Sleep, diet and physical activity are critical to health, including heart health and optimal blood pressure control. Experts warn that persistent difficulty falling or staying asleep causes high blood pressure that is difficult to treat.

Sleep is necessary for survival. Humans spend about one third of their lives sleeping. During sleep, the body takes the opportunity to cleanse and regenerate. Through the sleep cycles, the body is actively producing hormones that put humans in a growth state and allow for recovery and healing of muscles and tissues. Sleeping is also instrumental to reinforcing memories and in processing complex emotions.

Because of the importance of sleep, insomnia presents a huge challenge and carries significant consequences. Insomnia, which is defined as a difficulty falling asleep, and/or staying asleep, or disturbances in sleep patterns that result in inadequate amounts or quality of sleep, can eventually affect every area of life.

Chronic insomnia, for whatever reason, significantly affects health, performance, safety, and pocketbook. Signs of not getting enough sleep or sleeping poorly include consistently taking more than 30 minutes to fall asleep, awakening more than a few times or for long periods each night, feeling sleepy during the day, or having trouble concentrating at school or at work.

The amount of sleep that a person needs to function normally depends on several factors, such as age. Infants sleep most of the day; teenagers usually need about nine hours a day; and adults need an average of between seven and eight hours a day. Although elderly adults require about as much sleep as young adults, they usually sleep for shorter periods and spend less time in deep stages of sleep.
Many people experience temporary insomnia from a few days to a few weeks. This kind of insomnia usually results from normal happenings in life such as a stressful event, emotional stress, illness or temporary pain. In addition, factors such as caffeine, nicotine, noise, bright lights, or an uncomfortable room temperature, can contribute to poor sleep.

With rare exceptions, insomnia is a symptom of a problem, and not the problem itself. Poor sleep is often a sign of some malfunctioning and may signal either minor or serious medical or psychiatric disorders. It could also signal the worsening of a medical problem like high blood pressure or hypertension.

A study from the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions stated that for people with high blood pressure, not sleeping well or long enough can have serious consequences. Poor sleep quality in high blood pressure patients was found to be associated with resistant hypertension, a type of high blood pressure that is difficult to treat.

Hypertension, an uncontrolled high blood pressure, is coming up strong in some countries of the world, Nigeria included. However, hypertension is a complex disease with many risk factors such as age, gender, nutrition, environment, stress, obesity and heredity, interacting to determine those that may have a raised blood pressure.

Blood pressure measures the rate at which blood pushes against the walls of the arteries as it moves through the body. The systolic pressure is the rate at which the heart is contracted and is pumping blood into the body, and the diastolic pressure is the rate at which the heart is resting between pumps. When blood pressure is too high on a regular basis, it can quietly damage the organs of the body for years before symptoms develop.

Today, hypertension and its complications such as stroke and heart attack are some of the leading causes of death among adults, especially in the middle age worldwide. It is the most frequent reason for consultation to physicians and the most frequent reason for which medications are prescribed in many countries of the world, stated Professor Babatunde Salako, in his lecture on non-communicable

diseases in Nigeria at the College of Medicine, University of Ibadan.

Overall, up to 40 per cent of adults may be hypertensive and it is often diagnosed for the first time in middle age. Thus, it is referred to as the silent killer," stated Professor Salako.

Previous studies have shown that people who have poor-quality sleep are more likely to get high blood pressure. To explore if poor sleep also plays a role in making some people’s blood pressure difficult to treat, the researchers looked at 234 people with high blood pressure, who were being treated at a clinic in Pisa, Italy.

Some of the participants (around 15 in every 100) still had high blood pressure despite taking multiple drugs. All the participants filled in a detailed questionnaire about their sleep habits and sleep quality. After factoring in their ages, use of sleeping tablets, and several other things that might affect their sleep quality and blood pressure, the researchers estimated that people with poor-quality sleep were twice as likely to have treatment-resistant high blood pressure as those who slept well.

The researchers wrote: "Short sleep duration is highly prevalent in hypertensive patients. This condition is accompanied by poor sleep quality and depressive symptoms in women. Poor sleep quality is associated with a two-fold higher probability of having resistant hypertension. This association could be mediated by the presence of depressive symptoms."

Most people can lower their blood pressure by making lifestyle changes - such as exercising more and eating less salt - and taking medications. But some people’s blood pressure remains high despite treatment.

Blood pressure is considered resistant or difficult to treat when a person with hypertension is taking three or more blood pressure medications or antihypertensive drugs but still has a blood pressure reading higher than 140/90 mmHg.

Unfortunately, cases of people with resistant hypertension are also on the rise in Nigeria, stated Professor Adindu Chijioke, a consultant nephrologist, University of Ilorin Teaching Hospital, Ilorin, Kwara State.

"In a study that we carried out at the University of Ilorin among patients with chronic kidney disease and hypertension, over 80 per cent of them were found to have resistant hypertension," he stated.

Professor Chijioke, who remarked that lack of deep sleep could contribute to a raised blood pressure, stated that individuals with poor sleep control stood a high chance of poorly controlled blood pressure.

"In fact, poor sleep has been identified as one of the risk factors for the development of resistant hypertension," he stated.

According to him, individuals with sleep disorders also stand the risk of their antihypertensive medications being unable to control the blood pressure as effective as they should.