February, often referred to as heart month, is a perfect time to remind ourselves and those we care for and about how to live heart healthy. Living heart healthy is viewed more broadly than just living free of cardiovascular disease. In fact, the concept of cardiovascular health was reconceptualized in 2010 when the American Heart Association (AHA) proposed that ideal cardiovascular health equated to living free of cardiovascular disease plus meeting 7 other metrics collectively known as “Life’s Simple 7”.
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The 7 metrics included maintaining a heart healthy diet, engaging in adequate physical activity, having a healthy body weight, not smoking cigarettes, and having healthy blood pressure, cholesterol, and blood glucose (through nonpharmacologic means).- Lloyd-Jones D.M.
- Hong Y.
- Labarthe D.
- Mozaffarian D.
- Appel L.J.
- Van Horn L.
- Greenlund K.
- Daniels S.
- Nichol G.
- Tomaselli G.F.
- Arnett D.K.
- Fonarow G.C.
- Ho P.M.
- Lauer M.S.
- Masoudi F.A.
- Robertson R.M.
- Roger V.
- Schwamm L.H.
- Sorlie P.
- Yancy C.W.
- Rosamond W.D.
Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.
Circulation. 2010; 121: 586-613
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Evidence has shown that when these 7 health behaviors and health factors are ideal, individuals live longer, free of cardiovascular disease, with a higher quality of life.- Lloyd-Jones D.M.
- Hong Y.
- Labarthe D.
- Mozaffarian D.
- Appel L.J.
- Van Horn L.
- Greenlund K.
- Daniels S.
- Nichol G.
- Tomaselli G.F.
- Arnett D.K.
- Fonarow G.C.
- Ho P.M.
- Lauer M.S.
- Masoudi F.A.
- Robertson R.M.
- Roger V.
- Schwamm L.H.
- Sorlie P.
- Yancy C.W.
- Rosamond W.D.
Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.
Circulation. 2010; 121: 586-613
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In April of 2022, the AHA updated their definition of cardiovascular health to include sleep as a new cardiovascular health component, renaming “Life’s Simple 7” to “Life’s Essential 8”.2
It makes sense that sleep has been added as an essential component to optimize health. After all, who doesn’t feel better after a good night’s sleep? Yet how is “good” sleep health defined? Sleep health is multidimensional; duration, timing, efficiency, regularity (weekend-weekday difference), satisfaction, and impact on daytime sleepiness/alertness collectively make up sleep health.
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The AHA recommends that getting 7-9 hours of sleep per night which can be systematically measured as self-reported average hours of sleep per night.2
Assessment can be low-tech (simply asking “on average, how many hours of sleep do you get per night?”) or high-tech (e.g., measuring sleep duration more objectively through actigraphy via wearable technology).2
In my clinic I treat adults with uncontrolled hypertension. This past year I added sleep health to discussions related to lifestyle modifications to help patients improve their blood pressure and their cardiovascular health. Many patients disclose to me that they get about 5-6 hours of sleep per night. From these discussions, I have found that there are 2 major reasons why they don’t get enough sleep – both of which apply to me and members of my household. The first impediment to a good night’s sleep is binge watching television. Watching television for extended periods of time, especially late at night, has gotten worse during the COVID pandemic. During stay-at-home orders, we found ourselves homebound and got hooked on various shows, especially those without commercials. As I well know, as soon as 1 episode is done, by default another episode automatically begins, unless you opt out. You tell yourself – just 1 more! Before you know it, hours have passed cutting into precious sleep time! For this, I recommend that patients give themselves a time limit (e.g., not past midnight – something that generally works for me) or set an alarm as a reminder to go to bed.
Distractions are a second barrier to getting enough sleep, typically from having the phone on the nightstand in the sleeping area. I, like many of my patients, check email or scroll through social media. As with watching television or gaming, before you know it you have been on your device longer than expected, shortening sleep time. Or worse yet, you find yourself thinking about work or other obligations after checking email, thus interfering with sleep. To resist these temptations, I recommend cutting off or putting your phone on a “do not disturb” mode – or better yet charging your phone in another room. This also helps to prevent robot calls that seem to come all hours of the day or night. These strategies have helped me and my patients whom I counsel. Recommend these strategies to your patients to improve their sleep health as a way to live heart healthy or try them yourself. After all, if your phone is in the other room and you find yourself staring at the ceiling, you can always occupy your mind by counting sheep. One, two, three, four, five, …… zzzzzz.
References
- Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.Circulation. 2010; 121: 586-613
- Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory from the American Heart Association.Circulation. 2022; 146: e18-e43https://doi.org/10.1161/CIR.0000000000001078
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