Do you find yourself dozing off whilst standing during the day? You’d better check your blood pressure

Hands up anyone who’s never spent a whole night tossing and turning in bed, unable to get to sleep, only to drag themselves around like a zombie for the whole of the following day. It’s an experience shared by many and, if it’s only occasional, it doesn’t cause any major problems, apart from those linked to reduced concentration and slower reflexes. But if the ‘combination’ of insomnia and daytime sleepiness becomes a regular occurrence, it serves as a warning sign for a further problem: high blood pressure.

A restless night’s sleep, accompanied by profound drowsiness the following day, doubles – or rather, triples – the risk of high blood pressure. The warning comes from research presented at the SLEEP 2026 conference held recently in the US. American researchers suggest that excessive daytime sleepiness, combined with difficulty falling asleep, characterises a group of people at particular risk of high blood pressure, and this should prompt thorough checks to ensure appropriate management.

The study, carried out on over 1,700 adults taking part in the Penn State Adult Cohort (a longitudinal population-based study on sleep and health), found that people with significant daytime sleepiness are 52 per cent more likely to already have high blood pressure (i.e. to have a blood pressure above 140/90 mmHg or to be taking antihypertensive medication) and a 74 per cent higher risk of developing this condition in the immediate future, compared with those who do not suffer from this condition. These figures are significant in their own right. However, the risk of high blood pressure literally ‘skyrockets’ when daytime sleepiness is accompanied by another ‘nuisance’, namely difficulty falling asleep in the evening, defined as a sleep latency of 30 minutes or more.

In fact, for these people, the likelihood of already having high blood pressure has more than doubled, whilst the risk of developing high blood pressure in the future is more than three times higher than for those who do not have either condition.

According to Alexandros N. Vgontzas, Professor of Psychiatry and Behavioural Health and Director of the Sleep Research and Treatment Centre at Penn State College of Medicine (Pennsylvania, USA) and author of the study, the combination of ‘difficulty falling asleep and daytime sleepiness’ constitutes a clear risk profile (phenotype). The resulting advice is therefore: if you feel drowsy and tired during the day and struggle to fall asleep at night, monitor your blood pressure regularly over time. The recommendation for doctors, however, is not to limit their assessment to a suspected case of obstructive sleep apnoea syndrome (OSAS) when faced with a patient complaining of tiredness and drowsiness. Instead, it is necessary to examine the overall picture to understand whether sleep is becoming a problem for that individual, thereby also investigating the possible presence of insomnia and depression, conditions which, in the study, were found to be significantly more common precisely amongst those presenting with the combined disturbance of difficulty falling asleep and daytime sleepiness, and which can benefit from behavioural and pharmacological therapies. In short, the assessment of sleep duration and quality should be incorporated into the algorithm for assessing cardio-renal-metabolic risk (whose checklist should include sleep disorders – insomnia, restless legs syndrome, OSAS). Sleep hygiene and sleep health must be considered as modifiable cardio-renal-metabolic risk factors.