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This chapter reviews the research evidence from epidemiological and clinical studies of cardiac patients that establishes sleep disruptions as an independent risk factor for cardiovascular disease. The impact of both sleep duration and sleep apnea are reviewed. The circadian distribution of cardiac events in the early morning and late afternoon argue strongly for the involvement of 24-hour circadian processes in precipitating angina, myocardial infarcts, thrombotic strokes and cardiac deaths. The pathophysiological processes underlying these events are discussed with particular attention paid to evolving understanding of the circadian rhythms of the cardiovascular and metabolic systems. The combined effect of stress system dysregulation and sleep disturbance presents challenges to the clinician managing these patients. The chapter presents an overview of the suggested clinical interventions to help these patients recover from their cardiovascular events. Two case studies are used to illustrate the interventions.