Sleeping Better With Peripheral Artery Disease

If you’re living with advanced peripheral artery disease (PAD), you might feel worse at night, with aching and discomfort that keep you awake. It’s a situation that can be frustrating and exhausting.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Can changing your sleeping position help? Let’s get the lowdown on lying down from interventional cardiologist Aravinda Nanjundappa, MD.

The link between PAD and sleep problems

PAD occurs when plaque builds up in the arteries that supply blood to your legs and feet. These blockages limit the amount of oxygen-rich blood reaching your muscles, which can lead to pain and fatigue.

The condition typically brings on leg pain during physical activity, like walking. Nighttime symptoms are usually seen in more advanced stages of the disease.

“Most patients with mild or moderate PAD do not experience symptoms while sleeping,” states Dr. Nanjundappa. “Nighttime discomfort typically occurs in patients with advanced PAD, particularly those with what we call ischemic rest pain.”

Rest pain develops when blood flow to your feet becomes severely compromised. When you’re lying down, with your feet level with your heart, blood flow may be even more limited as gravity isn’t pulling it down.

This can lead to burning, aching or cramping pain, often in the toes or forefoot. Some people find temporary relief from rest pain by dangling their legs over the side of the bed, allowing gravity to do its thing.

Sleep and PAD also influence each other in another important way: Poor sleep quality has been associated with increased inflammation, higher cardiovascular risk and progression of atherosclerosis — all of which contribute to PAD.

“Over time, inadequate sleep may contribute to worsening vascular disease,” says Dr. Nanjundappa.

Is there a “best“ sleeping position for PAD?

There is no scientifically proven “best” sleeping position for PAD. “For most people with PAD, sleep position has little impact on reducing symptoms,” notes Dr. Nanjundappa.

But some individuals with severe PAD find modest relief by sleeping on their back and slightly elevating the head of the bed. This reclined position allows gravity to assist blood flow to the lower extremities.

But it’s important to remember that this adjustment does not address the underlying issue.

“If your leg pain is severe enough to wake you from sleep or forces you to hang your legs off the bed for relief, that’s a warning sign of advanced PAD and warrants medical attention,” emphasizes Dr. Nanjundappa.

What about side sleeping?

Sleeping on your side — especially your left side — is another option if you have PAD-related leg pain. While not proven to relieve PAD symptoms directly, it may offer other health benefits that make it easier to catch ZZZs.

“There’s some evidence that sleeping on your left side can help with digestion, reduce acid reflux and support better drainage of lymphatic fluid,” explains Dr. Nanjundappa. “It also eases pressure on the vena cava, the large vein that returns blood to your heart.”

Side sleeping may also be a better choice than back sleeping if you have sleep apnea, which often seems to coexist with PAD, according to research.

Another important point: Side sleeping is not recommended if PAD is affecting one or both of your arms. (That’s especially true if you’re lying on the side where you’re experiencing pain.) Back sleeping is the better option in this case.

Sleeping positions to avoid with PAD

While back and side sleeping can be helpful, there are two positions you may want to avoid:

Sleeping on your stomach: This puts unnecessary strain on your neck and spine, and it doesn’t help with circulation. Plus, this position may make it harder for you to breathe deeply and get restful sleep.
Sleeping with your legs elevated: This is a common recommendation for people with venous disease, a condition where veins struggle to return blood to the heart. But it’s not ideal for PAD and for addressing arterial blood flow to the legs. “Raising your legs can worsen pain by further reducing circulation,” clarifies Dr. Nanjundappa.

And while it might be tempting to sleep with your feet hanging off the bed for some quick relief, it’s not sustainable or safe over time, he cautions.

Tips to sleep better with PAD

What you do before crawling under the covers can help you get a restful snooze once you close your eyes. Dr. Nanjundappa says improving your sleep when you have PAD often means addressing the condition and other health issues.

You can do that by:

Exercising regularly: Regular movement — even something as simple as short walks or stretching — helps improve circulation and reduce PAD symptoms. Work with your healthcare provider to build a plan that works for you.
Adjusting your diet: Limiting processed foods and saturated fats on your plate can help lower inflammation and improve vascular health. The best diets for PAD also focus on eating more fruits, vegetables, whole grains and lean meats.
Drinking enough water: Dehydration can worsen leg cramps and pain, so make sure you’re getting enough H2O throughout the day.
Maintaining a healthy weight: Extra pounds can place extra pressure on your legs and worsen PAD symptoms.
Taking medications: Prescribed and over-the-counter medications (like aspirin) can help improve blood flow and lessen PAD symptoms. Talk with your doctor about your options.
Not smoking: Smoking worsens PAD by restricting blood flow and damaging blood vessels. Need help quitting? Talk to your healthcare provider to take the first step.

Pay attention to your bedtime routine, too. That includes: