As though people who have survived a heart attack don’t have enough to worry about, they often find themselves experiencing relentless insomnia. Sleep is key to healing, and a lack of it can substantially slow recovery — all the more reason for anxiousness and stress. Until now, there’s been no scientific explanation for the onset of insomnia, although mental stress has been under suspicion as the primary cause.

So here’s a surprise — it isn’t just stress that keeps heart attack survivors awake at night. Canadian scientists believe that they have found a genuine physiological basis for the sleeplessness. As it turns out, they say, the physical damage of a serious heart attack extends beyond the cardiovascular system all the way to the brain stem where important aspects of sleep are controlled.

The Heart-Brain Connection

In earlier research at the University of Montreal, Roger Godbout, PhD, and his colleagues had performed a series of studies with rats, demonstrating that heart attacks affect the limbic system — the part of the brain that controls your mood — something that explains why so many people experience depression after acute myocardial infarction. “Since depression is frequently accompanied by insomnia, we wanted to verify whether the neurons in the brain stem were also affected,” Dr. Godbout explained.

Dr. Godbout’s theory proved to be right. In his latest study (also done with rats and reported in the December 2010 issue of Sleep), he demonstrated that within a few hours of a serious heart attack, the study subjects lost neurons in the brain stem, and within two weeks it was taking them twice as long to get to sleep. The disturbing effect on their sleep didn’t end there. When they finally did fall asleep, it took them a shorter time than before to reach the restful state of deep dream sleep — but this stage, which is when memories are believed to be consolidated, was considerably shortened.

“Thanks to this study, we have been able to show that sleep disturbance following an acute heart attack is not a psychological phenomenon. In fact, there is a clear physiological explanation that the death of cells play a key role in sleep,” says Dr. Godbout.

Poor quality of sleep is a known risk factor for people with cardiovascular disease. Since insomnia can increase the chances of relapse after heart attack, the risk for complications rises — and a vicious cycle can easily be set in motion.

While there is no specific sleep therapy for those who have lost sleep neurons, Dr. Godbout says, this new study illustrates the importance of “rapid intervention” in the days following a heart attack, before the first signs of insomnia and depression are even apparent… and before recurring patterns have a chance to set in. Much of this intervention you can do yourself. For some, it will mean consulting with your doctor about sleeping medication, and for others it will simply mean what doctors call good “sleep hygiene”…

  • Fix a regular bedtime and wake-up hour.
  • Avoid alcohol, caffeine and spicy foods for four to six hours before retiring.
  • Get regular exercise (but no evening workouts). Be sure to check with your doctor, as you may need to pass stress tests, blood pressure tests, etc., to be sure that your heart is strong enough to start exercising.
  • In your bedroom, block out light and noise… make sure the temperature is comfortable (it’s worth the higher heating/cooling bills!)… and use bed only for sleep and sex — no TV watching or computer use, because these activities tend to be stimulating and because the temptation to check one more channel or click on just one more Web site is too great.

If you feel that you need a buffer in between your waking activities and lights out, establish a calm and relaxing presleep ritual that works for you, such as taking a warm bath, reading a relaxing book, praying or listening to relaxing music. You can still have sweet dreams!