“Sleep is the golden chain that ties health and our bodies together.” – Thomas Dekker

After a heart attack, heart surgery, cardiac arrest, or a diagnosis of heart disease, many people focus on medication, rehabilitation, exercise, and diet. All of these are important.

But there is another powerful healing tool that is often overlooked.

Sleep!

Good quality sleep is not a luxury. It is a biological necessity. It is one of the most important things your body and mind need in order to heal, recover, and function well.

Yet sleep is something many people struggle with after a cardiac event.

You may find yourself lying awake worrying about your health, replaying events in your mind, or feeling anxious about the future. You might fall asleep easily but wake up several times during the night. You may feel exhausted during the day despite spending plenty of time in bed.

If this sounds familiar, you’re certainly not alone.

Why sleep matters so much after a cardiac event and what you can do to improve it.

What Happens When We Sleep?

Many of us think sleep is simply a period of “switching off.” In reality, sleep is a remarkably active process. Throughout the night, your brain and body move through different stages of sleep, broadly divided into:

Non-REM Sleep

This is where the body does much of its physical repair work. As you drift into deeper stages of Non-REM sleep:

• Heart rate slows
• Blood pressure lowers
• Breathing becomes more regular
• Body temperature drops
• Muscles relax
• The immune system gets to work

During deeper Non-REM sleep, your body repairs tissues, supports healing, and helps restore the cardiovascular system.

REM Sleep

REM stands for Rapid Eye Movement. This is often called dream sleep. During REM sleep:

• The brain becomes highly active
• Dreams occur
• Memory processing takes place
• Emotional experiences are processed
• Learning and cognitive function are supported

Throughout the night, we cycle between these stages several times. Each stage has a unique and important role in maintaining both physical and emotional wellbeing.

Why Sleep Matters for Your Heart

Sleep gives your cardiovascular system valuable time to recover. During healthy sleep:

• Blood pressure naturally drops
• The heart doesn’t have to work as hard
• Inflammation levels can reduce
• Blood vessels have an opportunity to rest and repair
• The immune system functions more effectively

Sleep also supports many of the factors that influence heart health, including:

• Blood sugar regulation
• Weight management
• Mood and emotional wellbeing
• Stress hormone regulation
• Cognitive function and memory

Put simply, sleep helps both your heart and your brain heal.

Why Sleep Can Become Difficult After a Cardiac Event

Many people tell me: “I was never a bad sleeper before all this happened.”

A cardiac event such as an implantable device, cardiac arrest, heart failure, heart attack or heart surgery can shake your sense of safety and certainty. During the day, appointments, family responsibilities, work, television, and daily life can keep your mind occupied.

Then bedtime arrives. The house becomes quiet. The distractions disappear. And suddenly all the thoughts you’ve been pushing aside start demanding attention. You might find yourself thinking:

• What if this happens again?
• Why am I still feeling this way?
• Am I recovering normally?
• What will my future look like?
• What if I don’t sleep tonight?

Unfortunately, worrying about sleep often creates even more difficulty sleeping. This can lead to what sleep specialists sometimes call the anxiety-sleep cycle:

Anxiety causes poor sleep → Poor sleep increases anxiety → Increased anxiety makes sleep harder.

It can quickly become a frustrating loop.

Why Does Anxiety Often Feel Worse at Night?

Many people recovering from a cardiac event tell me that their anxiety seems to come alive at bedtime. You may have coped reasonably well throughout the day, only to find that the moment you get into bed your thoughts begin racing. This isn’t unusual, and there are several reasons why it happens.

The Distractions Have Gone

As I mentioned during the day, your mind is occupied. There are jobs to do, conversations to have, television to watch, appointments to attend, meals to prepare, and countless little distractions competing for your attention. When bedtime arrives, all of that disappears. The quietness creates space for thoughts that may have been pushed aside during the day to come rushing forward.

Questions such as:

• Am I recovering properly?
• What if something happens during the night?
• Will I ever feel like myself again?
• What does my future look like now?

Can suddenly feel much louder when there is nothing else to focus on.

Your Brain Is Trying to Protect You

After a heart attack, heart surgery, cardiac arrest, or other significant health event, your brain can become more alert to signs of danger. This is a completely normal survival response.

The problem is that your brain doesn’t always know when it is safe to switch off.

Even when you are tucked up in bed, part of your mind may still be scanning for threats, monitoring symptoms, or anticipating problems. This can keep your body in a state of hypervigilance when what it really needs is rest.

Physical Sensations Feel Bigger at Night

When we’re busy during the day, we rarely notice every heartbeat, ache, sensation, or change in our breathing. At night, when we are lying still in a quiet room, those sensations can become much more noticeable. For someone recovering from a cardiac event, this heightened awareness can sometimes trigger worry.

You notice a flutter. You notice your heartbeat. Your blood pumping in your ears. You notice a strange sensation. Then your mind starts asking questions. Before you know it, anxiety has joined you in bed.

The Fear of Not Sleeping

Many people develop what psychologists call anticipatory anxiety around sleep. After a few difficult nights, they begin worrying about whether they will sleep before they have even switched the light off. Thoughts such as:

“What if I’m awake all night again?”

“I’ll feel dreadful tomorrow if I don’t sleep.”

“Why can’t I just switch off?”

Can actually increase alertness and make sleep harder to achieve. The more pressure we put on ourselves to sleep, the more elusive it often becomes.

The Anxiety-Sleep Cycle

Unfortunately, anxiety and poor sleep can feed each other. Anxiety makes it harder to fall asleep or stay asleep. Poor sleep leaves us feeling more emotionally vulnerable the next day. This increased vulnerability can make anxiety feel stronger. And so the cycle continues.

The good news is that once we start improving either side of the cycle, reducing anxiety or improving sleep, we often begin to see improvements in both.

A Gentle Reminder

If anxiety seems worse at night, it does not mean you are coping badly. It does not mean you are weak. And it certainly does not mean there is something wrong with you.

For many people, especially after a life-changing health event, bedtime is simply the first quiet moment their mind has had all day to process everything they have been through.

Understanding this can be reassuring in itself. Sometimes the goal isn’t to stop anxious thoughts appearing altogether. Sometimes the goal is simply learning how to respond to them with kindness, patience, and a few helpful tools that allow your mind and body to feel safe enough to rest.

The Problem Isn’t That You’re Awake

One of the most important things I teach people is this:

The problem isn’t always being awake.

Often, the problem is what we’re doing while we’re awake. Many people spend hours trying to solve problems, plan tomorrow, analyse symptoms, or replay difficult experiences. Your brain remains in “problem-solving mode” when what it really needs is permission to switch into “rest mode.”

A Sleep Technique Worth Trying: Cognitive Shuffling

Recently, a technique called Cognitive Shuffling has gained attention among sleep researchers and psychologists. It was developed by cognitive scientist Dr Luc Beaudoin and is designed to mimic the random, dream-like thinking that naturally occurs as we fall asleep.

The idea is beautifully simple. Instead of allowing your mind to race through worries and plans, you deliberately think of random, unrelated objects. For example, choose a neutral word such as:

HOUSE

Then think of unrelated words beginning with each letter:

H: Horse, Hammer, Hedgehog, Helicopter

O: Orange, Owl, Oven, Octopus

U: Umbrella, Uniform, Unicorn

And so on with the S and the E.

The aim isn’t to think deeply. The aim is to gently occupy your mind with random, neutral images so it stops trying to solve problems. Research suggests this may help interrupt racing thoughts and reduce the mental activity that keeps many people awake. Some people find they fall asleep before they even reach the second or third letter.

Will it work for everyone?  No.

But it is free, simple, safe, and many people report finding it surprisingly effective.

Other Gentle Ways to Improve Sleep

If sleep has become a struggle, try focusing on progress rather than perfection. A few simple habits can make a significant difference:

1. Create a Consistent Routine

Try going to bed and getting up at roughly the same time each day. Your brain loves predictability.

2. Keep Your Bedroom Cool

A slightly cooler room helps the body lower its temperature, which supports the natural sleep process.

3. Limit Caffeine

Caffeine can remain in your system much longer than many people realise. If you’re sensitive to it, consider reducing afternoon and evening intake.

4. Move During the Day

Gentle activity such as walking, cardiac rehabilitation exercises, stretching, or gardening can help regulate sleep and improve mood.

5. Reduce Screen Time Before Bed

Phones, tablets, and televisions can stimulate the brain when we’re trying to wind down. Consider creating a calming bedtime routine instead.

6. Create a “Worry Time”

If your mind tends to become busy at bedtime, try setting aside 10–15 minutes earlier in the day to write down worries, questions, or tasks for tomorrow. Sometimes giving worries a designated space helps stop them following us into bed. Make sure this is not close to the time you go to bed,

7. A Positive Psychology Approach to Better Sleep

Positive psychology isn’t about pretending everything is fine. It’s about deliberately creating the conditions that help us flourish. When it comes to sleep, that means focusing on what supports rest rather than what prevents it. Instead of asking:

“What if I don’t sleep?”    Try asking:  “What can I do tonight to help my body feel safe enough to rest?”

Perhaps that’s reading a comforting book. Listening to calming music. Practising gratitude. Doing a breathing exercise. Or reminding yourself:

“Rest is still helpful, even if sleep takes a little longer to arrive.”

Sometimes reducing the pressure to sleep is exactly what helps sleep return.

Further Reading on Sleep

• How to use your mind to help you fall asleep
• How to change your behaviours to help you get a good night’s sleep
• How to help your body, help you to sleep well

My Final Thoughts

Sleep is not just something that happens at the end of the day. It is an active healing process. It supports your heart. It supports your brain. It supports your emotional wellbeing. And while you may not be able to control exactly when sleep arrives, there is a lot you can do to create the best possible conditions for it.

• Be patient with yourself.
• Recovery is hard work.
• Healing takes energy.

And sometimes one of the most important things you can do for your heart is simply give yourself permission to rest.

If sleep has become a challenge since your cardiac event, know that you’re not alone. Many people experience changes in their sleep during recovery, and there is support available.

Improving your sleep may be one of the most powerful steps you can take towards improving your health, your recovery, and your quality of life.

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