sleeping?

While it is commonly known that heart attacks are more likely to strike early in the morning, can they occur when a person is asleep?

The rising incidence of heart attacks has been a cause of concern globally. In an earlier interaction with, Dr Subhendu Mohanty, Head and Senior Consultant, Sharda Hospital said that cardiac arrest and heart attack are becoming more common in the younger age group today than it was 10-15 years back. “In the last two years or so, there have been rising incidences, so much that we have seen heart attacks in those aged 18 and 20 also,” he said.

While it is commonly known that heart attacks are more likely to strike early in the morning, can they occur when a person is asleep? “Yes, heart attacks can happen while sleeping,” Dr Keshava R, Director – Interventional Cardiology, Fortis Hospital, Cunningham Road, Bangalore said.

Agreeing, Dr Guru Prakash A, Consultant Interventional Cardiologist, Yashoda Hospitals Hyderabad said that heart attacks can happen in sleep in around 10 per cent of patients, especially during early morning hours when catecholamine [a neurohormone] surge is high. “It is common among elderly, diabetics, obese, hypertensive, and people with obstructive sleep apnea.”

Before we understand how heart attacks can happen while sleeping, it’s crucial to know the science behind their occurrence. “The most common cause of heart attacks is a buildup of plaque in the coronary arteries, which can eventually rupture and cause a clot to form. Other risk factors include high blood pressure, diabetes, smoking, and a family history of heart disease,” Dr Keshava added.

Further, Dr Sibashish Dey, Head of Medical Affairs, South Asia, ResMed, explained the science behind heart attacks that occur when one is asleep. “When we sleep, all of our muscles relax, including those in the neck and throat. If you have excess neck tissue, this can put pressure on your airway and cause it to collapse. As your airway collapses, the path air takes to get to your lungs narrows and has to squeeze through instead of moving freely. This will cause you to snore or even temporarily stop breathing while you sleep — up to hundreds of times each night,” he said, adding that constantly depriving your body of oxygen each night has a tremendously negative impact on your body.

Another possible reason behind heart attacks while sleeping is the chronic obstructive sleep apnea disorder. “Normally, your blood pressure falls at night. If you have sleep apnea, your blood pressure may not fall, which can lead to high blood pressure. Every time your oxygen level drops, this raises your blood pressure and causes an adrenaline surge. This puts increased stress on your heart because it has to work harder to normalise your blood pressure. The connection doesn’t end there. High blood pressure can lead to other consequences like heart attack and stroke,” Dr Dey said.

This has been corroborated by several studies, including the one published in the American Journal of Cardiology, which states that sleep apnea is frequently observed in patients with heart failure. It has further been found to be associated with about 52 per cent of cases of type 2 diabetes mellitus, 80 per cent of cases of resistant hypertension, 77 per cent of cases of obesity and 50-60 per cent in various cardiovascular diseases.

“Sleep apnea patients have blood pressure that is frequently elevated and also has a tendency to reduce cardiac output and may promote the progression of heart failure,” he said.

An inadequate sleep schedule can also put one at risk of having a heart attack during sleep. “While sleeping less for a day or two can be endurable, consistently skipping sleep can cause serious health issues and exacerbate some existing conditions. Heart health and well-being are significantly influenced by sleep. Atherosclerosis, or the buildup of lipids, cholesterol, and other substances on and within the walls of blood vessels, is linked to poor sleep quality and frequent short sleep increases the cardiovascular event risk,” Dr Dey said.

Now that it’s established that heart attacks are common during sleep, experts advise following certain preventive measures to avoid their occurrence. Dr Keshava suggested maintaining a healthy lifestyle, including eating a healthy diet, getting regular exercise, not smoking, and managing any chronic health conditions such as high blood pressure and diabetes. “It is also important to manage any sleep disorders and to get enough sleep on a regular basis,” he said.

Sharing some tips for better sleep health, Dr Dey said that regardless of whether your cardiovascular health is in great condition, getting a good night’s sleep is essential. “The energy levels, the ability to think clearly, and overall health are all improved by sleep,” he said.

*Employ relaxation techniques: Some helpful methods for people include deep breathing, yoga, gentle stretching, and mindfulness meditation.

*Regularly engage in physical activity: Exercise on a regular basis helps people sleep better at night but avoid it shortly before bed.

*Establish a regular sleeping schedule: One of the most effective approaches to promote sound sleep is to keep the same bedtime and wake-up time every day.

*Diagnosing sleep disorders: People who experience typical sleeping problems like obstructive sleep apnea or insomnia are also far more likely than the general population to experience heart arrhythmias, plaque build-up, heart failure, and coronary artery disease. Diagnosing disorders and managing disorders is essential to improve sleep quality.

*Acquire adequate daylight: Sunlight causes our bodies to make melatonin, a natural hormone that helps keep your sleep-wake cycle regular and one should avoid artificial light, especially in the hours before going to bed.

*Minimise sleep-interfering stimulants: Alcohol, foods high in fat or sugar and caffeine ought to both be prevented at night because they can both disrupt sleep. The use of electronic devices excessively could interfere with sleep.

*Managing anxiety and stress: Stress from the day can make it difficult to go to sleep. Individuals will have the ability to sleep better when they are productive and optimistic.

*Create a comfortable sleeping space: Make sure the room is dark and quiet, has a comfortable temperature, and meets the demands for temperature and comfort.

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