#323 The 12 Best Ways to Fix Atrial Fibrillation with Sleep
Dr. John Day
Dr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology.
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The 12 Best Ways to Fix Atrial Fibrillation with Sleep
Whenever people try to get healthier, and no matter what the underlying reason for that effort, they almost always start with diet and exercise. Those are two very important factors, but without addressing a third factor—sleep—they are almost assuredly doomed to fail in their efforts to eat better and exercise more. In this article, I’m going to give you my 11 best ways to fix atrial fibrillation with sleep.
Most of Us Are Really Bad at Sleep
Let’s face it, most of us are really bad at sleeping. And as a global community, it would appear, we’re actually getting worse at it, even as the science that demonstrates its importance to our lives has gotten more and more compelling. The World Health Organization has raised the possibility that sleep problems are an emerging global epidemic. In the United States, 70 percent of adults report insufficient sleep at least once a month, and 11 percent report insufficient sleep every night.
For a while, it did seem like we were getting the message about the importance of sleep to our health. After a century of consistently diminishing sleep, researchers who study the way we slumber noticed something promising. From 2004 to 2012, the number of people who were getting less than six hours of sleep each night finally started to level out.
Maybe, some thought, we were finally getting the message. Or maybe, others argued, we’d simple hit rock bottom. Either way, it seemed, we could finally start working to move the needle in the other direction. But when demographic sociologist Connor Sheehan and his collaborators dove into the subject in the late 2010s, they were dismayed by what they found. Yes, there had been a leveling out starting in 2004, but between 2013 and 2017 there was a significant shift. Far more people were reporting far less sleep. We hadn’t hit rock bottom after all.
What changed? Among the most important factors are the devices we increasingly carry in our pockets, purses, and person. Closely coinciding with the quickly falling rate of adequate sleep was the rapidly rising rate of smartphone ownership, which went from 35 percent in 2011 to 77 percent in 2016.
“Americans now spend more time looking at a screen,” Sheenan and his collaborators wrote, “and, due to the mobile nature of these devices, technology has increasingly entered the bedroom.” This isn’t just happening in the United States. More than 5 billion people around the world now have mobile devices, and more than half of those devices are a smartphone. Leading the way in the adoption of tiny, glowing screens is South Korea, where 95 percent of adults have a smartphone and where, perhaps not coincidentally, adults get nearly 40 minutes less sleep each night, on average, than their global counterparts.
Because smartphones may be a cause of poor sleep, and also because these devices are increasingly equipped to detect the health consequences that result from poor sleep, it should come as no surprise atrial fibrillation diagnoses have skyrocketed in Korea in recent years.
Why is Sleep so Critical for Atrial Fibrillation?
The impact of poor sleep on AFib has been well documented. Even small interruptions of sleep quality and duration can increase the risk of atrial fibrillation by 18 percent, and people who experience insomnia are 30 to 40 percent more likely to develop atrial fibrillation. People who do not reach deep levels of sleep—the sort of sleep that is key to recovery—have an 18 percent increased risk of atrial fibrillation, and it worsens each time they wake up at night.
It’s even worse for people with sleep disorders such as sleep apnea; they have a 200 to 400 percent increased risk of AFib over individuals without a sleep breathing disorder. And the problem is compounded once AFib actually develops; the presence of an abnormal rhythm can increase the risk of poor sleep quality, or short sleep, by three to four times. It’s a vicious cycle.
That makes complete sense. In addition to the miserable experience of simply not feeling well-rested, sleep deprivation causes the release of excess cortisol and adrenaline. The former hormone causes you to retain water, lose potassium, have a high blood sugar, and have a higher blood pressure. The latter also increases your blood pressure, forcing your heart to work harder. In fact, when we want to trigger an atrial fibrillation episode during procedures intended to identify the trouble spots within a patient’s heart, we give our patients a form of intravenous adrenalin.
The 12 Best Ways to Fix Atrial Fibrillation with Sleep
Now that we know why sleep is so critical to maintaining normal sinus rhythm, below are my 11 best ways to fix atrial fibrillation with sleep.
1. Go to Bed at the Same Time Every Night
Studies show that just one night of bad sleep can increase your risk of an AFib attack the next day by more than three-fold! And the best way to get the sleep your heart needs is to actually put it on your calendar. Then, just like you do everything you can to avoid being late to work, you should do everything you can to avoid being late to bed.
This is a simple and powerful step: Studies show that the mere act of setting a bedtime, and sticking to it, results in an entire additional hour of sleep each night. And remember, seven hours is the target for actual sleep—not for time in bed. If it takes you 30 minutes to fall asleep and you typically have a middle-of-the night awakening to use the bathroom, get a drink of water, check the locks on the doors, or whatever, then you should probably schedule at least eight hours.
For me, I have a strict bedtime of 10 pm. And for most people suffering from AFib, studies now show that a 10 pm bedtime (or at least before 11 pm) is best to prevent AFib and other heart problems.
2. Wake Up at the Same Time Every Morning
At the same time you schedule going to bed in your calendar, you also should schedule the time you’ll get up in the morning—and rise no later than that time. This can be a tall order in a world in which more people than ever before are working remotely, with flexible hours and start-of-the-day times that are all-too-often aspirational rather than required.
That can make it seem like hitting the snooze button is a harmless choice. But, contrary to popular belief, getting a few extra minutes of sleep in this way doesn’t actually result in restorative sleep. In fact, waking, dozing off again, and abruptly waking again can result in sleep inertia—a period of up to four hours of lowered functionality.
This doesn’t mean that you should stay in bed if you have woken up and feel rested. If you wake up and are ready to go, there’s no reason not to greet the day. Conversely, if you need an alarm clock to wake up in the morning then you likely didn’t get enough sleep the night before. Our bodies are designed to wake once we’ve gotten the amount of sleep we need. So once you’ve figured out how much sleep your body truly needs, you can set your bedtime accordingly.
Alarm clocks should be like insurance policies; they are there to put our minds at ease just in case we oversleep but best when they are never really needed. Our bodies function best when we are able to wake up naturally, and that is most likely to happen when we schedule our bedtime and steadfastly adhere to that schedule.
In my experience, people can train their bodies when to fall asleep and when to rise. If your body learns, for example, that you go to bed every night at 10 pm and arise by 5 or 6 am then sleep can become effortless.
3. Create the Perfect Sleeping Room
Scheduling a bedtime is important, but once you get to bed, everything needs to be in order so that you can do what you’re supposed to be doing there. This includes maintaining a clean, quiet and cool room with plenty of fresh air. If little sounds awake you, consider some background “white noise” for better sleep.
It also means remembering the most important purpose for your bed: Sleep. Everything else can be done somewhere else, and most things should be done somewhere else.
To be very clear on this point: Our beds are not the right place for eating. They’re not the right place for working. And they’re absolutely not the right place for “screen time” of any sort.
4. Bright Natural Light in the Mornings and Dim Lights in the Evenings
Just as bright lights in the morning, especially bright natural light, is perfect to energize your day, keeping things dim in the evening can prepare you for sleep. And that is why electronic devices before bed can be especially problematic.
If you absolutely must use an electronic device as bedtime approaches, don’t do it in the bedroom, and make sure the blue light filtering feature is on. Most televisions don’t have a built-in blue light filtering option, so if you are going to watch a television program after dinner, do so while wearing glasses, which are designed to filter blue light. Indeed, most prescription eyeglasses now offer blue light filtering.
And for your bedroom, you want it dark. Really dark. The darker the better when it comes to restful sleep.
The reason why light timing is critical for sleep is that light works with natural melatonin production to set your circadian rhythm. Keeping your circadian rhythm in rhythm is the key to not only a great night of sleep but a long life free from cardiovascular disease as well.
5. Have a Caffeine Curfew
Most people are already aware that caffeine can impact sleep, but they tend to underestimate its effects. Caffeine isn’t just a mild stimulant; it’s a very powerful drug that can stay in your body for more than a day. For many people, the majority of the effects of this drug are gone in about five hours, but about 50 percent of people have a variant of a gene known as CYP1A2 that lowers the amount of a certain liver enzyme that causes their bodies to metabolize caffeine more slowly. From one person to the next, in fact, there can be as much as a 40-fold difference in the rate that caffeine metabolizes.
In most people—even those who are slow metabolizers—it’s generally safe to consume up to 100 milligrams of caffeine per day without adversely impacting sleep. But that’s not much caffeine; it’s the equivalent of one cup of coffee, two cups of tea, three servings of soda pop, or four ounces of dark chocolate. Start combining those sources, and you’ll quickly blow past the limit at which most people can consume caffeine without a significant impact to sleep.
Also, it should probably go without saying that so-called energy drinks, which are packed with lots of caffeine and other stimulants, will put you past the limit faster than you can say the words “Red Bull.” For most people, a “caffeine curfew” that comes six hours before bedtime is a good rule.
6. Avoid the Booze
If avoiding the booze doesn’t immediately make sense to you, you’re not alone. Alcohol, after all, is a central nervous system depressant, with an oppositional effect to caffeine. And yes, it’s true that a drink before bed can help some people fall asleep more quickly, but that initial benefit is offset by a reduction in the quality of sleep they get.
Research shows that people who drink alcohol before bed get less REM sleep, the sort of sleep that is characterized by rapid eye movements, dreaming and bodily movement, and which offers the biggest benefits in terms of health and restfulness. REM is also key to keeping our hearts in rhythm. One study, for instance, showed that people who have less REM sleep have higher rates of AFib, with the risk increasing as REM decreases.
A single glass of wine or beer during a dinner that comes several hours before bedtime is unlikely to be detrimental to most people’s sleep but, as is the case with caffeine, there are a lot of factors at play. Biological sex, race, weight, medications, experience with drinking, microbiome composition, and myriad genetic factors can impact how alcohol is metabolized in the body. And, since the hard truth is that even minimal alcohol consumption results in worse outcomes for people with AFib, the best possible amount of alcohol is none at all.
7. Time Your Workouts (Outdoors is best)
It’s a given, if you want to sleep better you need to be physically active throughout the day. For most people, a vigorous morning workout energizes them for the day and helps them sleep at night. And exercising outdoors is even better as bright natural light in the morning optimizes your circadian rhythm for sleeping soundly at night.
While it goes against everything you read on the internet, I’ve found that an evening workout usually works best for me. My mind is the clearest in the morning so I like to dedicate that time to work. As exercise is so relaxing for me, I like to save that time for the evening. Even better is that a vigorous workout makes me tired so I sleep better.
I’ve also found that the more activity I’ve logged on my Apple Watch during the day (steps, exercise time, calories burned, etc.), the easier I fall asleep and then stay asleep at night. In fact, I’ve now logged 134 consecutive days, without a miss, of hitting 1,000 calories burned each day according to my Apple Watch. And on the days I’ve burned more than 1,500 calories, I’m always asleep within 5 minutes of my head hitting the pillow and stay asleep the entire night.
8. Take a Warm Bath or Shower
People often turn to alcohol to unwind from a stressful day and relax. There are other ways to promote relaxation that can also have profound benefits on your sleep quality and duration. Taking a scheduled warm bath or shower can improve the time it takes you to get to sleep, your sleep quality and total sleep time, and how often you wake during the night.
Are you the type who needs a shower to get moving in the morning? Fair enough. Keep that habit, but build in an evening bath as well. This simple lifestyle change can be done with little disruption to your daily routine, after all, with a pretty significant payoff. In studies that have shown a significant benefit on sleep, the bath or shower can be as short as 10 minutes.
Personally, this is something I have started doing over the last year following my evening workouts as mentioned in number 6 above. A warm shower before bed has helped me sleep so much that I never go a night without a warm shower before bed.
9. Read Something Relaxing
Reading emails or social media before bed is a really bad idea unless you want to lie in bed for hours ruminating on what you just read. While reading something potentially stressful like emails or social media is bad before bed, reading a relaxing novel can be especially helpful to calm your mind or even put you to sleep. For me, I’ve found that reading something really boring in bed works best as I quickly start dozing off while reading.
10. Treat Your Sleep Apnea
Do you snore? Do you weigh a little more than you should? If you answered yes to both odds are you have sleep apnea.
The problem with sleep apnea is that all of the fatty tissue in your neck can choke off your airway while sleeping causing oxygen levels to plummet to dangerously low levels.
Sleep apnea is really bad for AFib. Indeed, studies show that sleep apnea quadruples your risk of AFib. In addition, sleep apnea makes you fatigued during the day, raises your blood pressure, and increases your risk of heart failure and an early death.
If you snore and weigh a few pounds more than you should tell your regular doctor and get tested for sleep apnea. Fortunately, most patients can make their sleep apnea go away with weight loss.
In addition, not sleeping on your back can also be curative for sleep apnea in some patients. For example, you can even buy stop snoring sleeping shirts on Amazon. By simply putting a tennis ball in the little pouch on the back of the shirt it will go a long way in helping to keep you off your back while sleeping.
11. Time Your Fluids
Unless you are feeling dehydrated, avoid drinking anything after dinner, and make sure to head to the restroom as your last stop before you go to bed. One of the main reasons people get up at night is to use the bathroom and, once up, those who have trouble sleeping in general are more likely to stay up.
If you’ve hydrated thoroughly throughout the day, a few hours without water before sleeping probably won’t hurt you. If you do have to use the restroom, it should be a direct to-and-from trip. Don’t take a lap around the house to make sure everything is shipshape.
Don’t get another drink of water (which will begin a vicious cycle.) And finally, do not go to the kitchen — especially not to open the refrigerator to get a blast of light that will signal your brain to start waking up.
12. Consider a Natural Sleep Aid
Even if you’ve scheduled your sleep, controlled your caffeine and alcohol intake, turned the lights out when you should, taken a warm bath before bed and, if needed, gotten treatment for your sleep apnea, slumber can be an elusive friend. And that can make pharmaceutical sleep aids and supplements very alluring.
Resist! Sleep drugs and supplements should only be used under a doctor’s supervision, and only as a last resort. Even something as “benign” as over-the-counter Benadryl (diphenhydramine) has been associated with dementia. And if something like Benadryl (diphenhydramine) increases your dementia risk, you can only imagine what a prescription-strength sleeping pill must do to your brain.
If supplements must be tried, studies show magnesium may not only help your AFib but your sleep as well. Likewise, melatonin is generally quite safe and may help with sleep. Personally, I take magnesium and melatonin every night to help with sleep.
I’ve also used L-Theanine and L-Tryptophan on the nights I knew sleep was going to be difficult. L-Theanine helps to calm my mind and just a tiny amount of L-Tryptophan seems to really put me to sleep. But as with any medications or supplements, please discuss with your healthcare provider first as serious complications could arise.
To see me or one of the other cardiologists specializing in AFib in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are no longer possible due to post-COVID government regulations.
Also, if you liked the photo attached to this article, it is a picture my daughter took of my running shoes during one of our sunset runs on Laguna Beach over the Thanksgiving Day weekend.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.
I have been in “permanent AFIB” for about 4 years now having progressed from paraxysmal AF. Is it possible for me to revert back to sinus rythm naturally as I turned down the opportunity of an ablation – Kind Regards – Derek from New Zealand
These are some great tips. Thanks for sharing, Dr. Day. I hope you are doing well.
Thank you so much. I have severe chest pain and one time the hospital said heart arithmia. I have PTSD from early trauma, so panic attacks too. I never sleep. One time for 5 years other than 10 min here 10 min there. Quit work and got on disability. My cardiologist gets so angry with me because my blood pressure is good. No one knows what to do. I’m trying chamomile tea with juice of at least a quarter of a lemon, plus 6 mg of melatonin. It’s helping some. They are also just finding out I have hyperparathyroid so calcium is being taken out of my bones. That doesn’t help me sleep either. Any help you could offer would be absolutely fabulous!!!
Dear Doctor, I wish you a happy new year. Thank you for the helpful information you’ve been putting together for us. I’ll tell you that after applying the AFib information, I put my mother-in-law on a strict regimen of lifestyle changes, including significant weight loss, and she reverted from permanent AFib to sinus rhythm, where she has remained for over a year.