Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
The Essential Eight Behaviors and the Importance of Sleep | How to Sleep Better
Overview
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of mortality in the United States. It’s no surprise then that The American Heart Association (AHA) publishes a “Life Essentials” list of modifiable factors that could cause heart attacks or cardiovascular disease, providing a clear guide as to what to focus on for prevention.
Until recently, essential components of heart health, such as weight management and smoking, featured heavily on this list for good reason. However, a particular factor that has been knocking on the door of this list was missing.
For years, research has found mounting evidence that sleep irregularities can and do affect heart health.[1]
In 2022, the AHA responded to these findings and published an updated essentials list titled “Life’s Essential 8,” which now includes quality sleep as a factor in maintaining good heart health and longevity.
The Essential Eight Behaviors and the Importance of Sleep
According to the AHA, here are the eight research-backed health behaviors that are vital to heart health:
1. Eat better
2. Be more active
3. Quit tobacco
4. Get healthy sleep
5. Manage weight
6. Control cholesterol
7. Manage blood sugar
8. Manage blood pressure
The physiological processes that make sleep so impactful on heart health are, in fact, many-fold. Sleep duration and cardiovascular health are intricately linked, and the relationship between Obstructive Sleep Apnea (OSA) and heart disease is thoroughly understood.
For example, sleep that is too short or too long (using 7-9 hours per night as the standard goal) suppresses the natural nocturnal decrease in blood pressure, directly leading to many cardiovascular diseases – particularly hypertension.[2,3]
Inflammation is a mechanism of many chronic diseases, and shortened sleep specifically can negatively affect this crucial marker of cardiovascular health.[4]
Shortened sleep can also drive insulin resistance and blood glucose metabolism – both significant factors in potentially driving obesity and diabetes, both drivers of heart disease.[5]
How to Sleep Better
Many of us don’t get sufficient sleep – whether in duration or quality. Fortunately, there are ways to start paying closer attention to our sleep and make adjustments as needed.
Sometimes a sleep tracker can help you identify how often you wake up, when you wake up, and how long you wake up. Understanding sleep patterns can give you better insight and determine the best course of action.
If you have trouble sleeping in general, a great way to start addressing the issue is with sleep hygiene. This practice is where bedtime habits and sleep environments are manipulated to provide the best foundation for healthy, proper sleep.
Part of this approach is going to bed at the same time every night and waking up at the same time every day, even on weekends or whenever the possibility of sleeping in is present. This practice keeps the natural sleep-wake cycle synchronized.
The bedroom should be cool and dark (use blackout curtains or eye masks if needed). Pillows and mattresses should be comfortable for your body. You may even want to try a weighted blanket, as some people experiencing insomnia swear by them.
Things to avoid before bedtime include alcohol, caffeine, stimulating electronics (smartphones, laptops, and tablets), and heavy, spicy meals. The cognitive and metabolic processes involved in managing these prevent the body from the relaxation and hormone production it takes to become sleepy or rest well.
If you have tried these approaches for better sleep and are still experiencing challenges, it may be time to try Cognitive Behavioral Therapy for Insomnia (CBT-I).
This modality is the best long-term treatment to end the cycle of sleeplessness because it is a lifelong, drug-free solution. It targets behavioral and psychological factors that lead to sleep disruption. CBT-I programs are available online, and you can also talk to your doctor about accessing this form of treatment.
Conclusion
When considering the ‘Essential 8’ factors for good heart health and how sleep affects cardiovascular processes, the picture becomes clearer: sleep is connected to nearly all other health behaviors on the list.
It’s quite the head-scratcher to think that it took so long for sleep to be added to this list – but now that it is there, the hope is that more people will recognize the importance of this aspect of good health that touches on nearly all of the others and can help us live healthier and longer lives.
If you have been diagnosed with cardiovascular disease, it is strongly recommended that evaluation of sleep duration and quality should be included in its management. Please speak with your doctor.
References:
- Full KM, Huang T, Shah NA, Allison MA, Michos ED, Duprez DA, Redline S, Lutsey PL. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2023 Feb 21;12(4):e027361. doi: 10.1161/JAHA.122.027361. Epub 2023 Feb 15. PMID: 36789869.
- Friedman, O., Shukla, Y., & Logan, A. G. (2009). Relationship between self-reported sleep duration and changes in circadian blood pressure. Am J Hypertens,22(11), 1205-1211. https://doi.org/10.1038/ajh.2009.165
- Yano, Y., & Kario, K. (2012). Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res,35(7), 695-701. https://doi.org/10.1038/hr.2012.26
- Irwin, M. R., Olmstead, R., & Carroll, J. E. (2016). Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biol Psychiatry,80(1), 40-52. https://doi.org/10.1016/j.biopsych.2015.05.014
- Antza, C., Kostopoulos, G., Mostafa, S., Nirantharakumar, K., & Tahrani, A. (2021). The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol,252(2), 125-141. https://doi.org/10.1530/JOE-21-0155
