According to a study that looked at 53 million U.S. death certificates issued from 1973 to 2001, researchers found a significant overall increase (5%) in heart related deaths during the winter holiday season, with the highest number of cardiac deaths occurring on December 25, the second highest on December 26, and the third highest on January 1st.
In the medical journal Circulation, where this study was published, researchers cited cold temperatures, along with emotional stress and holiday overindulgence as possible triggers for this sudden peak in heart attacks. This may be true, but there’s still one other major factor that this and other studies like this overlook. And that is that anyone who suffers from a sleep-breathing problem like obstructive sleep apnea, may be more at risk during this time of the year especially if they’re not aware.
The Deadly Link Between Sleep Apnea and Heart Problems
If you look at all the medical studies out there linking sleep apnea and high blood pressure, heart disease, and heart attacks, it seems almost implausible that anyone who’s at risk for heart problems, wouldn’t also know that they may also be suffering from a sleep-breathing problem.
However, 80-90% of people with obstructive sleep apnea or OSA in this country remain undiagnosed and therefore untreated. As I often reiterate to my patients, and expound in my recently released book, Sleep, Interrupted, OSA is a massive trigger for heart problems but many, including some physicians, may miss its severe implications–especially when so many other factors come in to play during the winter holiday season.
According to one other research done on this subject, respiratory disease, which tends to rise and therefore weaken patients with heart problems, was thought to play a role in increasing cardiac arrests.
Some doctors also cite that frigid temperatures can aggravate heart problems since cold weather constricts blood vessels which in turn raises blood pressure and makes you more susceptible to blood clots. Add to this the sudden physical exertion of shoveling snow and it seems more than plausible that deaths by heart attacks would certainly peak during during these icy, snowy, blistery months.
Yet studies show that even in Los Angeles, where the temperature is much more temperate, deaths by cardiac arrest peak during the holiday season. Therefore, factors like over-eating and heightened stress during the holiday season were also cited as possible causes along with people putting off seeking medical treatment as to not disrupt their holiday plans. The study also pointed out that the shortage of staffs at local hospitals during major holidays may contribute to this rise in heart related deaths as well.
Even though all these seasonal triggers are problematic for those with preexisting heart problems and should be addressed appropriately (like staying warm and avoiding strenuous activities), they nonetheless mislead patients and physicians alike to attend to the symptoms rather than the cause.
Specifically if a patient has OSA and this is what’s aggravating or even causing his heart problem, taking care of their high blood pressure, or their respiratory problems with medications is like treating a bullet wound with a band aid. Sooner or later, undiagnosed and untreated sleep breathing problems can wreak more havoc on your health than any of these other factors combined. It may just be that the holiday season with all its manifold health risks are providing the right place at the right time for heart patients to feel the full effects of OSA.
But before I can explain how you can avoid being part of this grim statistic, an explanation of what obstructive sleep apnea is is in order.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a condition where a person, due to an obstruction in the airway, stops breathing anywhere from 50-200 times a night while sleeping. These obstructions occur as a cause of several factors, one of which is that the muscular structures surrounding airway can slacken and close off the airway resulting in a cessation of breath or "apneas."
Ceasing to breathe multiple times throughout the night leads to a number of different physiologic consequences. Periods of low oxygen levels (along with elevated carbon dioxide levels) triggers a stress response by activating blood gas level sensors in the body, which constricts blood vessels. During an apnea episode, tremendous vacuum pressures are created (up to -80 cm of water pressure), which prevents proper blood flow to the heart, which ultimately results in less blood being pumped out of the heart.
After the apnea ends, chest pressure returns to normal, and a sudden increase in blood flow through the heart along with constricted blood vessels can lead to a severe rise in blood pressure.
In effect, frequent arousals like these over many nights, and years can cause injury to the lining of the blood vessels, which can promote or aggravate heart disease. The elevated blood pressure can also carry over into the daytime where any acute external trigger, like emotional stress can further aggravate. Add to this the excess weight gain, along with more inactive time indoors during these cold winter months, and it’s just a massive coronary waiting to happen.
Some classic symptoms of OSA include daytime fatigue and drowsiness, snoring, frequent nighttime urination, and morning headaches. Unfortunately, most doctors still are taught that you must be an older, heavy-set, snoring man with a big neck to have sleep apnea. Yes, that’s true, but that’s the extreme end of the spectrum. We now know that even young, thin women who don’t snore can have significant sleep apnea.
(To find out if a sleep breathing problem may be making you sick take our free quiz )
Practical Solutions For An Impractical Season
If you suspect that you may have OSA, then the first thing you must do to protect yourself from impending heart problems is to get a formal sleep evaluation by a sleep medicine doctor as well as undergoing a formal overnight sleep study.
However, even if you don’t have sleep apnea, there are many common sense measures you can take to avoid the risk of heart problems or any number of health problems for that matter during this special time of the year. As I explain in my book, Sleep, Interrupted, everyone is susceptible to sleep breathing problems to some degree as a result of our unique airway anatomy. Consequently, any measures taken now to reduce or to allay this problem will allow you to enjoy a much healthier winter season.
Reduce nasal congestion: Any amount of nasal congestion can aggravate airway collapse, thereby causing more breathing cessations, frequent arousals, or overall inefficient sleep. Use lots of nasal saline irrigate your nose to keep your airway clear. Saline acts as a mild nasal decongestant. Allergies can aggravate nasal congestion, so you should take steps to reduce your exposure. Some people with flimsy nostrils that cave in when they breathe in may benefit from nasal dilator strips (Breathe-rite strips). For a detailed explanation on how to breathe better through your nose, read 7 Tips to Breathe Better Through Your Nose).
Maintain your normal sleep routine: As difficult as it may be, try to maintain your typical sleep-wake schedule. Sleeping too long or too little can definitely trigger sleep breathing problems since certain hormones and stress levels can be affected due to rapid changes in our sleep patterns.
Don’t eat late: Although it’s important to avoid overindulging this holiday (for help on how to eat healthy for the holidays read, 10 Tips For Healthy Holiday Eating), it’s also more imperative to eat about 3-4 hours PRIOR to going to bed. Stomach juices have been known to aggravate sinus problems and prevent restful sleep.
Avoid alcohol before bedtime. Rather than eliminate spirits of any kind this season, avoid drinking 3-4 hours before you go to sleep. Alcohol relaxes your throat muscles and can aggravate obstruction while you breathe at night.
Slow down and take a deep breath. During these hectic and stressful times, many of us forget to pause and take breaks regularly in between our daily routines. Every few hours, when you’re transitioning from one major activity to another, stop everything you’re doing, sit down, and take 5-6 slow, deep breaths. Focus on the air as it moves through your nostrils, down the back of your throat, into your lungs, and back out again. If you do this regularly, what you’ll find is that not only will you feel less stressed, but you’re more productive and focused for the activities that you perform.
In addition to all the above measures, try to maintain your regular exercise routine along with a modest diet. More importantly, rather than take these suggestions as a moratorium on your holiday fun this season, consider it a life long policy to ensure many more future holidays in the years to come.
Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time: The Holidays as a Risk Factor for Death
David P. Phillips, Jason R. Jarvinen, Ian S. Abramson, and Rosalie R. Phillips
The "Merry Christmas Coronary" and "Happy New Year Heart Attack" Phenomenon
Robert A. Kloner
Circulation 2004 110: 3744-3745.