Insomnia complaints in heart failure often have a cardiac or treatment cause. Orthopnoea and paroxysmal nocturnal dyspnoea point to congestion. Nocturia from a late diuretic dose wakes patients repeatedly. Sleep-disordered breathing, both obstructive and central, is common in heart failure and worsens symptoms.
Before prescribing a hypnotic, ask how many pillows the patient uses, whether they wake breathless, when they take their diuretic, and whether a partner has noticed snoring or pauses in breathing.
- Ask about pillow count and waking breathless; new orthopnoea suggests congestion
- Give loop diuretics in the morning or early afternoon to limit nocturia
- Ask a bed partner about snoring, gasping or breathing pauses
- Consider a sleep study when sleep-disordered breathing is suspected
Why it matters
A sedative can hide worsening heart failure that a diuretic adjustment would fix.
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