Heart failure sleeping position

Five Ways to Sleep Well and Protect Your Heart

  • Have a consistent bedtime routine.

    Try to go to bed and wake up at approximately the same time every night. Wear special sleep clothes (or simply an undershirt and understhorts) rather than sleeping in the same clothes you wore while awake (even if they’re your comfortable jogging sweats). These things provide cues to tell your brain it’s time to sleep, Salas says.

  • Keep potential sleep-stealers out of the bedroom.

    “Sleep environment is a huge factor in getting good sleep,” Salas says. Lights and electronics are among the worst offenders. Avoid having a TV or computer in your bedroom, or reading at night with an e-reader 30 minutes before you turn in. If you’re prone to allergies (which can cause a stuffy nose, breathing through the mouth, and a constant need to wake up and drink water), remove the carpets or vacuum them regularly and change bed sheets weekly so dust doesn’t accumulate and bother you. Ask your doctor about taking antihistamines.

  • Drink less, exercise more.

    Avoid a nightcap: It’s a myth that alcohol will help you sleep better. Daytime caffeinated beverages matter too. It can take your body six hours or longer to rid itself of caffeine. Getting exercise during the day can help ready you for nighttime sleep. (Just get your health care provider’s OK before starting any new exercise program.)

  • Know that sleep and heart health work both ways.

    If you’re already being treated for heart issues, you may experience worse sleep as a result. The timing of medications such as beta blockers, for example, can impact your sleep, Salas says. Pain can also worsen sleep, and a condition such as heart failure can make it difficult to lie flat. Report sleep problems to your heart care team to look for solutions.

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    Is Left or Right Side Sleeping Best for Your Heart?

    Most of my cardiac patients sleep better on their right side. \xC2\xA0Is right side sleeping best for your\xC2\xA0heart? \xC2\xA0In this article, I discuss the science of behind right versus left side sleeping.

    Gravity and Left vs.\xC2\xA0Right Side Sleeping?

    Gravity plays a role in where the heart goes during sleep. \xC2\xA0For example, if you sleep on your left side, then gravity will pull your heart toward your chest wall. \xC2\xA0In contrast, gravity pulls the heart toward the center of the chest with right side sleepers. This subtle change in where gravity pulls your heart may affect symptoms, cardiac output, or even your heart rate.

    Why Back Sleeping is Probably Bad for the Heart

    If you are carrying any extra weight, back sleeping is definitely bad for your heart. \xC2\xA0This is because when you sleep on your back, the extra weight collapses your airway (sleep apnea). \xC2\xA0And studies show that sleep apnea dramatically increases your risk of heart failure and atrial fibrillation.

    Stomach sleeping is another possibility. \xC2\xA0However, as I have learned personally, stomach sleeping is a perfect recipe for neck and back issues.

    4 Reasons to Sleep on Your Right Side

    If you suffer from heart issues, talk with your doctor about whether you should sleep on your right or left side. \xC2\xA0Based on the science, here are four reasons why you may want to consider sleeping on the right.

    1. \xC2\xA0Less Shortness of Breath

    As far back as 1937 doctors have noted that heart patients breath better sleeping on their right side. \xC2\xA0Indeed, the worse the cardiac function, the more likely people are to sleep right side down. \xC2\xA0While the reason for this isn’t entirely clear, it may have to do with a better venous return and lower pressures within the heart and lungs.

    2. Better Cardiac Output

    For the same reasons as number one above, cardiac output may be better with right side sleeping. \xC2\xA0Once again, gravity pulling the heart toward the center of the chest may optimize cardiac performance.

    3. Fewer Palpitations

    No one likes the sensation that their heart isn’t\xC2\xA0beating correctly. \xC2\xA0As the heart is in the center of your chest with right-sided sleeping, studies show that palpitations become much less noticeable. \xC2\xA0In contrast, when you are on your left side, the heart is pulled to the chest wall, and you may feel every irregular beat of your heart.

    While many atrial fibrillation patients have noted that they have fewer arrhythmias when sleeping on the right side, I could find no studies supporting this finding. \xC2\xA0Thus, when it comes to sleeping and arrhythmias, I suggest sleeping in whatever position that seems to help.

    4. Lower Heart Rate and Less Sympathetic Nervous Activity

    The sympathetic nervous system is the fight or flight response. \xC2\xA0This fight or flight response makes the heart rate and blood pressure go up.

    For most of my patients, sympathetic nervous system stimulation makes their heart failure, chest pain, or arrhythmias worse. \xC2\xA0And when it comes to sleeping and sympathetic stimulation,\xC2\xA0studies show that right-sided sleeping may be better.

    3 Reasons to Sleep on Your Left Side

    Not everyone does best with right side sleeping. \xC2\xA0In fact, there are three distinct groups of people that may do worse.

    1. Acid Reflux Sufferers

    People suffering from acid reflux may sleep better on their left side. \xC2\xA0This is because studies show that acid reflux may be worse with right side sleeping. \xC2\xA0Thus, if your acid reflux is causing you more symptoms than your heart, you may want to consider sleeping on your left side.

    2. Vagus Nerve Arrhythmias

    The vagus nerve connects the heart, brain, and gut. \xC2\xA0Because of this connection, vagus nerve activation may be an important cause of arrhythmias.

    With vagus nerve stimulation, you get increased parasympathetic activity which is the exact opposite of the fight or flight response with sympathetic stimulation. \xC2\xA0Thus, to quiet your vagus nerve at night, studies suggest that you may want to try sleeping on your left side.

    3. Too Slow of a Heart Rate at Night (Bradycardia)

    If you have ever worn a heart monitor, your doctor may have told you that your heart beats too slow at night. \xC2\xA0If this is the case, sleeping on your left side could stimulate a sympathetic response and increase your heart rate.

    Does it Really Matter Which Side You Sleep On?

    For those of you who suffer from sleep issues, you may be asking does it matter which side is down? \xC2\xA0I know for myself that I feel incredibly grateful for a great night of sleep regardless of which side is down. \xC2\xA0Indeed, trying to force sleep on my right or left side would only intensify my insomnia.

    Thus, I can’t definitively answer the question, is left or right side sleeping best for your heart. \xC2\xA0The answer is a personal choice based on your specific situation and what feels best for you.

    Do you prefer sleeping on the right or left side? \xC2\xA0Please leave your thoughts and questions below. \xC2\xA0For questions, please be patient as it may take me a few weeks to post a response.

    Want to read more about sleep optimization? \xC2\xA0Please check out this article I wrote called 10 Ways to Cure Insomnia without Medications.

    Understanding Pericarditis – Inflammation of the Heart Sac

    jlgentry: Is it important to investigate the cause of pericarditis? I know sometimes it has no cause but is it important to test to see if it is viral, bacterial, fungal etc. My husband was diagnosed with Pericarditis and then told after several weeks he had no symptoms so it must have been resolved. He then had a severe episode of chest pain and fever and he now has been diagnosed with a pericardial effusion. Should the fluid be tested for cause? Also his C reactive protein came back 210.8 – does this indicate there is something larger going on?

    Allan_Klein,_MD_: Your husband has a classic case of recurrent pericarditis. The elevated C-reactive protein, pericardial effusion and chest pain is very common. He needs to be evaluated and put on anti-inflammatories to manage this situation – otherwise this will keep recurring.

    sandi: In Jan. I had a very bad attack of pericarditis, called 911 and passed out. EMT’s told me that my blood pressure bottomed out and they couldn’t give me nitroglycerin. They thought it was a bad heart attack. It was during the cath lab that they said it was pericarditis. I had never heard of that before. The pain was worse than my heart attack 15 yrs. ago when I had bypass. The pain from pericarditis lasted three weeks. I was concerned when they said it could come back. What can I do to avoid it? Can you die of pericarditis? The info I pulled up on the Cleve. Clinic website was very informative but didn’t answer all my questions.

    Allan_Klein,_MD_: Over 30% of the time, the pericarditis can come back – this is called recurrent pericarditis. You can manage it by staying on low doses of anti-inflammatories.

    BETHELMOM: 1. What to do if colchicine, prednisone, and Aleve do not work – allow another flare?
    2. Does each flare up weaken/damage your heart? What are long term effects?
    3. Can having a baby help with pericarditis or make it worse?
    4. How much is too much exercise?
    5. Can diet cause a flare?
    6. What causes a flare?
    7. Is it normal to get tightness in your chest when decreasing the prednisone?
    8. Is it normal to occasionally feel tightness in your chest after you exercise or when doing too much the day after doctors have been trying to wean my daughter off the prednisone since August, 2011. Every time she gets down to 5MG, she flares up. We are not sure if is due to actual flare up and pericarditis returning or her body reacting to coming off the prednisone – body is too use to it. What is your opinion on this as well? Thank you very much! BETHELMOM

    Allan_Klein,_MD_: It appears your daughter has a bad case of recurrent pericarditis that is steroid dependent. In this case, she may need to go on a fourth medicine such as Imuran. Unfortunately exercise during flair up is not a good thing because it increases the heart rate and the pericardium could be irritated. Definitely she should come to a pericardial center of excellence for evaluation. I have no information on having babies and pericarditis. The pain may come back for several reasons – one is the weaning of the medicines or possible reactivation of the initial viral insult or other reasons. The reason why the flair up comes back could be from the decreasing the prednisone – the body needs it as well as, reactivation of the initial incident.

    norsky: I am a 55 y/o woman, very fit, ultra marathon runner, who was diagnosed with severe mitral regurgitation last fall and had minimal invasive open heart surgery, Nov 2013 to repair. Three weeks later I developed chest pain and SOB, was diagnosed with pleurisy and pleural effusion, treated with Prednisone. Symptoms returned as soon as course ended, new Prednisone course given. Symptoms returned, this time severe and pericarditis and pericardial effusion also diagnosed. Treated w/Prednisone 40mg, tapered over four months and Colcrys 0.6mg BID. Both meds stopped together. Severe symptoms returned three days later (early June). Back on Prednisone, Colcrys, and added 800mg Ibuprofen TID. Now tapering Prednisone 1mg/month from 10mg, still on Ibuprophine and Colcrys. Sedrate, CRP and EKG normal at this point but still have chest pain and SOB and exercise intolerance. Ht 5.7, pre surgery weight 120lbs, now 138lbs Feeling frustrated that symptoms still present and limit activities. Any suggest?

    Allan_Klein,_MD_: We would love to get you back to marathon running. My suggestion is to very slowly taper your prednisone as you are doing and continue your ibuprofen and colchicine. We can offer evaluation to stage where you are in your disease process. Unfortunately at this time on these medicines, marathon running is out of the question. The pericarditis has to heal after the open heart surgery and this does take months. We would be glad to evaluate you since we see a lot of patients with pericarditis after open heart surgery – and athletes. You definitely should have echo, MRI, and very frequent inflammatory markers measured.

    BPT: How common is it for pericarditis to recur without a comorbid autoimmune or heart disease? If it recurs multiple times (>5), what is the plan of care? What is the best schedule and timeline of drug treatment assuming both bacterial and fungal causes have been ruled out? Is steroid treatment appropriate? Can pericarditis recur years after the first episode? Thank you!

    Allan_Klein,_MD_: It often recurs without auto-immune condition being detected. That is called auto-inflammatory. It can recur many years after the initial episode. The recurrent episodes have to be managed appropriately with often dual and sometimes triple anti-inflammatories.

    Constrictive Pericarditis

    an1000: A cardiologist told me recently that I may have signs of constrictive pericarditis (on echo), but it is not yet a confirmed diagnosis. I had quite lengthy pericarditis Sept-December 2012, and some remaining symptoms (decreased exercise tolerance, shortness of breath) until November 2013. During that last month I had quite a dramatic improvement, and now I feel well. I seem to be deconditioned, but I am exercising a lot and trying to regain my former high conditioning status. What should I know about constrictive pericarditis? What will be looked for and how? If it is mild, can I just ignore it? Does it necessarily progress? Might it go away? Are there things I can do myself to help? I am 72, but (aside from this illness) healthy, energetic, still working. Thank you.

    Allan_Klein,_MD_: Based on the echocardiogram in 2012, it sounds like you have a mild form of constrictive pericarditis that can be transient. This means that with the proper anti-inflammatories, the constrictive pericarditis can resolve. It is very important to follow on echo and often MRI to see if the constrictive pericarditis has progressed. From your history, it appears that you are regaining some of your strength. We would be happy to see you – in the last year we have seen over 100 patients with constriction.

    davel: This question pertains to constrictive pericarditis. After a pericardectomy, where the pericardium is removed, is there any permanent weakening of the heart that might affect one’s life span?

    Allan_Klein,_MD_: That could be a side effect of the pericardiectomy – it depends on whether the thickened pericardium and possible calcium extended into the muscle. In those circumstances, medicines may be needed to strengthen the heart.

    Pericardiectomy

    JunkforJoy: I have been suffering for 19 years with recurrent Pericarditis. I had a cardiac window many , many years ago. It did help for a while. Then the fluid started to go into my lungs, especially my left lung. I have flare ups occasionally. Could I be a candidate for the removal of my entire pericardium? I have been on prednisone so long. I have made it down to 5 mg each day, but can’t seem to get off no matter how slowly I go down. Plus I have osteopenia now. I am 57 years old. Would the operation be too difficult for me? And what type of Dr. should I look for? I live in NH. Thank you.

    Allan_Klein,_MD_: Definitely this should be evaluated at a pericardial center of excellence. At this point, due to your complications of prednisone and difficulty weaning off the prednisone, you are a candidate for a pericardiectomy. We have excellent cardiac surgeons, including Dr. Johnston, Lytle and Pettersson that specialize in pericardiectomy.

    interva: What are possible complications of Pericardectomy?

    Allan_Klein,_MD_: The people that do the best after pericardiectomy are those patients that have a viral cause or unknown cause (idiopathic). The people with the worst outcomes are those who have had radiation to the chest, such as Hodgkins. In between are those patients that had post-surgical constrictive pericarditis. Not unusually, patients will have to be on some type of diuretics after surgery for three – six months.

    JunkforJoy: I know pericardiectomy is usually performed for serious constrictive pericarditis, however I have recurrent pericarditis for almost 20 years now and want to know if this is a good option for me? I have to get off the steroids since they have played havoc with my bones, however I am struggling with going lower than 5 mg. right now due to the stress that is occurring taking care of my elderly parents. Thank you.

    Allan_Klein,_MD_: I can sympathize with your situation of having long standing recurrent pericarditis and the complications of steroids. You definitely may be a candidate at this stage for a pericardiectomy.

    Newsworthy: Is pericardium removal surgery risky? I read it is high risk with a five – eight percent fatality rate?

    Allan_Klein,_MD_: At Cleveland Clinic, it is lower than that. However, it really depends on the cause of the constrictive pericarditis. The best outcomes is when the etiology is idiopathic – the worst from radiation.

    Pericardium Calcification

    cahummellogee: Is calcification of the pericardium, due to past traumatic injury, ever progressive? And is it important to use imaging to know the extent of the calcification?

    Allan_Klein,_MD_: Yes often traumatic injury can cause progressive pericardial disease including constrictive pericarditis. The best imaging test should be a cardiac CT.

    Reviewed: 08/14

    This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.

    The goals of treatment include:

    • Reducing pain and inflammation
    • Treating the underlying cause, if it is known
    • Checking for complications

    Specific Types of Treatment

    First, your doctor may advise you to rest until you feel better and have no fever. He or she may tell you to take over-the-counter, anti-inflammatory medicines to reduce pain and inflammation. Examples of these medicines are aspirin and ibuprofen.

    Stronger medicine may be needed if the pain is severe. Your doctor may prescribe a medicine called colchicine and a steroid called prednisone.

    If an infection is causing your pericarditis, your doctor will prescribe an antibiotic or other medicine. You may need to stay in the hospital during treatment so your doctor can check you for complications. Symptoms of acute pericarditis can last from a few days to three weeks. Chronic pericarditis may last several months.

    Other Types of Treatment

    If you have serious complications from pericarditis, you may need treatments that require hospital stays.

    Cardiac tamponade is treated with a procedure called pericardiocentesis, in which a needle or a tube, called a catheter, is inserted into the chest wall to remove excess fluid in the pericardium.

    This relieves pressure on the heart.

    With constrictive pericarditis, the only cure is surgery known as a pericardiectomy to remove the pericardium.

    Can Pericarditis Be Prevented?

    Usually, acute pericarditis can’t be prevented. You can take steps to reduce your chance of having another acute episode, having complications or getting chronic pericarditis. These steps include getting prompt treatment, following your treatment plan and getting ongoing medical care as advised by your doctor.

    Living With Pericarditis

    Pericarditis is often mild and goes away on its own. Some cases, if not treated, can lead to chronic pericarditis and serious problems that affect your heart. It can takes weeks or months to recover from pericarditis. Full recovery is likely with rest and ongoing care, and this can help reduce your risk of getting it again.

    Also in this section:

    • What is Pericarditis?
    • Symptoms and Diagnosis of Pericarditis

    Learn more:

    • Angina Pectoris (Chest Pain)

    Source:

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    Plenty of animals can sleep upright, such as horses and various livestock.

    But what about people? According to a recent BBC News article, it’s possible but not always comfortable.

    “We can sleep in a chair. We can sleep standing up, but we are not as good at it as other creatures, for example birds,” Derk-Jan Dijk, a professor of sleep and physiology at the University of Surrey in England, told BBC News.

    The article looks at a group of Buddhist monks who during their four-year retreat spend nights sleeping upright for less than five hours. This position can be fine for quick nap, but when it comes to Rapid Eye Movement (REM) or “active” sleep, it becomes harder to remain upright.

    “In Rapid Eye Movement sleep we lose the tone in our muscles, which makes it difficult to stand up or even sit up,” Dijk told BBC News.

    However, the monks claim someone who is well-attuned can use their sleeping time to remain upright for meditation. Of course, sleeping upright is not recommended for everyone — just as sleeping for less than five hours a night isn’t recommended for everyone.

    Getting enough continuous quality sleep contributes to how we feel and perform the next day, but also has a huge impact on the overall quality of our lives.

    • Check out the BBC News article.
    • Learn more about how you can Let Sleep Work For You.

    How to Sleep Sitting Up

    When you have less stuff your life changes. One of the nicest changes is the option to travel. Not every minimalist is a dedicated world traveler—we don’t all change countries every few months or walk to Brazil. But there’s a reason travel and minimalism get mentioned in the same breath. Whether you’re a jetsetter or just take a once a year vacation, it’s simpler with less stuff weighing you down (at home, in your luggage, or on the credit card bill).

    But that doesn’t mean travel is always easy. I like to do whatever I can to lower the barriers. So when my sister Zangmo came to visit, I had some questions for her.

    Zangmo is a Buddhist nun. She just finished a lengthy retreat in a Tibetan monastery in New York. We had a lot of catching up to do but after seeing her room at the monastery I particularly wanted to know about her bed.

    She told me before entering retreat that Tibetan monks sleep sitting up. They even have a special “box” to sleep in at night. This lets them fall asleep facing their shrines and contributes to good meditation posture. To me, it also sounded like torture.

    Though she makes it look good.

    Better Living Through Sleepytime

    Zangmo told a different story. She told me that she feels healthier sleeping upright. She never gets a sore back or stiff neck, she sleeps soundly and wakes up feeling rested and alert every morning (this depsite getting just 5 hours of sleep a night with the busy monastery schedule). I could see the effect it had on her: she was able to sleep anywhere and she was full of energy.

    I thought this could be useful. I’m an adventurer, setting out on a spiritual pilgrimage across two continents. Anything that makes me more portable is good. Some of the benefits of upright sleeping include:

    • It’s good for your back
    • No more taking special pillows everywhere you go
    • You don’t need a sleeping bag—one blanket will keep you warm
    • It’s impossible to snore
    • You’re more aware of your surroundings and can wake up easily

    I immediately saw the applications for my upcoming journey. I can carry less gear, and if I wake up to the sound of approaching footsteps I can be on my feet in a second. In the Colombian jungle that’s not a bad deal.

    Of course most travelers aren’t so extreme. But where upright sleeping really shines is on a bus or in a friend’s living room. Once you become proficient you can sleep truly anywhere, never worrying about what the mattress will be like. Bad hotel beds, air mattresses, futons—these will be things of the past.

    I asked Zangmo to teach me how to do it right, then tried it out for myself.

    How to Sleep Upright

    What Zangmo taught me was a series of tips to make the transition easy. It took her about three months to make the adjustment, but learning from her mistakes I was able to make it in four weeks. By the first week I could sleep an hour or two at a time comfortably, and within two weeks I had slept five straight hours upright (moving to a bed for the rest of the night).

    Prior to this my only experience with sleeping upright was in vehicles or at airports. It always led to horrible stiffness and pain. The reason is bad posture. If you can control your posture you can sleep upright with none of the pain, and that’s what most of these steps are aimed at.

    1. The Right Surface

    Set a board or other surface at about a 70 ° angle.

    Ultimately you can sleep against anything, even a vertical surface with no troubles. To start off though you’ll want gravity helping you, and that means a slightly sloped surface behind you. I put a piece of particle board against my bedroom wall at a 70 ° angle.

    To avoid scratching the wall you can throw a towel over the top.

    2. Padding

    Everybody likes pillows.

    If you’re used to sleeping on a bed you’re going to want some kind of padding or you’ll go nuts. At the beginning, two pillows should work: one to sit on and one to cushion your back. After about two weeks I stopped using the pillows and now lean directly on the board, with no comfort issues.

    3. Back Support

    Lower back support is how you make upright sleeping comfortable.

    The single most important part of upright sleeping is lower back support. If you support your lower back it will reinforce your torso’s natural curve, minimizing soreness. At the same time it will slope your body so that your head is leaning back onto the surface behind you. This makes it easier to fall asleep and avoid neck pain.

    If you under-do your lower back support or sleep leaning forward, you’ll wake up with the same kind of soreness you get from hours in front of a computer. That’s called slumping and it’s not your friend.

    Luckily it’s easily fixed. A rolled up towel or small pillow behind the lower back gets you the shape you need.

    4. Neck Support

    A seat cushion has a nice shape to support the neck without shoving the head forward.

    Just like with padding, in time you won’t need neck support at all. But it makes the transition easier for beginners. Ideally you’ll have something that supports your neck but is thinner behind your head. Err on the thin side. If you use a pillow that pushes your head forward you’ll find yourself with significant neck pain—it’s better to relax the neck and head and let them fall naturally back against the board or wall.

    If you have a small enough pillow you can support the neck without anything behind the head at all.

    5. Something Extra

    If you find that you slump over in your sleep, you have options.

    In theory you now have basic good posture: your lower back is supported, you aren’t leaning forward, and your head falls back naturally. But at the start your body might not want to stay that way—you’ll wake up lolling to one side, or slouched over.

    This will stop happening as your body gets used to the posture, but you can intervene if it’s frustrating. The easiest way is just to tie a scarf around your board and use it like a seatbelt for your head. This way you can’t lean forward or fall to the side.

    Buddhists make such good models. Thanks Zangmo!

    Putting it to Use

    Most people assume that lying down is the “natural” way for humans to sleep, but after experiencing upright sleeping I’m not so sure. I think most people just decide that however they were raised is the natural way, and anything that looks really different must be uncomfortable. But just like switching from sleeping on your side to sleeping on your back, after a short period of adjustment it becomes normal.

    When I sleep upright I have a very light, but amazingly refreshing sleep. I remember my dreams better, I wake up more easily if something is going on around me, and yet I don’t feel groggy or disrupted. I can jump right up without that usual feeling of disorientation that comes after sleep, which has led to not hitting the coffee so hard. Even though it’s a lighter sleep somehow it’s very satisfying.

    I’m curious to see if any other minimalists take the challenge and try this out. Is it something you could use when traveling? Or maybe even at home? If you try it out, share your experience. How hard is the adjustment period, and do you end up with the same refreshing sleep that I did?

    Drew Jacob is an adventurer and philosopher.

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    Sleeping Sitting Up: The Pros and Cons of Sleeping Upright

    We all know that a quality night’s sleep is a necessity for our health – both physically and mentally. But did you know that different sleep positions can have different effects on your health? For instance, if you have seasonal allergies or a cold, sleeping in an almost upright position could be beneficial. Conversely, sleeping sitting up might not be the best option if you suffer from neck pain. However, if you are required to sleep sitting up due to a medical condition or recovery from a medical procedure, fear not – with a little help, you can sleep safe and sound. We’ll tell you how! Allergies and the common cold: Allergies affect us all differently, but some have it worse than others. For some, allergy symptoms can lead to a severe lack of sleep. In fact, in a survey conducted by the National Sleep Foundation, 37 percent of Americans said their sleep has been impacted by allergies. This is where sleeping in an upright position comes in handy; by sleeping in a more upright position, congestion can drain from your nose and throat, making it easier for you to breathe. Tuck a few pillows under your head and upper back in order to comfortably sleep upright. But beware – sleeping in an upright position for too many days in a row could cause neck pain. Neck pain: Sleeping sitting up is not recommended for everyone, and it most likely shouldn’t be your normal sleep position. This is especially true if you are sleeping in a chair (sleeping upright but supported by a stack of pillows is a bit different). When we move into active sleep, or the Rapid Eye Movement (REM) stage of sleep, our muscles lose tone, making it difficult to maintain a seated position. As a result, when we sleep upright, our necks tend to strain or drop to one side, which can cause pain. That said, sometimes sleeping upright can be helpful. For example, sleeping upright can be a requirement for people recovering from certain medical procedures. In this case, it is important to consider the use of a neck pillow or neck roll in order to protect and support your neck. As most travellers know, neck rolls are also a necessity when flying or riding in a car for a long period of time. If you do need to sleep upright or if you’re a frequent traveller, check out Core Products’ adjustable travel roll, which can be adjusted to match your desired firmness.

    You are called to the house of a male with difficulty breathing. While your partner cares for the patient, you review his medications. You discover Digitalis, Lasix, Lisinopril and Micro-K. Conferring with your partner, you determine the patient’s complaints are symptoms of a worsening or exacerbation of congestive heart failure (CHF).
    CHF occurs acutely or develops chronically and can be defined as the heart’s inability to maintain adequate circulation of blood. CHF can involve the right ventricle, left ventricle or both. Signs and symptoms vary based on cause, degree of failure and ventricle involved.
    Acute heart failure is most commonly caused by myocardial infarction (MI). The death of tissue results in decreased muscle contraction or valve failure. Typical signs of cardiogenic shock ensue. These include chest pain, shortness of breath and pulmonary edema.
    Chronic heart failure presents more subtly than acute heart failure. It also may be more difficult to recognize. Left-ventricular failure is most concerning. Left-sided heart failure is most commonly caused by chronic hypertension. The left ventricle pushes against high arterial pressure. This causes an enlargement of the ventricular wall known as hypertrophy.
    As the disease process continues, the heart will begin to remodel. Remodeling is the process of the heart muscle changing shape. Normally the heart is pointed at the bottom with the ventricles in somewhat of a ‘V’ shape. This shape allows the ventricle to maintain a normal ejection fraction (EF) of about 70%. This means 70% of the blood in the ventricle is pumped out. As the heart remodels, the walls of the ventricle stretch and become thinner. The shape of the ventricle becomes rounded and cardiac muscle weakens. EF will drop, and blood backs up. Left-ventricular failure results in blood backing into the pulmonary circulatory system. As pressure in the pulmonary blood vessels increases, fluid is pushed into the alveoli resulting in pulmonary edema.
    The four stages of heart failure
    Early stages of heart failure (Class I) present with few signs or symptoms, and activities of daily life aren’t affected. Paroxysmal Nocturnal Dyspnea (PND), a condition where the patient is short of breath while lying supine, may present in early stages. PND is a result of fluid in the lungs blocking oxygen exchange. When the patient is in an upright position, the fluid is in the lung bases. When the patient lies supine, the fluid diffuses throughout the lung fields. This means more oxygen is blocked from exchanging in the alveoli. The patient will awaken with shortness of breath. The patient will progressively begin sleeping with more pillows and awake more frequently. Eventually, the patient won’t be able to lay supine. Levels of B-type natriuretic peptide (BNP), a protein released to help the body compensate for CHF, will elevate and be a helpful in-hospital diagnostic tool.
    Class II heart failure is still classified as mild, but the patient will begin to experience dyspnea with moderate exertion. The patient is comfortable at rest but becomes short of breath while performing routine chores.
    Patients with Class III heart failure, which is considered moderate, find it difficult to carry out activities of daily life. Once-simple tasks, such as walking to the mailbox or up stairs, now come with extreme respiratory distress. Evidence of this may be seen in the patient’s home. A chair at the top of the stairs may suggest the patient needs to rest frequently.
    Moving on to severe heart failure, patients in Class IV heart failure are in continual distress — even at rest. EF can approach single digits. These patients will not be able to carry out normal activities and may find themselves confined to a comfortable chair or in an upright hospital bed.
    Proper assessment and treatment
    Assessment of CHF patients requires a good history. Events leading to their shortness of breath help determine whether the cause is acute or chronic. They also help determine the stage of the patient’s disease. Medication history, such as in the patient above, helps confirm CHF. Digitalis, an inotrope, increases force of contraction. Lasix, a diuretic, helps eliminate fluid by causing urination. The latter is commonly prescribed with such potassium supplements as Micro-K. ACE inhibitors, such as Lisinopril, decrease blood pressure and preload, which helps limit fluid backup.
    Physical assessment finds these patients upright with their legs in a dependant or down position. Legs kept down decrease blood return to the heart, in turn decreasing fluid back-up into the lungs. Breath sounds will reveal bilateral rhonchi or crackles. These will usually be in the lung bases. Unilateral crackles are not indicative of CHF but suggest other diseases such as pneumonia. As the disease progresses and the bases fill with fluid, basilar sounds will become diminished or absent with crackles heard in the upper lobes. Early stages of CHF may present with wheezing. As fluid begins to move into the lungs, the bronchioles will constrict in an effort to keep fluid out. This constriction will create wheezing. This has been referred to as cardiac asthma. Caution! Treating heart failure as asthma can make the condition worse.
    Continued fluid backup into the lungs will eventually cause right-ventricular failure. At this time, fluid will back up into the rest of the body. Patients will develop swollen ankles and ascites, or fluid in the abdomen. This is a sign of disease progression but not considered an acute life threat.
    The goal of treatment is to oxygenate the patient and get fluid out of the lungs. High concentration of oxygen is a must. Next, consider patient position. CHF patients can be improved by helping them into an upright position as tolerated by mentation and blood pressure. Extreme cases may be treated with a bag mask assisting respiratory effort. Continuous positive airway pressure (CPAP), mask providing a continuous pressure into the lungs, may be allowed in some systems. This pressure helps the patient to exchange oxygen against the fluid backup. EMTs with pharmacologic abilities can consider higher doses of nitroglycerine such as 0.8 mg (two sprays or tablets) as an initial dose.
    Your assessment was correct. The patient experienced an exacerbation of CHF confirmed by elevated BNP. The patient was evaluated to rule out pneumonia and MI. His drug doses were adjusted, and he was discharged home.

    Daytime Sleepiness Provides Red Flag For Cardiovascular Disease

    The Three City study, published in Stroke, by the American Heart Association (February 26), found that elderly people who reported excessive day time sleepiness have a 49 % relative risk increase of cardiovascular death (from cerebrovascular disease, myocardial infarction and heart failure) , compared to those who do not report sleepiness.

    “Based on this study asking patients the simple question of whether they feel sleepy during the day, is a useful way of identifying a subgroup of elderly patients at higher risk of cardiovascular disease who require a more thorough follow up,” said Professor Guy DeBacker, from the Division of Cardiology at the University of Gent, Belgium, and former chair of the European Society of Cardiology Joint Prevention Committee.

    Professor Torben Jorgensen, from the Research Centre for Prevention and Health, Glostrup, Denmark, commented: “The study offers the opportunity to practice prevention by investigating the underlying causes of patient’s sleep problems, and then introducing lifestyle changes with the intention of preventing later cardiovascular complications.”

    The Three City study represents the largest yet investigation exploring the prospective association between EDS and mortality in the community dwelling elderly, and the only study yet to have been conducted in Europe – all the other studies were undertaken in North America. Criticisms of the study include a low responder rate (37%) that could introduce an element of bias, and the fact that it lacked objective measures of day time sleepiness (such as polysomnography readings), instead using self reported patient responses.

    “The subjects with EDS were less educated and had a lower income so there were differences between the two groups in “socioeconomic status”, which was not accounted for in the multivariate analysis. SES is a strong independent predictive factor for total and for cause specific mortality, and it might be that the difference between the two groups is just the effect of socioeconomic differences,” said DeBacker.

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    Both DeBacker and Jorgensen say the results are “hypothesis generating”, and that the data needs to be confirmed in other large scale studies in different populations before any changes should be made to existing guidelines.

    “Overall the study population had a particularly low number of cardiovascular deaths, suggesting that the French paradox may be in operation. We need to be asking identical questions to different populations to see if we still get the same effect,” said DeBacker.

    Jorgensen added that he would like to see future trials where EDS patients were randomised to receive sleep interventions or not, to see if cardiovascular complications might be prevented.

    Three-City Study

    The Three-City Study led by Jean-Philippe Empana from Inserm, (the French Public Institute on Health and Medical Research) and colleagues followed 9,294 community dwelling people aged over 65 (who did not live in nursing homes or other care facilities). In face to face interview, participants were asked if they had never, rarely, regularly or frequently experienced excessive sleepiness during the day. People diagnosed with dementia at baseline were excluded, providing an overall study population of 8,269 people.

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    Investigators found even after adjusting for other risk factors,(such as age, gender, body mass index and previous cardiovascular disease), people who experienced excessive day time sleepiness had a 49 % increase in relative risk of cardiovascular death, and a 33 % increase in the relative risk of overall death.

    Earlier studies have suggested that atherosclerosis might mediate the association between EDS and cardiovascular death, and that EDS might be associated with sympathetic tone activation.

    However, when investigators undertook ultrasound examination of the carotid artery in two-thirds of participants, they found no difference in carotid plaque burden between people with and without EDS. Additionally resting heart rate, a simple marker of increased sympathetic tone activation, was no different among people with or without EDS.

    Such data, say the authors, leaves them unclear as to whether sleep complaints are a symptom of underlying cardiovascular disease or whether sleepiness triggers or worsens disease.

    “These data may have clinical implications adding to the body evidence that EDS is not a benign but rather an important risk marker for midterm mortality in community dwelling elderly,” they conclude, adding that simple questionnaires incorporating questions on sleeping patterns should become part of routine examinations in the elderly.

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