Sleep

Sleep disorders can be common in individuals with autonomic dysfunction, and working to correct them can help decrease symptoms and improve quality of life. ¹

Individuals with postural tachycardia syndrome (POTS), neurogenic orthostatic hypotension (nOH), and other forms of dysautonomia have reported disturbed sleep, insomnia, and other sleep disorders. ² ³ ⁴

In individuals with dysautonomia and sleep dysfunction, there tend to be large numbers of spontaneous arousals that can be related to autonomic dysfunction. ⁵

One of the first steps in treating sleep disorders and sleep dysfunction is establishing good sleep hygiene. These suggestions below can be discussed with your provider to see if they are good options to incorporate based on your unique medical needs. 

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Tips for establishing good sleep hygiene can include ⁶ ⁷ ⁸ ⁹:

Sleep Schedule
  • Aim for 8-10 hours of sleep a night
  • Establish a sleep schedule with a fixed time to wake up each day, and then calculate backward when you need to go to bed to get your desired number of hours of sleep.
  • Start preparing to go to sleep an hour before intended bedtime.
  • Don’t overdo naps. They can be helpful to regain energy during the day but can alter the ability to sleep at night.
  • Establish a consistent nightly routine that helps signal your body it is time to sleep.
    • Turn off and limit exposure to devices with screens or visible LED lights, as this can hinder the body’s production of melatonin.
    • Set your phone to do-not-disturb, turn it to silent, turn it off, or keep it in a separate room.
Incorporate relaxation methods
  • If able, take a warm shower. 
  • Deep breathing techniques can help you wind down.
  • Mindfulness can also help you relax.
  • Progressive muscle relaxation can also help ease body tension and induce relaxation.
  • Consider drinking herbal tea without caffeine. Many contain chamomile and other herbs that can help with relaxation, though they may not be tolerable for everyone.
Optimize your environment
  • Invest in a comfortable mattress and pillow
  • Investigate which kinds of sheets and blankets are best for you 
    • Some individuals need sheets designed to help with cooling or wicking or moisture or sheets that help keep you warm. 
    • Other individuals like to use weighted blankets to help them relax and sleep better.
  • Set your room to a cool and comfortable temperature.
  • Block out the light with heavy curtains or an eye mask to block light that can interrupt sleep.
  • Consider using a white noise machine, fan, or other sounds that can help induce sleep and drown out other noises. 
Integrate healthy daily habits to support the wake/sleep cycle
  • Try to get daily exposure to sunlight, which can impact the circadian rhythm and encourage good sleep.
  • Reduce alcohol consumption.
  • Reduce the amount of caffeine in the afternoon and evening as it is a stimulant and can hinder sleep. 
  • Try not to eat big, heavy, or spicy meals late in the evening as it can impact sleep quality. 
  • Limit in-bed activity to sleeping as much as possible. This helps build a link in the mind of the bed being for sleeping. 
  • Try to exercise 20-30 minutes a day, but avoid exercise at least 4 hours before bed. 

Keep a sleep diary

Keep a sleep diary that can help track your sleep habits and other information such as intake of caffeine and alcohol, amount of time spent on electronics, bedtimes, sleep quality, and more.

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Sleep Positioning

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Some providers might also recommend sleeping with the head of the bed elevated by about 4-6 inches. ¹⁰ ¹¹

This sleeping position is commonly recommended in individuals with neurogenic orthostatic hypotension (nOH) as they can experience high blood pressure while lying down. ¹²

However, researchers suggest that elevating the head of the bed may be helpful for other forms of dysautonomia as it may help retain fluid volume as well. ¹³ ¹⁴

The best way to achieve the elevated head of bed is through placing the head of the bed up on raisers, blocks of wood, or other material to elevate the bed. This is preferred to sleeping on several pillows or using a pillow wedge as it creates an inclined plane with the body rather than just elevating the torso.

Reviewed by Medical Content Experts, 2021

REFERENCES

Bryarly, M., Philips, L. T., Fu, Q., Vernino, S., & Levine, B.D. (2019). Postural orthostatic tachycardia syndrome: JACC focus seminar. Journal of the American College of Cardiology, 73(10). 1207-1222. {10, 13}

Cleveland Clinic. (2018). Living with dysautonomia. {2, 6}

Goldstein, D.S. (n.d.). Principles of autonomic medicine 4.0. {3}

Hale, G. M., Valdes, J., & Brenner, M. (2017). The treatment of primary orthostatic hypotension. The Annals of Pharmacotherapy, 51(5), 417–428. {12}

Maxwell, A. J. (2020). Dysautonomia In D. Jovin (Ed.), Disjointed: Navigating the diagnosis and management of hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. (1st ed., pp. 135-215). Hidden Stripes Publications, Inc.  {4, 7}

Pocinki, A. (2015). Sleep Disorders in The Dysautonomias. In K. Freeman, D.S. Goldstein, & C.R. Thompson (Eds), The dysautonomia project: Understanding autonomic nervous system dysfunction for physicians and patients.(p. 140-142). Bardolf & Company. {1, 5, 8}

Raj, S.R., Guzman, J.C., Harvey, P., Richer, L., Schondorf, R., Seifer, C., Thibodeau-Jerry, N., & Sheldon, R.S. (2020). Canadian cardiovascular society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Canadian Journal of Cardiology, 36(3), 357-372. {11}

Suni, E. (2020). Sleep hygiene. SleepFoundation.org {9}

Wells, R., Spurrier, A. J., Linz, D., Gallagher, C., Mahajan, R., Sanders, P., Page, A., & Lau, D. H. (2018). Postural tachycardia syndrome: Current perspectives. Vascular Health and Risk Management, 14, 1–11. {14}

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