Healthy Sleep

What is sleep?

While you are sleeping your brain and body functions are still active. Sleep is a natural process that helps your body restore energy, supports learning and memory, and keeps you healthy.

During sleep, your brain cycles through different stages of non-rapid eye movement (non-REM) sleep and rapid eye movement (REM) sleep. Non-REM sleep has three stages that range from light to deep sleep, while REM sleep is when most dreaming occurs. During each stage, your brain waves, breathing, heart rate, and body temperature change throughout the night. Certain phases of sleep help you:

• Feel rested and energetic the next day.
• Learn new information, get insight, and form memories.
• Give your heart and blood vessels a rest.
• Release growth hormone, which helps children grow and assists in muscle repair and tissue healing for everyone.
• Release sex hormones, which contribute to puberty and fertility.
• Maintain a healthy balance of hormones that control hunger and fullness.
• Strengthen your immune system by producing cytokines (hormones that help the body fight infection).

You need all the stages to get a healthy sleep.

The amount of sleep you need depends on your age, lifestyle, health, and sleep patterns. The general recommendations for sleep are:

• Babies (4-12 months): 12-16 hours a day (including naps)
• Children (1-2 years): 11-14 hours a day (including naps)
• Children (3-5 years): 10-13 hours a day (including naps)
• Children (6-12 years): 9-12 hours a day
• Teens (13-18 years): 8-10 hours a day
• Adults (18 years and older): 7-9 hours a day

During puberty, teenagers' biological clocks shift. They tend to fall asleep later and wake up later, which can conflict with the early school start times. This is one reason many teenagers don't get enough sleep.

Some people think adults need less sleep as they age, but there is no evidence to support this. However, older adults often get less sleep or spend less time in the deep, restful stages of sleep. They also wake up more easily.

It's not just the number of hours of sleep you get that matters. The quality of the sleep you get is also important. People whose sleep is frequently interrupted might not get enough of certain stages of sleep. If you are wondering whether you are getting enough sleep, including quality sleep, ask yourself:

• Do I have trouble getting up in the morning?
• Do I have trouble focusing during the day?
• Do I doze off during the day?

If you answered yes to any of these questions, you may need to improve your sleep habits.

Sleep is important for overall health. When you don't get enough sleep (sleep deprivation), it does more than just make you feel tired. It can impair your ability to think clearly, react quickly, and form memories. This increases your risk of making mistakes, taking risks, or getting into accidents.

Sleep deprivation can also affect your mood, leading to:

• Irritability
• Problems with relationships, especially for children and teenagers
• Depression
• Anxiety

It can also affect your physical health. Not getting enough sleep, or getting poor-quality sleep, increases your risk of:

• High blood pressure
• Heart disease
• Stroke
• Kidney disease
• Obesity
• Type 2 diabetes

Not getting enough sleep can also lower your levels of hormones that help children grow and help the body build muscle, repair tissue, and fight infections.

Sleep deprivation also magnifies the effect of alcohol. A tired person who drinks too much alcohol will be more impaired than a well-rested person who drinks the same amount.

You can take steps to improve your sleep habits. First, make sure that you allow yourself enough time for sleep. Getting enough sleep each night may help you feel happier and more productive during the day.

To improve your sleep habits, it also may help to:

• Go to bed and wake up at the same time every day.
• Avoid caffeine, especially in the afternoon and evening.
• Avoid nicotine.
• Exercise regularly, but not too close to bedtime.
• Avoid alcoholic drinks before bed.
• Avoid large meals and drinks late at night.
• Don't take a nap after 3 p.m.
• Relax before bed by taking a bath, reading or listening to calm music.
• Keep your bedroom cool, dark, and quiet.
• Get rid of distractions such as TVs, computers, and phones.
• Get enough sunlight exposure during the day.
• If you can't fall asleep for 20 minutes, get up and do something relaxing.
• See a health care provider if you have continued trouble sleeping. You may have a sleep disorder, such as insomnia or sleep apnea. In some cases, your provider may suggest trying a sleep study or other treatments.

If you are a shift worker, getting good sleep can be more challenging. You may also want to:

• Take naps and extend your total sleep time
• Keep the lights bright at work
• Limit shift changes to help your body adjust
• Limit caffeine to the first part of your shift
• Remove sound and light distractions in your bedroom during daytime sleep (for example, use light-blocking curtains or earplugs)

Heart Health Tests

Heart diseases are the number one killer in the United States. They are also a major cause of disability. If you do have heart disease, it is important to find it early, when it is easier to treat. Blood tests and heart health tests can help find heart diseases or identify problems that can lead to heart diseases. There are several different types of heart health tests. Your health care provider will decide which test or tests you need, based on your symptoms (if any), risk factors, and medical history.

Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. For the procedure, your provider puts a catheter (a long, thin, flexible tube) into a blood vessel in your arm, groin, or neck, and threads it to your heart. The provider can use the catheter to:

• Do a coronary angiography. This involves putting a special type of dye in the catheter, so the dye can flow through your bloodstream to your heart. Then your provider takes x-rays of your heart. The dye allows your provider to see your coronary arteries on the x-ray, and to check for coronary artery disease (CAD). CAD is caused by plaque buildup in the arteries.
• Take samples of your blood and heart muscle.
• Examine your heart valves.
• Do procedures such as angioplasty or minor heart surgeries to repair congenital heart defects or replace heart valves.

A cardiac CT (computed tomography) scan is a painless imaging test that uses x-rays to take detailed pictures of your heart and its blood vessels. Computers can combine these pictures to create a three-dimensional (3D) model of your whole heart. This test can help providers detect or evaluate various heart problems, including:

• Coronary artery disease
• Calcium buildup in the coronary arteries
• Congenital heart defects
• Problems with the aorta (the main artery that carries blood away from the heart)
• Problems with heart function and valves
• Pericardial diseases

Before you have the test, you get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures. The CT scanner is a large, tunnel-like machine. You lie still on a table that slides you into the scanner, and the scanner takes the pictures.

Cardiac MRI (magnetic resonance imaging) is a painless imaging test that uses radio waves, magnets, and a computer to create detailed pictures of your heart. It can help your provider figure out whether you have heart disease, and if so, how severe it is. A cardiac MRI can also help your provider decide the best way to treat heart problems such as:

• Congenital heart defects
• Coronary artery disease
• Heart valve problems
• Pericarditis
• Cardiac tumors
• Damage from a heart attack

The MRI is a large, tunnel-like machine. You lie still on a table that slides you into the MRI machine. The machine makes loud noises as it takes pictures of your heart. Sometimes before the test, you might get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures.

A chest x-ray creates pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. It can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to heart disease.

Coronary angiography (angiogram) is a procedure that uses contrast dye and x-ray pictures to look at the insides of your arteries. It can show whether plaque is blocking your arteries and how severe the blockage is. Providers use this procedure to diagnose heart diseases after chest pain, sudden cardiac arrest (SCA), or abnormal results from other heart tests such as an EKG or a stress test.

You usually have a cardiac catheterization to inject the dye into your coronary arteries. Then the provider will take special x-rays while the dye is flowing through your coronary arteries. The dye lets your provider study the flow of blood through your heart and blood vessels.

Echocardiography, or echo, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart's chambers and valves are working. Providers use an echo to diagnose many different heart problems, and to check how severe they are.

There are several different types of echocardiography. For transthoracic echocardiography (the most common type), a technician applies gel to your chest. The gel helps sound waves reach your heart. The technician moves a transducer (wand-like device) across your chest. The transducer connects to a computer. It transmits ultrasound waves into your chest, and the waves bounce (echo) back. The computer converts the echoes into pictures of your heart.

An electrocardiogram, also called an ECG or EKG, is a painless test that detects and records your heart's electrical activity. It shows how fast your heart is beating and whether its rhythm is steady or irregular.

An EKG may be part of a routine exam to screen for heart disease. Or you may get it to detect and study heart problems such as heart attacks, arrhythmia, and heart failure.

For the test, you lie still on a table and a nurse or technician attaches electrodes (patches that have sensors) to the skin on your chest, arms, and legs. Wires connect the electrodes to a machine that records your heart's electrical activity.

Stress testing looks at how your heart works during physical stress. It can help to diagnose coronary artery disease, and to check how severe it is. It can also check for other problems, including heart valve disease and heart failure.

For the test, you exercise (or are given medicine if you are unable to exercise) to make your heart work hard and beat fast. While this is happening, you get an EKG and blood pressure monitoring. Before or after the test, you might also have an echocardiogram, or other imaging tests such as a nuclear scan. For the nuclear scan, you get an injection of a tracer (a radioactive substance), which travels to your heart. Special cameras detect the energy from the tracer to craeate pictures of your heart. You have pictures taken after you exercise, and then after you rest.

NIH: National Heart, Lung, and Blood Institute

Heart Surgery

What is heart surgery?

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

There are different types of heart surgery that can help treat many heart conditions:

• An implantable cardioverter defibrillator (ICD) to help prevent sudden cardiac arrest.
• A biventricular pacemaker to coordinate the heart's pumping action so it's more powerful.
• A ventricular assist device to help the heart pump blood.
• A total artificial heart to pump blood for the heart.

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)

NIH: National Heart, Lung, and Blood Institute

Heart Valve Diseases

What are heart valve diseases?

Heart valve disease happens when one or more of your heart valves don't work well.

Your heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats they close to stop the blood from flowing backwards.

If one or more of your heart valves doesn't open or close correctly, it can affect your blood flow and strain your heart. Fortunately, treatment helps most valve diseases.

Heart valves can have three basic kinds of problems:

• Regurgitation, or backflow, happens when the flaps of a valve don't close tightly. This allows the blood to leak backwards. A common cause of regurgitation is prolapse, where the flaps of the valve flop or bulge back. Prolapse most often affects the mitral valve.
• Stenosis happens when the flaps of a valve become thick, stiff, or stuck together. This prevents the heart valve from opening all the way. Not enough blood can pass through the valve. Aortic valve stenosis is a common type of stenosis. It affects the valve that controls blood flow into the large artery that carries blood out of the heart to the body.
• Atresia happens when a heart valve did not form properly and does not have an opening for blood to pass through.

Sometimes a valve can have both regurgitation and stenosis.

Some people are born with heart valve disease. This is called congenital heart valve disease. It can happen alone or along with other congenital heart defects. Heart valve disease can also develop over time as you get older or have certain conditions that affect the heart.

Your chance of having heart valve disease is higher if:

• You are older. With age, the heart valves can become thick and stiff.
• You have or have had other conditions that affect your heart and blood vessels. These include:
  • Rheumatic fever. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years. Today, most people take antibiotics to cure strep throat before it can cause heart valve damage.
  • Endocarditis. This is a rare infection in the lining of the heart and heart valves. It is usually caused by bacteria in the bloodstream.
  • A heart attack.
  • Heart failure.
  • Coronary artery disease, especially when it affects the aorta (the large artery that carries blood from the heart to the body).
  • High blood pressure.
  • High blood cholesterol.
  • Diabetes.
  • Obesity and overweight.
  • Lack of physical activity.
• A family history of early heart disease:
  • A father or brother who had heart disease younger than 55.
  • A mother or sister who had heart disease younger than 65.
• You were born with an aortic valve that wasn't formed right. Sometimes this will cause problems right away. Other times, the valve may work well enough for years before causing problems.

Many people live their whole lives with a heart valve that doesn't work perfectly and never have any problems. But heart valve disease may get worse slowly over time. You may develop signs and symptoms, such as:

• Shortness of breath (feeling like you can't get enough air)
• Fatigue
• Swelling in your feet, ankles, abdomen (belly), or the veins in your neck
• Chest pain when you're physically active
• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Dizziness or fainting

If you don't get treatment for heart valve disease, the symptoms and strain on your heart may keep getting worse.

When the valves don't work well, your heart has to pump harder to get enough blood out to the body. Without treatment, this extra workload on your heart can lead to:

• Heart failure
• Stroke
• Blood clots
• Sudden cardiac arrest or death

Your health care provider may listen to your heart with a stethoscope and hear that your heart makes abnormal sounds, such as a click or a heart murmur. These sounds may mean a valve isn't working normally. The provider will usually refer you to a cardiologist, a doctor who specializes in heart diseases.

The doctor will also listen to your heart and will do a physical exam. You will also likely need to have one or more heart tests.

Most heart valve problems can be treated successfully. Treatment may include:

• Medicines to control your symptoms and keep your heart pumping well
• Heart-healthy lifestyle changes to treat other related heart conditions
• Surgery to repair or replace a valve

It's possible that you may need surgery, even if you don't have symptoms. Fixing the valve can help prevent future heart problems.

There are many ways to do heart valve surgery. You and your doctor can decide what's best for you, based on your valve problem and general health. Heart valve repair surgery has fewer risks than heart valve replacement. So, when repair is possible, it's preferred over valve replacement.

In some cases, valve replacement is necessary. There are 2 types of replacement valves:

• Biologic valves made from pig, cow, or human tissue. These valves tend to wear out after 10 to 15 years, but some may last longer.
• Mechanical (human-made) valves usually don't wear out. But with a mechanical valve, you usually have to take blood thinners for the rest of your life to prevent blood clots. And your risk of endocarditis (a heart infection) is higher than with a biologic valve.

NIH: National Heart, Lung, and Blood Institute

Heartburn

Heartburn is a painful burning feeling in your chest or throat. It happens when stomach acid backs up into your esophagus, the tube that carries food from your mouth to your stomach.

If you have heartburn more than twice a week, you may have GERD. But you can have GERD without having heartburn.

Pregnancy, certain foods, alcohol, and some medications can bring on heartburn. Treating heartburn is important because over time reflux can damage the esophagus.

Over-the-counter medicines may help. If the heartburn continues, you may need prescription medicines or surgery.

If you have other symptoms such as crushing chest pain, it could be a heart attack. Get help immediately.