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Peripheral Artery Disease (PAD) and Sleep

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Leg pain and other symptoms of peripheral arterial disease (PAD), which occur when narrowed blood vessels reduce blood flow to the limbs, can make it difficult to get enough sleep. In addition to the physical symptoms of PAD, certain sleep disorders are linked to this condition, further affecting sleep quality.

PAD is primarily caused by atherosclerosis, a condition in which fats and other debris accumulate inside the arteries. While it most commonly affects the blood supply to the legs, it can also involve the arms in some cases. Proper treatment for PAD and any associated conditions can help individuals achieve the restful sleep they need.

Best Sleeping Positions for Peripheral Artery Disease

Optimizing your sleep position can significantly alleviate the discomfort caused by PAD. The following sleeping positions are beneficial:

Leg Elevation

Elevating your legs while sleeping can relieve the discomfort associated with PAD. By raising your legs above the level of your heart, you prevent blood from pooling in the extremities, reducing swelling and discomfort. Adjustable beds provide an easy way to achieve leg elevation, but if you have a regular bed, you can use pillows to prop up your legs to a comfortable height.

Sleeping on Your Back

Sleeping on your back is recommended for individuals with PAD, as it distributes weight evenly and reduces pressure on affected blood vessels. This position also promotes natural leg and foot elevation, further improving blood circulation. Placing pillows under your legs can provide additional support and reduce strain on the lower back.

Side Sleeping

If sleeping on your back is not feasible, side sleeping is the next best option for individuals with PAD. Ensure that your legs remain straight and aligned with your body while sleeping on your side. Placing a pillow between your knees can help maintain proper leg alignment and reduce strain on the hips.

Investing in Quality Pillows and Mattresses

Consider investing in supportive pillows and mattresses to enhance sleep quality. Memory foam mattresses and contour pillows provide targeted support and pressure relief, making them particularly beneficial for individuals with PAD. Mattresses that offer adequate support to the hips and legs, along with pillows that provide proper neck and shoulder support, can significantly improve sleep for PAD sufferers.

Avoiding Sleeping on Your Stomach

Sleeping on your stomach is not recommended for individuals with PAD for several reasons. Firstly, this position naturally lowers the extremities, causing blood to pool in the legs and resulting in swelling and discomfort. Additionally, sleeping on your stomach can put excess pressure on the neck and spine, hindering blood flow. To avoid this position, place firm pillows, extra blankets, or a long body pillow on either side of your body to prevent rolling onto your stomach during sleep.

Symptoms of PAD

The symptoms of PAD, also known as peripheral arterial disease, can vary from mild to severe. Some individuals with this disorder may not experience any symptoms at all, according to Dr. Lee Kirksey, a vascular surgeon at the Cleveland Clinic. However, in more severe cases, PAD can lead to the following problems:


Claudication refers to leg pain that occurs during physical activity, typically in the calf or thigh muscles. Patients often describe cramping, heaviness, or a charley horse sensation when they walk a certain distance. The discomfort subsides when they rest, but it reoccurs when they resume walking a similar distance.

Wounds and other pain

People with PAD may develop sores or ulcers on their toes and feet. They may also experience pain in their toes or the front of their foot, even when they are not engaged in physical activity. These symptoms, along with cool, pale, or numb legs and feet, indicate severe peripheral arterial disease.

Tissue damage

Critical limb ischemia (CLI) represents the most advanced stage of PAD. In this stage, blood flow to the limb is severely restricted, resulting in non-healing sores. Individuals at this stage are at risk of requiring amputation, and surgery is necessary to improve blood flow. However, it is important to note that only a small percentage of people with PAD reach this stage, and around 30% of them will require amputation.

How PAD Affects Your Sleep

Depending on the severity of PAD, it can disrupt sleep in three main ways:

Related Pain Keeps You Up

Mild PAD typically does not affect sleep. However, as peripheral artery disease becomes more severe, individuals may experience pain even when they are at rest. This nighttime pain can awaken them from sleep. Tingling sensations in the foot or toes can also interrupt sleep. Activities such as standing up or hanging the legs over the side of the bed can help improve blood flow to the lower limbs.

Sleep Apnea Disrupts Your Sleep

There is a clear association between PAD and obstructive sleep apnea, a sleep disorder characterized by frequent awakenings during the night. People with sleep apnea experience episodes of breathing cessation or shallow breathing. These interruptions in breathing and the resulting drop in oxygen levels can lead to inflammation in the body, affecting the heart, blood vessels in the brain, and arteries supplying the limbs. This inflammation can cause scarring in the arteries and contribute to the development of PAD.

Restless Legs Syndrome Wakes You

Restless legs syndrome is another sleep disorder associated with PAD. Around 10% to 20% of individuals with PAD also experience restless legs syndrome, characterized by an irresistible urge to move the legs at night. The leg movements often disrupt sleep, causing frequent awakenings.

Risks of Sleep Deprivation

Long-term sleep deprivation due to PAD-related symptoms can have detrimental effects on overall health. Sleep deprivation is associated with an increased risk of various health conditions, including coronary artery disease, heart failure, diabetes, heart attacks, strokes, and obesity. Therefore, it is crucial to address sleep disturbances caused by PAD promptly.

If severe leg pain is preventing you from getting adequate sleep, it is important to contact your doctor as it requires immediate medical attention. Similarly, if restless legs syndrome frequently disrupts your sleep, it is advisable to consult with a healthcare professional to explore treatment options. It is also worth discussing the potential risk of PAD with your doctor if you have sleep apnea, especially if there is a family history of the condition.

What You Can Do to Sleep Better with PAD

If you are experiencing any symptoms of PAD that affect your sleep, it is essential to seek medical advice as soon as possible. Your doctor can assess your condition and recommend appropriate treatment options. Here are some strategies to improve sleep quality with PAD:

Seeking Medical Help

Contact your doctor if you notice any symptoms of PAD, particularly those that keep you awake at night. Your doctor will evaluate your situation and suggest suitable treatment methods based on your specific needs.

Exercise for Mild PAD

For individuals with mild PAD, exercise can be an effective approach to managing symptoms. Walking is a recommended exercise for improving blood flow. Your doctor may suggest a supervised exercise program, typically involving walking on a treadmill under the guidance of a nurse, exercise therapist, or physical therapist. It is important to continue exercising even if you experience leg cramping (claudication), as this helps develop alternative pathways for blood flow, ultimately improving sleep quality.

Wrapping Up

Peripheral artery disease (PAD) can significantly impact sleep quality due to leg pain, sleep apnea, and restless legs syndrome. Sleep deprivation associated with PAD can increase the risk of various health conditions. However, there are strategies to improve sleep with PAD. Seeking medical help, engaging in exercise programs, and adopting proper sleeping positions, such as leg elevation, sleeping on the back, or side sleeping, can alleviate discomfort and enhance sleep quality. Investing in quality pillows and mattresses that provide adequate support can further contribute to better sleep. Avoiding stomach sleeping is advisable for individuals with PAD. By prioritizing these strategies, individuals with PAD can manage symptoms effectively and improve their overall sleep experience.


1. Can PAD cause leg pain even when not exercising?

Yes, PAD can cause leg pain even when you are not engaged in physical activity. Leg pain at rest, especially in the toes or front of the foot, can indicate severe peripheral artery disease. It is important to consult with a healthcare professional if you experience such symptoms.

2. Can PAD lead to amputation?

In advanced cases of PAD, particularly critical limb ischemia (CLI), the restricted blood flow to the limb can lead to non-healing sores and an increased risk of amputation. However, it is important to note that only a small percentage of people with PAD reach this stage, and there are various treatments available to alleviate symptoms and improve blood flow.

3. How does sleep apnea relate to PAD?

There is a clear association between sleep apnea and PAD. Sleep apnea, characterized by frequent awakenings due to breathing interruptions, can cause a drop in oxygen levels, leading to inflammation and scarring in the arteries. This can contribute to the development or progression of PAD.

4. Can exercise help improve sleep with PAD?

Exercise, particularly walking, can be beneficial for individuals with mild PAD. Engaging in a supervised exercise program that encourages you to continue walking even with leg cramping (claudication) can help develop alternative pathways for blood flow, ultimately improving sleep quality.

5. How can investing in quality pillows and mattresses help with sleep and PAD?

Quality pillows and mattresses, such as memory foam mattresses and contour pillows, can provide targeted support and pressure relief, enhancing sleep comfort for individuals with PAD. Supportive bedding materials that properly align the body and support the hips, legs, neck, and shoulders can significantly improve sleep quality.

Wynne Lee, MD

Dr. Wynne Lee is a physician at Massachusetts General Hospital (MGH), where she provides primary care.

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