How ATTR-CM Affects Your Sleep

Sleep problems are extremely common when you’re living with transthyretin amyloid cardiomyopathy (ATTR-CM). This heart condition involves misshapen transthyretin protein building up in your heart muscle and sometimes in your nerves.

With ATTR-CM, sleep-related symptoms like loud snoring, waking up gasping, a feeling of “drowning” after a few hours of sleep, or frequent nighttime bathroom trips can make getting shut-eye difficult and even frightening. It’s also common to struggle with leg or hand discomfort from resulting nerve damage.

The good news is that living with ATTR-CM doesn’t automatically mean restless nights of interrupted sleep. The root causes of these sleep issues are often treatable when you have this condition, which could help you breathe easier, sleep longer, and feel better during the day.

The protein buildup that occurs in ATTR-CM creates a cascade of other issues in your body that can make a number of sleep issues more common.

“The most common sleep-related symptoms in people with ATTR-CM include obstructive sleep apnea (OSA) symptoms, such as loud snoring, gasping for air during sleep, and excessive daytime sleepiness,” says J. Emanuel Finet, MD, a Cleveland Clinic cardiologist and heart failure specialist based in Ohio. In OSA, your airway repeatedly collapses during sleep, causing brief periods of interrupted breathing. This sleep disorder affects a large proportion of people with ATTR-CM, says Dr. Finet.

As ATTR-CM progresses, these issues can continue to get worse, thereby increasing the severity of sleep disruptions, says Finet.

While it’s clear that poor sleep poses a greater risk to overall heart health, it’s not known whether sleep disturbances accelerate the actual disease progression of ATTR-CM, says Finet. However, it’s reasonable to believe that an increase in irregular heart rhythms, increases in the body’s stress response, and intermittent drops in oxygen during sleep (as with sleep apnea) can further strain the heart, he says.

Steps to improve your overall sleep quality should be personalized with help from your healthcare team. That’s especially important if you’re taking medicines for heart failure or using devices for breathing support. Consider the expert recommendations below as a starting point.

1. Adjust Diuretic Timing to Curb Nighttime Bathroom Trips

“Decreasing fluid consumption and taking diuretics earlier in the day will help minimize trips to the bathroom at night to urinate, which should protect sleep,” says Finet.

2. Follow Your Heart Failure Treatment Plan to Limit Swelling

3. Treat Sleep Apnea if You Have It

A large proportion of people with ATTR-CM have sleep-disordered breathing. So, healthcare providers should screen for OSA when a person has daytime sleepiness, frequent nighttime urination, or witnessed apneas (an event in which breathing is interrupted), says Finet.

“Therapies to manage sleep apnea such as CPAP and BiPAP machines [can] be of tremendous help in improving sleep," says Finet.

4. Elevate Your Upper Body if You Feel Breathless Lying Flat

5. Address Neuropathy Symptoms That Wake You Up

6. Practice Smart Sleep Habits That Complement Medical Care

• Exercise regularly.
• Go to bed and get up around the same time every day.
• Avoid caffeine or heavy meals before bedtime.
• Limit alcohol if you drink it.
• Don’t smoke.

• Transthyretin amyloid cardiomyopathy (ATTR-CM) can cause significant sleep disruptions, including obstructive sleep apnea, insomnia, and fragmented sleep due to discomfort from nerve damage.
• The protein buildup in ATTR-CM can lead to heart muscle thickening and fluid retention, which may cause symptoms like sudden shortness of breath and an increased need to urinate at night, further disrupting sleep.
• Getting quality sleep is essential when you’re living with ATTR-CM, as it supports heart health, improves mood and energy, and can reduce the risk of developing other chronic conditions.
• To improve sleep, work with your healthcare team to adjust diuretic timing, follow heart failure treatment plans carefully, treat sleep apnea, elevate your upper body while sleeping, manage neuropathy symptoms, and practice good sleep-hygiene habits.