How to Get Better Sleep When You Have Obstructive Hypertrophic Cardiomyopathy

If you have obstructive hypertrophic cardiomyopathy (oHCM), a condition that causes the heart muscle to thicken, potentially blocking blood flow out of the heart, sleep can be challenging for a few reasons.

OHCM can cause nighttime shortness of breath, palpitations, and anxiety, any of which can make it hard to fall asleep or stay asleep. Adding to that, many people with oHCM also have obstructive sleep apnea (OSA), a condition in which your airway relaxes too much and repeatedly collapses during sleep, causing you to temporarily stop breathing each time it happens.

But having either — or both — conditions doesn’t mean that restless and interrupted sleep is inevitable. Here’s what you can do if you’re not getting good, refreshing sleep, and when it’s time to call your cardiologist.

Optimize Your Sleeping Position

Lying flat doesn’t typically worsen the obstruction itself in oHCM, says Eric Smith, MD, a cardiologist at the University of Michigan Health Frankel Cardiovascular Center and a clinical instructor of internal medicine-cardiology at the University of Michigan Medical School in Ann Arbor. In fact, more blood filling the heart’s chamber can actually slightly improve blood flow through the outflow tract, he says.

There’s no research specifically testing sleep positions in oHCM, but some patients with oHCM may improve their sleep by adjusting their position, says Smith. Here are some options.

Try an incline. Propping yourself up with a wedge pillow or an adjustable bed may help if breathlessness is your main issue, since it can ease pressure buildup in the lungs, he says.

Skip the left side. Sleeping on your left side tends to feel worse for many heart patients, he says.

The Link Between oHCM and Sleep Apnea

“Obstructive sleep apnea is unusually common in oHCM, affecting about half of patients,” says Virend Somers, MD, PhD, a researcher and the director of the cardiovascular facility and the sleep facility within Mayo Clinic’s Center for Clinical and Translational Science in Rochester, Minnesota.

“The direction of the relationship is still not clear — whether oHCM itself contributes to sleep apnea, or sleep apnea adds to oHCM, or both,” says Dr. Somers.

One theory is that the thickened heart affects blood flow and pressure in ways that could lead to airway congestion or changes in how the brain signals breathing during sleep, both of which can raise the risk of sleep apnea, he says.

Get Screened for and Manage Sleep Apnea

Untreated sleep apnea adds real strain to an already thickened heart, says Smith. “Each pause in breathing raises pressure, triggers stress hormones that can worsen obstruction, and increases the risk of irregular heartbeats like atrial fibrillation,” he says.

Repeated drops in oxygen overnight may also contribute to scarring of the heart muscle over time. In a study of more than 200 people with obstructive HCM, sleep apnea and its severity were independently linked to greater scarring on cardiac MRI, and that scarring is associated with worse long-term outcomes.

“We know treating OSA in more general cardiology patients is very beneficial,” says Smith.

Somers and his colleagues have published research on how sleep apnea affects the body’s stress response and blood vessel function in people with HCM. In a study of more than 230 patients, those with untreated sleep apnea had higher stress hormone levels, higher blood pressure, and more impaired blood vessel function than those without sleep apnea, all of which were linked to a higher risk of major cardiac events during follow-up.

• Disruptive snoring at night, especially if it’s loud enough to wake a bed partner
• Gasping or choking sounds during sleep
• Morning headaches or a dry mouth upon waking
• Severe daytime sleepiness or fatigue, even after what seems like enough sleep

Every oHCM patient should be asked directly about sleep symptoms, regardless of whether they fit the profile of a “typical” person with sleep apnea, says Smith. If concerns come up, your doctor may refer you to a sleep specialist or order an overnight sleep study, he says.

“An in-lab study is usually better than an at-home one, since it can better detect heart-related events during sleep,” he says.

Talk to Your Doctor About Medication Timing

Some oHCM medications can affect sleep.

“Beta-blockers have been linked to insomnia and vivid dreams or nightmares; taking your dose earlier in the day may help,” says Smith.

Create a Heart-Friendly Wind-Down Routine

If you have oHCM, a calming wind-down routine before bed may set the stage for a restful night of sleep.

Sleep Problem Red Flags

Call 911 right away for fainting, chest pain, a racing heartbeat that won’t stop, severe breathlessness that doesn’t improve when you sit up, trouble speaking in full sentences, confusion, or cold, clammy skin, says Smith.

“Less urgent symptoms, like needing more pillows to sleep comfortably, mild ankle swelling, new snoring, or sleep problems that start after a new medication, are still worth a call to your cardiologist’s office even if they don’t require an emergency room visit,” he says.