Woman Sleeping With High Blood Pressure

How to Sleep With High Blood Pressure (Doctor’s 7 Tips)

by
Dr-Babar-Naeem.

This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

Approximately half of the people who have high blood pressure (hypertension) in the US also have insomnia and sleep disturbances.

So how can you get better quality sleep if you have high blood pressure?

The most effective way to sleep better with high blood pressure is to sleep on your left side because it can lower your blood pressure without causing back pain – since stomach sleeping can also reduce blood pressure but is typically very uncomfortable.

In the rest of this article, I have expanded upon this point and provided you with 7 tips to help you sleep better if you have high blood pressure.

Although I have used my expert knowledge as a practicing medical doctor, this is not medical advice and you should always consult with your own doctor for the best guidance.

Related: discover the 8 ways that sleep affects blood pressure here.

7 Ways to Sleep Better With High Blood Pressure

What Is The Relation Between High Blood Pressure and Sleep?

According to the CDC, about 116 million people in the United States have hypertension, constituting about 47% of the adult population.

High blood pressure is one of the greatest risk factors for heart attack and stroke.

Sleep disturbance and insomnia are very frequent in patients with hypertension.

A meta-analysis of 24 studies concluded that about 52.5% of patients with hypertension have poor quality sleep [1].

Insomnia is also associated with increased blood pressure, so it is very important for patients with hypertension to manage their high blood pressure.

Some important tips to help patients with hypertension sleep better are described below.

1: Sleep On Your Left Side

The best sleeping position to lower your blood pressure is on your front – however, this position often isn’t comfortable for many sleepers and can cause back pain, so sleeping on your left side is the best option to reduce blood pressure and remain pain-free.

Blood pressure is higher when you sleep on your back compared to sleeping on your front.

Moreover, blood returning from the lower part of the body also increases in the supine position, which provides extra blood for the heart to pump.

A study conducted at the University School of Nursing, Izmir, Turkey, confirmed the idea that systolic and diastolic blood pressure was highest in individuals who were in the supine position, compared to any other posture [2].

Recent studies have also demonstrated that sleeping on the stomach reduces blood pressure in hypertensive patients [3].

But you should always be aware of the dangers of sleeping on your stomach.

This sleeping posture can cause supine misalignment, back pain, increased acid reflux, and GERD.

So it would be best if you carefully considered the risks associated with the position.

I generally do not recommend this sleeping position to all patients.

Sleeping on the Left Side is Best

The experts believe that sleeping on the left side is the best position for patients with high blood pressure.

Blood returns from the lower part of the body via a major blood vessel called the inferior vena cava.

The upper part of the body drains through the superior vena cava.

Both of these vessels are located on the right side of the heart.

If we sleep on the right side, the whole weight of the body puts pressure on the right side of the chest, resulting in compression of these vessels.

So sleeping on the left side relieves pressure, and encourages the blood to drain from the blood vessels to the heart.

This position is generally safe for most people, as it is not associated with other health hazards, as is sleeping on the stomach.

I recommend hypertensive patients sleep in this position.

Here are 11 ways to sleep better with acid reflux.

2: Limit Your Salt Intake to Less Than 5g Per Day

Limiting your salt intake to less than 5 grams per day is recommended by the World Health Organization (WHO), to control high blood pressure and associated sleep disturbances.

Salt is an essential component of life, that adds a special taste to our food.

It performs many important functions in the body, including fluid and water regulation.

When salt is consumed in large amounts, it becomes difficult for the kidneys to excrete it.

When salt is retained in the body, it is accompanied by water retention.

Salt and water retention is the main factor that raises blood pressure.

The INTERSALT study is a very famous and large study that looked at patients from 52 population groups worldwide.

It demonstrated that those individuals who consumed more salt had a higher chance of developing higher blood pressure [4].

A moderate reduction in dietary salt can have a marked effect on blood pressure and cardiovascular health.

Salt reduction is the first strategy that we recommend to control hypertension.

The recommended salt intake for adults should be less than 5 grams per day.

The WHO estimates that about 2.5 million deaths could be prevented per year if global salt consumption was within the recommended levels [5].

However, most people do not limit their salt intake to the recommended amount.

The average salt intake of most people is 9-12 grams per day, which is about twice the recommended level [5].

There is a common misconception that diets containing sodium (the main component of salt) are always salty.

Sodium can be hidden in many foods and contributes to poor hypertension control.

Hidden sources of sodium include salad dressings, bread, bran muffins, sauces, soups, cheeses, etc.

Therefore, it is always good to check your food’s labels for its sodium content.

I always tell my patients to avoid hidden salt sources they can unintentionally consume.

Sodium is found in various foods, like milk, fish, and meat.

Its concentration increases when food is processed.

I recommend these tips for decreasing salt consumption:

  • Do not place a salt shaker on the table.
  • Limit your consumption of snacks.
  • Do not use salt for the preservation of foods.
  • Always look at the labels of foods for sodium components.
  • Minimize your consumption of processed foods.

3: Increase Physical Activity to Lower Blood Pressure

Regular exercise helps patients sleep by reducing blood pressure, lowering stress, and strengthening the cardiovascular system.

A sedentary lifestyle is a major causative agent of many health problems, including hypertension, diabetes, stroke, and heart attack.

Physical activity strengthens the cardiovascular system by increasing blood flow to the heart, lungs, and muscle tissues.

So everyone, especially hypertensive patients, should make it a habit to exercise regularly.

The American Heart Association, the American College of Cardiology, the Canadian Hypertension Education Program, the European Society of Hypertension, and the European Society of Cardiology recommend exercise to manage and prevent hypertension.

Aerobic Exercise Offers Maximum Benefits

Aerobic exercise refers to low to moderate-intensity physical activity, that uses oxygen to turn carbohydrates into energy.

Anaerobic exercise is a high-intensity exercise performed for a short period.

The term aerobic means oxygen, and anaerobic means without oxygen.

When we perform low-intensity exercise, there are good sources of oxygen available in the body to support the process of energy production.

In anaerobic exercise, the body cannot provide continuous oxygen because of high demand, resulting in the production of by-products, like lactate.

Aerobic exercises include walking, swimming, jogging, climbing stairs, dancing, and sports.

Research has revealed that aerobic exercise reduces blood pressure by 5-10 mmHg, and reduces the risk of heart attack and stroke by 20-30% [6].

Dynamic Resistance Exercises are Also Good for Hypertension

Dynamic resistance exercises involve the movements of the muscles against an opposing force, to improve muscle strength.

Examples of this category include weight lifting and circuit training.

Research has shown that dynamic resistance exercises also lower blood pressure, but their effect is less significant than aerobic exercise.

They lower the blood pressure by 2-3 mmHg, and the risk of stroke by 14-17% [7].

So how much exercise do we need?

Experts recommend that you perform 150 minutes of moderate physical activity, or 75 minutes of vigorous exercise, in one week.

This doesn’t mean that you can run a marathon on day one, and rest for the next six days.

Research has shown that maximum benefits are seen when patients exercise at least five days a week.

So I recommend my patients do 30 minutes of exercise per day for five days a week.

You can rest for the remaining two days, to allow growth and repair of the muscles.

Consult a Doctor if You Experience Any Problems While Exercising

Increased physical exercise is generally helpful for most people, but it can create problems.

I always recommend my patients discuss the duration and type of exercise with their doctors, especially if they have chronic diseases, like diabetes, heart disease, high cholesterol, or lung disease.

If you feel severe chest pain, dizziness, and difficulty breathing, you should discontinue exercise, and immediately consult a doctor.

Try these 10 strategies for getting better sleep after exercising too late at night.

4: Lower Your Blood Pressure by Losing Weight

Blood pressure increases with every pound we gain.

Weight loss is prescribed as a first-line, anti-hypertensive strategy for managing high blood pressure.

Weight loss improves both systolic and diastolic components of blood pressure.

Losing weight has a great effect on individuals who are obese or overweight.

According to a meta-analysis of 25 studies, five kilograms of weight loss reduces the systolic blood pressure by 5 mmHg.

There are two ways to lose weight: the first is to decrease the number of calories you consume, and the second is by burning more calories.

I recommend losing no more than half-pound a week, as rapid weight loss can harm the body.

Experts recommend combining both these strategies for maximum benefits.

One pound is approximately equal to 3500 calories.

So if you want to lose one pound, you should consume 500 fewer calories than usual, or burn 500 more calories per day [8].

Here are 10 ways to stop sleep apnea from causing weight gain.

5: Eat the Right Foods to Lower Blood Pressure

A healthy, balanced diet decreases the risks of developing hypertension and cardiovascular diseases.

The Dietary Approach to Stop Hypertension, also known as the DASH diet, was introduced in 1997 to offer a non-pharmacological treatment for high blood pressure.

Researchers have proven that the DASH diet is highly effective in reducing high blood pressure and cholesterol levels.

Complete control of high blood pressure can be achieved without using any medicine, by combining the DASH diet with low salt intake, weight loss, and regular exercise [9].

The DASH diet alone can reduce blood pressure by 6-11 mmHg.

It is also very useful when used as an adjuvant to drug therapy.

Another important aspect of the DASH diet is that its blood pressure reduction is more pronounced in hypertensive patients than in normal individuals.

The DASH diet is high in fruits, vegetables, lean meats, and dairy products.

It is low in sodium, saturated fats, and cholesterol.

The DASH diet recommends five servings of fruits and vegetables per day, seven servings of carbohydrates, and 2 to 3 servings of nuts and seeds [9].

Another important aspect of the DASH diet is that it provides all the nutrients necessary for growth and development.

Carbohydrates

Carbohydrates are an important source of energy and micronutrients.

DASH recommends the consumption of healthy carbohydrates, like broccoli, spinach, kale, and mustard leaves.

Whole grains, including oats, wheat, millet, legumes, and beans, are also recommended.

Good Fats

Good fats decrease inflammation and promote cardiovascular health.

The sources of good fats recommended by DASH include nuts, olive oil, fish, avocados, and flax seeds.

Proteins

Proteins are an important structural component of every cell and are essential for growth and repair.

DASH recommends consuming nuts, seeds, legumes, soy products, eggs, and lean meat as protein sources [9].

The U.S. News and World Report ranked the DASH diet as the best overall diet for health for eight consecutive years [10].

6: Take Blood Pressure-Lowering Drugs as Prescribed

If high blood pressure is not controlled with lifestyle changes, your doctor will prescribe suitable anti-hypertensive drugs.

Anti-hypertensive medicine works best when combined with low sodium intake, the DASH diet, and regular exercise.

There are different types of drugs available, and your doctor can choose what is best for you.

A summary of these drugs is provided below:

Diuretics

These drugs act on the kidneys and increase water and salt excretion in the urine.

That’s why these drugs are also known as water pills.

Examples of diuretics include furosemide (Lasix), bumetanide (Edecrin), spironolactone (Spiromide), and amiloride.

Side effects of diuretics include dehydration, hypotension, electrolyte imbalance, dizziness, and headache.

ACE Inhibitors

This category includes captopril (Capoten), lisinopril (Zestril), enalapril (Vasotec), and benazepril.

ACE Inhibitors decrease blood pressure by relaxing arteries and veins.

They are the best choice for diabetes, heart, and kidney disease patients.

Side effects include intractable cough, dizziness, skin rash, hypotension, and hyperkalemia.

Another category, with almost similar effects to that of ACE inhibitors, is Angiotensin II receptor blockers (ARBs).

Angiotensin-II is a powerful chemical that constricts the blood vessels and results in hypertension.

ARBs protect vessels from this chemical, and ACEI prevents the formation of angiotensin-II.

Drugs in this category include valsartan, losartan and candesartan.

Calcium Channel Blockers

Calcium channel blockers (CCBs) are commonly prescribed to treat high blood pressure in the elderly.

Calcium is an important mediator of vessel contraction and results in constriction of the arteries.

CCBs prevent the entry of calcium into cells and result in the relaxation of the vessels.

Drugs in this category include amlodipine (Norvasc), nifedipine (Procardia), verapamil, and diltiazem.

Side effects of CCBs include constipation, flushing, dry mouth, nausea, and palpitations.

Find out if sleeping on a full stomach is bad for you here.

7: Avoid Substances That Increase Blood Pressure

There are many drugs and other substances that can affect your blood pressure.

Some of these are helpful for hypertensive patients, while others are detrimental.

So you should be aware of these before attempting blood pressure-lowering interventions.

Smoking Increases Blood Pressure

Smoking tends to increase blood pressure, due to the presence of nicotine.

Nicotine results in increased heart rate, and constriction of blood vessels, and both of these factors increase blood pressure.

Smoking cessation has been shown to reduce blood pressure significantly in hypertensive and normal individuals [11].

Find out how nicotine affects sleep here.

Limit Your Consumption of Caffeine

The effects of caffeine on blood pressure are different for different individuals.

Caffeine stays in the system for 10-12 hours and increases blood pressure.

The blood pressure raising effect is less marked in people who consume caffeine regularly [12].

I always recommend my patients limit caffeine intake, in order to have a night of good quality sleep.

Click here to discover the exact caffeine content of many popular drinks.

Dark Chocolate Reduces Blood Pressure

Dark chocolate helps with high blood pressure, due to the high cocoa content.

Flavanols present in dark chocolate increase the formation of nitric oxide, which relaxes blood vessels [13].

You should, however, be aware of the harmful effects of eating too much chocolate, which are obesity, weight gain, dental caries, anxiety, and restlessness.

Click here to find out if hot chocolate can help you sleep or not.

Summary

To solve your sleep problems caused by high blood pressure, you should sleep on your left side.

Increased physical activity, sodium restriction, and weight loss are non-pharmacological interventions that should be tried before starting any drug.

If these interventions fail, then there are a variety of anti-hypertensive medications available that a doctor can prescribe.

Up next: 7 tips for sleeping better with ear pain.

References

[1] L. Li et al., “Prevalence of Poor Sleep Quality in Patients With Hypertension in China: A Meta-analysis of Comparative Studies and Epidemiological Surveys   ,” Frontiers in Psychiatry  , vol. 11. 2020, [Online]. Available: https://www.frontiersin.org/article/10.3389/fpsyt.2020.00591.

[2] İ. Eşer, L. Khorshid, Ü. Yapucu Güneş, and Y. Demir, “The effect of different body positions on blood pressure,” J. Clin. Nurs., vol. 16, no. 1, pp. 137–140, Jan. 2007, doi: https://doi.org/10.1111/j.1365-2702.2005.01494.x.

[3] K. Kario, “Nocturnal Hypertension,” Hypertension, vol. 71, no. 6, pp. 997–1009, Jun. 2018, doi: 10.1161/HYPERTENSIONAHA.118.10971.

[4] “Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group,” BMJ, vol. 297, no. 6644, pp. 319–328, Jul. 1988, doi: 10.1136/bmj.297.6644.319.

[5] “Salt Reduction,” World health organization, 2020. https://www.who.int/news-room/fact-sheets/detail/salt-reduction (accessed Feb. 06, 2022).

[6] V. A. Cornelissen and N. A. Smart, “Exercise training for blood pressure: a systematic review and meta-analysis,” J. Am. Heart Assoc., vol. 2, no. 1, pp. e004473–e004473, Feb. 2013, doi: 10.1161/JAHA.112.004473.

[7] A. S. Ghadieh and B. Saab, “Evidence for exercise training in the management of hypertension in adults,” Can. Fam. Physician, vol. 61, no. 3, pp. 233–239, Mar. 2015, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/25927108.

[8] U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Your Guide to Lowering Blood Pressure. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2003.

[9] H. J. Challa, M. A. Ameer, and K. R. Uppaluri, DASH Diet To Stop Hypertension. Treasure Island (F.L.), 2020.

[10] “DASH ranked Best Diet Overall for eighth year in a row by U.S. News and World Report,” National institute of health, 2018. https://www.nih.gov/news-events/news-releases/dash-ranked-best-diet-overall-eighth-year-row-us-news-world-report.

[11] S.-Y. Tsai, W.-H. Huang, H.-L. Chan, and L.-C. Hwang, “The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study,” Tob. Induc. Dis., vol. 19, p. 82, Oct. 2021, doi: 10.18332/tid/142664.

[12] J. M. Geleijnse, “Habitual coffee consumption and blood pressure: an epidemiological perspective,” Vasc. Health Risk Manag., vol. 4, no. 5, pp. 963–970, 2008, doi: 10.2147/vhrm.s3055.

[13] “Dark Chocolate,” Harvard T.H.Chan. https://www.hsph.harvard.edu/nutritionsource/food-features/dark-chocolate/ (accessed Feb. 07, 2022).

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