When living a healthy life, especially when you have a disease like pulmonary hypertension (PH), focusing energy on assessing your pillars of health become very important. When combined with a medical treatment plan, maintaining strong pillars of health can greatly improve your quality of life. In this section we discuss the importance of good quality sleep.

Sleep is foundational to health and like water, oxygen, and food, is something that we cannot live without. Insufficient sleep is associated with a wide variety of health outcomes, including 7 of the 15 top causes of death in the USA (including high blood pressure, heart disease and strokes). The CDC recommends that adults get at least 7 hours of sleep for best health and wellbeing, however many people get insufficient sleep. In addition, sleep problems are common. More than 50 million adults in the US live with a sleep disorder based on data from the American Sleep Association. Poor sleep may be due to just not getting enough time asleep in bed. It can also mean getting poor quality sleep, such as in people who live with sleep apnea.

Sleep apnea is a disorder where people have episodes where they stop breathing at night. Most often this comes from the muscles in the throat (mainly the tongue) relaxing when people are going to sleep and this obstructs their breathing passages. This is called obstructive sleep apnea, and affects 50-70 million adults in the US, according to the American Sleep Association. At other times people may have an issue where their brain sometimes is involved in pauses in breathing at night (called central sleep apnea). When it occurs, sleep apnea may cause drops in oxygen levels during the night, which then places a stress/strain on the heart and blood vessels in the lungs to try to make up for this, raising the blood pressure in the lungs. This stressed state of sleep can also contribute to other health issues like non-pulmonary high blood pressure and type 2 diabetes, as well as depression, anxiety, poor concentration, and many aspects that can negatively impact a person’s quality of life.

How is sleep apnea diagnosed? Because sleep apnea and low oxygen levels at night can contribute to pulmonary hypertension, your PH team will talk to you about having a night oxygen test at home, or sometimes a sleep study, done either at home or in a sleep lab. This is to make sure that you get your healthiest quality of sleep possible.

Sleep apnea can be difficult to diagnose because people may believe that they “get plenty of sleep,” and actually spend 10-12 hours in bed each night. But in this case a lot of poor quality sleep may not make up for the fact that their sleep efficacy is not optimal and may be contributing to their pulmonary hypertension. Therefore, it is important to review a detailed sleep history and also do the appropriate testing for this possible contributing factor.

Treatment of sleep apnea usually involves wearing a mask with positive airway pressure (PAP) that helps push pressure into the breathing passages to open up the airways at night so they do not collapse. This can be continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), or another type of device. Devices and masks have evolved a lot over recent years to be more comfortable and therefore effective for the person living with sleep apnea.

Similar to working closely with your PH team to make sure you are on the best PH medications and have minimal side effects, it is crucial to follow closely with your sleep medicine team to make sure that you have the right equipment for you to be able to sleep your best sleep every night.

In addition to sleep apnea, good sleep hygiene is also important. This means practicing healthy habits so you can also get a good duration and quality of sleep. Good sleep habits include: avoiding caffeine in the afternoons, minimizing alcohol if that disturbs your sleep, avoiding a heavy meal right before bedtime, and - perhaps the hardest tip - avoiding screens in the 2-3 hours before bedtime. Bright lights signal to our brain that it is daytime, and in this day and age that includes computers and portable devices. Minimizing their use or at least dimming the screens to the lowest possible level for viewing can be helpful in preparing your brain for getting your best sleep. Getting regular sleep is also important. People who are shift workers and work at night, or people who alternate with night and day shifts, are more likely to suffer from health problems including diabetes and obesity. Therefore, it is best if you can get regular sleep, sleeping at night and being awake during the day.

For more information about sleep, check out our resources below and talk with your PH team to make sure your sleep has been assessed and you are sleeping as well as possible.

This information is intended for educational purposes only and not to be used to change or direct medical care. This information should not replace direction by your treating care team and all medical management should be directed by your PH treating physician and your care team.
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