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MEDICAL CAUSES OF INSOMNIA: HEART TROUBLE

Sleep can cause changes in the circulatory system, such as lowered heart rate and blood pressure levels, which may precipitate or aggravate stroke, heart attack, arrhythmias (irregular heart rhythms), and other cardiac conditions. Conversely, some types of heart disease may themselves lead to changes in sleep patterns.

Right ventricular failure (RVF) is a form of congestive heart failure, a syndrome in which the heart is unable to move the blood efficiently or normally through its chambers. As a result fluids build up and cause congestion in the blood vessels and the lungs. The condition is specifically described as either right or left ventricular failure, depending on which of the lower chambers of the heart is involved. Patients with RVF are often told to rest in bed to alleviate edema, the swelling of the ankles that results from the accumulation of fluids. As a consequence of this drainage, however, the patient feels the need to urinate frequently. The increased number of nightly trips to the bathroom can disrupt sleep and prevent the patient from enjoying a restful night.

Left ventricular failure (LVF) often causes acute pulmonary edema, or sudden accumulation of fluid in the lungs. Victims experience difficulty in breathing and anxiety associated with a sense of suffocation. Frequently people with this condition sleep—not too comfortably—in chairs. Because of the disruptions in their breathing, they will often awaken at night and try to find some kind of relief, either by opening a window or by going for a walk "to get some fresh air." Relief is often obtained through the judicious use of the class of drugs called diuretics, or "water pills," which increase the excretion of liquids. Again, however, the increased frequency of bathroom visits can affect sleep.

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