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Stroke, Mini-Stroke, And Sleep – How Are They Related?

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If you or your loved one has suffered a stroke or a small (ischemic) stroke, you may be familiar with sleep problems that follow it – insomnia, obstructive sleep apnea, and sleep-wake cycle disorders are among the most common. Those who sleep well after a stroke usually recover faster and much better than those who don’t. 

Sleep problems seem to increase the risk of the first stroke and if they continue after stroke, they are very likely to cause the second one. That’s why you might as well take care of your sleep starting tonight.

Source: Sunnybrook Health Sciences Centre

Sleep disorders that may cause stroke

Your body isn’t able to restore properly when your sleep is compromised. In the long run, this causes other problems like hypertension, mood disorders, hormonal imbalances, and a higher risk of serious problems like cancer and stroke. Check out these sleep disorders that have been linked to stroke. 

  • Insomnia is among the top risk factors. Whether you have problems falling asleep, staying asleep (frequent wakings) or wake up much earlier than desired – it all classifies as insomnia.
  • Obstructive sleep apnea (OSA) and other sleep-related breathing disorders are disorders in which a person’s breathing is interrupted, causing them to snore or even wake up in an attempt to catch a breath. 
  • Sleep duration that is both too short and too long seems to be dangerous. However, although 8 hours a night is recommended by virtually every authority on sleep, some studies say that women who report sleeping 7 hours are at a lower risk of having a stroke than those who sleep eight. Long sleep doesn’t only cause stroke, but also stroke mortality.
  • Shift work and circadian rhythm disorders are recognized as carriers of serious risks for many illnesses. Shift workers, especially those who work in rotating shifts, often have to adjust and re-adjust their sleep patterns. This can cause circadian rhythm disorders which are basically a shift in the inner biological clock that governs your hormones, energy levels, and sleep-wake times. If you can’t catch up with the rest of society, you may have this disorder.
  • Movement disorders are unwanted and uncommon body movements while we are falling asleep or during sleep. For example, restless leg syndrome is when a person can’t fall asleep because every time they try to relax they get unpleasant sensations in the legs that urge them to move.

Common telltale signs of poor sleep or sleep disorders are excessive daytime sleepiness, non-restorative sleep, slow reactions and impaired motor skills, forgetfulness and mood changes. 

Sleep disorders that often come as a consequence of stroke

Sleep disorders that can cause stroke are the same as those that follow stroke. They include insomnia and OSA as the most frequent disorders, circadian rhythm disorders, sleep-related movement disorders, and a significantly shortened or prolonged duration of sleep.

Sometimes an otherwise healthy sleeper can become an insomniac or OSA sufferer following a stroke or ischemic stroke. 

If you suffered a stroke and have insomnia, you won’t only take longer to fall asleep – your sleep will be less efficient (more awakenings, and more time spent in the light sleep stages instead of having the restorative deep sleep). These insomniacs make more mistakes and are not alert but they also don’t have daytime naps to compensate for lost sleep. Sometimes insomnia is caused by increased psychological efforts, pain or discomfort, and insufficient activity. It may also be caused by lesions (damage) in parts of the brain that regulate sleep.

Sleep disturbances impair the life quality and rehabilitation of post-stroke patients

Sleep disturbances have a negative effect on post-stroke patients when it comes to maintaining balance and the ability to walk. They are also clumsier and likely to overlook or forget things.

Sleep helps neuroplasticity which includes reorganization of brain circuits that were cut off or damaged during the stroke. This results in better learning, memory and physical movement. Sleep deprivation is at the same time deprivation of the opportunity to recover successfully.

Source: The role of sleep in recovery following ischemic stroke: A review of human and animal data 

Patients who have sleep disorders are usually not willing to go all the way with rehabilitation therapy – they lack motivation, energy, and focus.

Sleep disorders can cause a recurrent stroke if left untreated because they lead to and aggravate cardiovascular issues that are related to stroke.

Source: The role of sleep in recovery following ischemic stroke: A review of human and animal data 

Improving your sleep after stroke

Most of the advice we see on websites of sleep associations or stroke associations are what can be classified as healthy sleep practices that everyone should follow. We included those as well as tips that are specific to stroke survivors.

Your sleep-wake schedule should be regular (go to sleep and wake up at approximately the same time). If you have problems with falling asleep at night, try to expose yourself to natural light (light therapy) which can set your inner clock straight, especially if paired with melatonin supplements. Melatonin is a hormone that makes you sleepy at night. Please consult your doctor before taking any supplements because they may interfere with medications you’re already using.

Your bedroom environment should have:

  • A good pillow, mattress, breathable linen
  • Complete darkness (turn off any LED lights)
  • Silence
  • Low room temperature (about 65°F)
  • Fresh air (make sure it’s not damp)

Your diet should include:

  • Probiotic-rich foods
  • Calming, relaxing tea like camomile 
  • Very little or no coffee. You can have some early in the morning and stop all caffeine intake at 2 pm.
  • Light meals in the evening – no fatty, spicy or any kind of strong food.
  • No alcohol in the evening whatsoever.

You should shut down most of the lights in the evening and avoid TV and other technology.

You should go out and be as physically active as possible.  

Insomnia after stroke is sometimes treated with sleeping pills, antidepressants, and sometimes with CBT – Cognitive Behavioral Therapy. CBT is an all-natural approach that teaches patients how to behave in order to have better sleep. 

You may get antihypertensive medications to address circadian rhythm disorder-related high blood pressure. Circadian rhythm disorders can be alleviated with light therapy, CBT, and melatonin.

Sleep-related movement disorders are treated with prescribed medications and breathing disorders are usually dealt with using CPAP machines.

Things to fight for

Poor sleep is often caused by sedentary behavior in post-stroke patients. They spend up to three-quarters of their waking time sitting or lying. This means if you are awake for 16 hours you’re likely to spend 12 of those hours not moving at all. A stroke survivor’s walking is completely minimized. Such inactivity could seriously harm even a young, strong person’s body, let alone an elderly patient.

Although even the most basic of actions can be extremely difficult and exhausting after stroke, you might find great joy when you see all the progress you’ve made after much effort – the progress that can give you freedom and independence. It can also give you better sleep and improved overall health, including the lowered risk of recurring stroke.

The National Stroke Association has made a recovery guide that can help you with all aspects of life after stroke, like coping with fatigue and emotions, dealing with bowel and bladder functions, working on your movement and balance and much more.

Additional resources

  1. Sleep disturbances negatively affect balance and gait function in post-stroke patients. https://www.ncbi.nlm.nih.gov/pubmed/30040752
  2. Sleep disorders and stroke https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387919/ 
  3. Insomnia is a likely long-term side effect of stroke, study finds https://www.sciencedaily.com/releases/2018/05/180530113136.htm 
  4. Sleep disorders and stroke https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387919/
  5. Sleep Medicine: Stroke and Sleep. https://www.ncbi.nlm.nih.gov/pubmed/30643347
  6. The role of sleep in recovery following ischemic stroke: A review of human and animal data https://www.sciencedirect.com/science/article/pii/S2451994416300141 

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