Understanding the impact of sleep on your overall health and following good sleep habits can help you manage chronic diseases as you age.

Key Takeaways

• Adults should get seven to nine hours of sleep per night, but about 1 in 3 of us report not getting enough rest.
• Sleeping less than six hours a night has been linked to dementia.
• Sleep problems can lead to chronic health diseases like cardiovascular disease, osteoporosis, and diabetes.
• Sleep quality significantly impacts the likelihood of heart failure, diabetes, and kidney disease.
• Developing and maintaining good sleep habits can minimize the negative impact of poor sleep on your overall health and wellness.

Sleep is critical for maintaining good health, yet it is often taken for granted. In general, adults should get seven to nine hours of sleep each night, but the Centers for Disease Control and Prevention (CDC) reported 1 in 3 adults in the United States don’t get enough sleep. This is troubling considering research that finds lack of sleep can lead to poor health.

It’s important to understand how sleep impacts our health and find ways we can get quality rest. That’s why our Reviews Team put together this comprehensive guide on how sleep can impact the top health concerns older adults face and how quality sleep impacts overall well-being.

Rakesh V. Alva, MD, FCCP, board-certified in sleep and a member of the LeBauer pulmonary team at Cone Health in Greensboro, North Carolina, said, “Sleep is such an integral part of our lives that it’s not surprising we are starting to discover the cardiovascular impact and metabolic consequences of poor-quality sleep.”

Heart failure

Congestive heart failure (CHF) occurs when the heart cannot adequately pump blood to the lungs or the body, depending on which part of the heart is affected. As a result, fluid backs up into the lungs, arms, and legs, making breathing and walking difficult.

CHF can cause, or be a result of, sleep disorders. In obstructive sleep apnea (OSA), the decreased oxygen levels in the blood that occur when you stop breathing can damage the heart and ultimately lead to CHF.

If you already have CHF, your condition can worsen if you develop sleep apnea. Central sleep apnea (CSA) has been observed in roughly 40% of people who have CHF. In CSA, the brain doesn’t send the proper signals to the lungs to stimulate them to breathe. As a result, frequent awakenings at night occur with CSA and are typically accompanied by an elevation in heart rate and blood pressure.

Here are some sleep-related tips and habits that may help if you have heart failure:

• Researchers found people who went to bed later than 11 p.m. or woke up later than 8 a.m. had an increased incidence of CHF.
• Set a goal to sleep at least seven to nine hours a night to minimize health risks.
• Ask your health care provider about a sleep study if you suspect you may have sleep apnea.
• If you’re prescribed a continuous positive airway pressure (CPAP) or bilevel positive airway pressure machine, use this consistently when you sleep.
• Talk to your health care provider about an exercise program to help your heart failure. Research shows exercise training in patients with heart failure can be safe and beneficial.
• Avoid sleeping on your left side, as this position has been shown to reduce the amount of blood the heart is able to pump (cardiac output).
• Elevate the head of your bed or add pillows to support a more upright position that will help alleviate shortness of breath caused by lung congestion.

Chronic kidney disease

Roughly 25% of older adults have experienced a slow loss of kidney function, which is known as chronic kidney disease (CKD). Progressing CKD can lead to other chronic diseases like heart disease and kidney failure. The function of the kidneys is closely regulated by our bodies sleep-wake cycle. People who sleep less may have a faster kidney function decline, which is possibly related to decreased levels of melatonin, a hormone that helps regulate our sleep-wake circadian rhythm.

As CKD progresses, it can lead to end-stage renal disease (ESRD). Around 80% of people who have progressed to ESRD and require dialysis report difficulty sleeping. Insomnia, poor sleep quality, daytime sleepiness, and sleep apnea are much more prevalent in patients with CKD than they are in the general population. Achieving better quality sleep when you have CKD requires a focus on treating conditions like sleep apnea and insomnia.

Alva explained, “It has been shown that the incidence of sleep apnea is very high, almost 50% in the renal and dialysis patient population.”

Here are a few ways to treat sleep apnea and insomnia for anyone experiencing CKD:

Sleep apnea

• Undergo a sleep study to evaluate your need for a CPAP machine.
• Consider using oral devices, like mouthguards, anti-snoring appliances, and chin straps instead of a CPAP.
• Speak with your health care team about oral surgery to correct any abnormalities that impact breathing.
• Address obesity and thyroid problems, which may cause sleep apnea.
• If you are on dialysis, consider changing your dialysis routine to occur overnight to improve breathing.

Insomnia

• Address anxiety, depression, and pain to minimize their impact on sleep.
• Use supplements that include melatonin to improve sleep in people on hemodialysis.
• Ask your health care team about cognitive behavioral therapy for insomnia, which has been helpful for people with CKD.
• Try acupressure and exercise; both have also been studied with some sleep quality improvement for those with CKD.

Diabetes

Diabetes occurs when your body does not produce enough insulin or is resistant to insulin, which is responsible for helping convert food to energy. You can develop high blood sugar if the conversion does not occur properly. Continued periods of high blood sugar can lead to complications like heart and kidney disease. About 27% of older adults have been treated for some form of diabetes.

Getting enough quality sleep is crucial if you have diabetes. In particular, lack of sleep can make managing your diabetes more difficult as it changes how your body responds to insulin.

Because periods of high or low blood glucose can cause you to wake up during the night, keeping your diabetes under control can help you with your sleep. In fact, sleep apnea has been associated with type 2 diabetes and should be properly treated.

Additionally, some of the diabetes complications can directly impact sleep include nighttime urination (nocturia), frequent urination (polyuria), nerve pain, and damage (diabetic neuropathy).

If you are experiencing any of these symptoms, discuss them with your primary care provider or endocrinologist. The addition of medications or rescheduling of existing medications may be required to ease the impact on your sleep.

Ischemic and coronary heart disease

The buildup of plaque in the arteries results in a narrowing of the vessels, impacting the blood and oxygen supply to the heart (coronary arteries and veins). Inadequate blood flow to the muscles in the heart or other areas of the body is called ischemia. And this ischemia can lead to life-threatening cardiovascular events, including heart attacks, blood clots, or strokes. An estimated 29% of older adults have been treated for ischemic heart disease.

Alva explained how sleep apnea can be a serious concern especially for people with ischemic heart disease. “When we talk about sleep apnea, we’re specifically talking about sleep disordered breathing and consequent drop in oxygen level,” Alva said. “When that happens repeatedly throughout the night, that causes stress on the cardiovascular system.”

Getting less than the recommended amount of sleep can lead to adverse cardiac events. Research has shown sleeping seven to eight hours per night lowers the risk of ischemic heart disease, cancer, and stroke. Notably, people working overtime and sleeping less than five hours a night have a much higher risk of heart attack than those who work 40 hours a week and get six to eight hours of sleep.

You can improve sleep if you have heart failure by following the acronym DREAM:

• Determine the underlying sleep condition: Sleep studies (polysomnography) are considered the standard of care when checking for sleep problems. Sleep studies usually take place in a sleep clinic and involve monitoring brain waves, heart rate, breathing, and the oxygen level in your blood during a full night of sleep. After the test, a sleep specialist examines that data and determines if you have an underlying sleep disorder.
• Relaxation routine: Develop a personalized nighttime routine to maximize your sleep quality. Music, meditation, and reading are some methods you can use to help wind down before you go to sleep.
• Eating and exercise: Avoiding large meals, spicy foods, and excessive liquids less than two hours before bedtime can prevent sleep disruption. Exercising at least twice a week has also been shown to improve sleep quality.
• Avoid stimulants: Alcohol, caffeine, and nicotine can interfere with sleep if used within two hours of bedtime since their stimulating effects can continue for several hours.
• Massage: Depression, pain, anxiety, and stress are some symptoms of heart failure that can be improved with regular massages.

Arthritis

Arthritis comes in many forms, including rheumatoid arthritis (RA) and osteoarthritis (OA). In general, symptoms of rheumatoid arthritis include pain and inflammation of the joints caused by the immune system attacking the lining of the joints. Osteoarthritis is caused by wear-and-tear damage to bones, cartilage, ligaments, fat, and tissues within the joints and also causes pain and inflammation.

More than 80% of people with RA report fatigue and many have problems sleeping. The relationship between the two is circular—poor sleep can lead to increased stress hormones, which can ultimately lead to RA flares. An RA flare is an acute increase of inflammation and other symptoms, like joint pain and stiffness, lasting for days or months. As a result, people with RA may have increased difficulty sleeping when they are first diagnosed and during flares due to increased pain.

Similarly, a study of 300 people showed that roughly 70% with OA experienced difficulty sleeping. Sleep problems were also associated with increased depression and disability in those studied. Again, the primary cause of difficulty sleeping is related to pain.

Yvonne Lee, MD, a board-certified rheumatologist at Northwestern Medicine in Chicago, shared, “Patients often attribute sleep problems to pain. While pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to be multidirectional.”

Due to this close relationship between pain, sleep, and inflammation, it’s important to treat insomnia in patients with arthritis. Recommendations for sleeping better with arthritis include practicing good sleep hygiene, avoiding electronic devices and stimulants before bed, and sticking to a regular bedtime schedule.

High cholesterol

An estimated 50% or more of older adults are treated for high cholesterol. As a result of high cholesterol, increased fat (lipids) buildup can block arteries and lead to heart disease.

Unlike the other health concerns we have discussed thus far, high cholesterol has been shown to be impacted by poor sleep as opposed to high cholesterol directly impacting sleep quality. A relationship between high cholesterol and heart disease has been shown to impact sleep.

In fact, sleep disturbances have been associated with an increased risk for metabolic diseases, including type 2 diabetes and obesity. For example, early metabolic changes from disturbed sleep have impacted cholesterol levels, resulting in higher levels than in people without sleep difficulty. By managing your diet, maintaining good sleep hygiene, exercising, and taking any cholesterol-lowering medications as directed, you can minimize the impact of sleep problems on your cholesterol levels.

Hypertension

The increased resistance to the heart’s blood-pumping ability, along with increased volumes of blood, causes blood pressure to rise. Commonly referred to as high blood pressure, hypertension affects nearly 60% of older adults.

As we discussed with high cholesterol, hypertension does not directly impact sleep. Still, there has been a relationship between poor sleep and high blood pressure. Typically our blood pressure decreases when we sleep, but with sleep problems, your blood pressure may remain elevated for longer periods of time.

For instance, obstructive sleep apnea (OSA) is more common in people with high blood pressure, increasing the risk of hypertension-associated conditions, like stroke and heart failure. OSA can also cause hypertension as airway obstruction events at night negatively impact the vascular system, leading to an increase in nighttime and daytime blood pressure readings.

As with high cholesterol, experts have many of the same sleep hygiene suggestions for minimizing the impact of sleep, along with watching your salt and water intake, taking your blood pressure medications as directed, and monitoring your blood pressure readings on a regular basis.

How to establish healthy sleep habits

Sleep is key to our overall health and well-being. In particular, sleep affects our hormones, metabolism, breathing, immune system, thinking, and memory.

Sleep also is important to a number of brain functions like the communication between nerve cells. It also supports our brain health by removing toxins that build up during the day.

Sleep deprivation occurs when we do not get enough sleep. And that can lead to sleep deficiency when combined with sleeping during the day, not sleeping well, little deep or restorative sleep, and sleep disorders. With sleep deficiency comes an increased risk of physical and mental health problems and higher rates of accidents and injuries.

Here are some top tips for establishing better sleep habits:

• Go to bed and get up at the same time every day. Following an established bedtime routine can prevent any interruptions to your circadian rhythm that could lead to sleep problems.
• Set your bedtime when you are able to get seven to eight hours of sleep. Plan your nightly routine so you will be sleepy and go to bed with time for adequate rest before your wakeup time.
• Don’t go to bed if you’re not sleepy. Going to bed when you are not sleepy can result in frustration with not being able to go to sleep, and this frustration can make it even harder to get to sleep.
• If you have not fallen asleep after about 20 minutes in bed, you should get up and do a quiet activity, like reading, and then return to bed when sleepy. Do not use electronics at this time.
• Keep the use of your bed for sleep and sex. Working or other activities in the bedroom can be stimulating and negatively affect your sleep environment.
• Set a quiet and relaxing atmosphere for your sleep, including a comfortable temperature. Your sleep environment should be as relaxing and comforting as possible to maximize your sleep success.

Bottom line

Achieving the recommended seven to nine hours of sleep can be difficult. Nearly 1 in 3 adults report they have problems getting enough quality sleep. But that can have a negative impact on your overall health. In fact, sleeping less than six hours a night has been linked to dementia, and poor sleep has been associated with risk of cardiovascular disease, osteoporosis, and diabetes.

Sleep problems can worsen some of the most common age-related health concerns like heart failure, chronic kidney disease, diabetes, and arthritis. Poor sleep can also lead to high cholesterol and high blood pressure issues.

Fortunately, understanding the relationship between quality sleep and our health can help us improve our overall wellness. For example, treating underlying conditions like sleep apnea and insomnia, and developing good sleep habits, can improve your sleep quality and reduce the risk of chronic health conditions. Better sleep also can help you manage any chronic conditions you are living with.

Have questions about this article? Email us at reviewsteam@ncoa.org.

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Steven Marshall, DNP, MSN, BSN, RN Author

Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services. He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.