After a day of hard work, we all feel tired. However, there is a type of tiredness that’s different. Heart failure may cause feeling of “running out of battery”. For patients with heart failure, walking a few steps is tiring enough, not to mention climbing the stairs!

Why does patient with heart failure feel tired easily? Dr. Shin of the cardiovascular intensive care unit of the Far Eastern Memorial Hospital explains that patient with heart failure feels tired easily because the heart muscle doesn’t plump enough blood, resulting in inadequate blood running through the circulation. Hence, patient feels tired and endurance drops. They start panting just by walking a few steps due to the blood amount not meeting the body’s need.

Aside from the inadequate blood in the surrounding tissues which causes insufficient oxygen and nutrition. Reduction in the amount of blood circulation may negatively affect the transition of waste. With lack of nutrition and too much waste in the body, it is no wonder that patient with heart failure feels tired.

Why does Patient with Heart Failure have Sleep Apnea, Insomnia and other Sleeping Disorders?

“Sleep apnea may be what causes heart failure; it may also be a result. Amongst 5 to 10 patients with heart conditions, 1 has sleeping disorder or sleep apnea.” says Dr. Shin, “Sleep apnea does causes the condition of heart failure to worsen, with the composition of the heart being damaged even more.”

Sleep apnea can be divided into two types, one is “central sleep apnea”, due to problems with the brain stem, the force that causes breathing during sleep is lost, this is especially common among elderlies and those with serious heart failure. Another type is called“obstructive sleep apnea”, this is due to the gullet and the upper respiratory tract dropping and blocking the airway. This type of sleep apnea is most commonly seen among elderlies, those who are overweight or are born with short neck.

Heart failure may also have something to do with this type of sleep apnea, with the tissues swollen, this may cause a detrimental effect on sleep apnea.

Dr. Shin points out that the biggest problem to sleep apnea is insufficient oxygen. When the oxygen saturation level drops, heart condition will deteriorate under such circumstance. Inadequate oxygen will stimulate the nervous system, causing people to wake up in the middle of the night, have faster heartbeats, which leads to an even worse oxygen-inadequacy. Inadequate oxygen also impacts hormones, causing adrenaline to rise while releasing angiotonics.

The release of such hormones will affect the heart structure, and worsen the condition of heart failure. All in all, sleep apnea has a detrimental effect on the heart, so it is crucial to start from treating sleep apnea.

What are some Heart Failure Symptoms that are often Neglected?

Dr. Shin states that panting when walking and having swollen feet are common symptoms of heart failure, yet some symptoms are often neglected. For example, some patients “does not have good appetite”, this is because heart failure causes blood flow to be obstructed, which leads to mesenteric ischemia or mucosal inflammation. Patient may misbelieve that they do not have an appetite because the weather is too hot, or opt to seek medical attention from the gastroenterological department instead. Some patients tend to cough during the night when they are lying down, and they might misinterpret this as having a cold. However, this is because when the level of heart failure reaches a certain degree, it may cause pulmonary edema, this will cause the patient to start coughing whenever they are lying down, some might even only be able to breathe while sitting up, we call this as orthopnea.

For some patients, they tend to feel sleepy during daytime, but they overlook the situation, believing this tiredness to be a consequence of working for long hours.

Actually, there are also patients who suffers heart failure as a result of myocarditis. They misjudge this as a cold and fail to seek medical attention in the first place. By the time they realize something is wrong, their heart function has already greatly deteriorated, which often comes as an unpleasant surprise for both patient and their family.

Dr. Shin suggests that patients take a chest X-ray if they continue to cough for over two weeks in order to exclude the possibility of pneumonia and other problems. These non-specific symptoms are easily ignored which often causes the delay in treatment.

How to Improve Sleep Quality for Patients with Heart Failure

“First of all, you must deal with heart failure”, says Dr. Shin. “One must comply to the doctor’s instructions and take the standard medication as instructed.”

Patients with heart failure and sleep apnea, or patients with orthopnea should consider using positive airway pressure. This is a mode of respiratory ventilation that contains a mask and compressor to delivers air into the airway. This not only ensures unblocked upper airway, but can also help relief pleural effusion.

Can Patients with Heart Disease take Sleeping Pills?

Whether or not to give patients with heart failure sleeping pills is a dilemma, for without the medication, the patient will continue to experience discomfort. However, those with sleep apnea will have their conditions worsen if given sleeping pills, for it causes spasticity to drop and increases the possibility of the upper respiratory tissue falling. Dr. Shin says that typically, mild sedatives are given, if the patient can endure positive airway pressure, then stronger medications will be given. However, if the patient can endure positive airway pressure, then it is also likely that they do not require the help of sleeping pills as their sleep quality is already lifted thanks to positive airway pressure. Each case requires evaluation.

Dr. Shin emphasizes that those with heart failure and sleep apnea should refrain from taking sleeping pills without a doctor’s prescription lest more problems arise.

【本文由「照護線上」授權轉載，原文出處：越睡越疲倦？心臟衰竭可能已經找上你】

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