Stroke And Sleep: What’s Important?

Stroke and Sleep: The connection

Sleep is critical for every human and it affects mood, health and recovery. Stroke interrupts a lot of healthy body functions and a variety of these may in turn affect the sleep patterns of stroke patients.

Poor sleep can slow your recovery and lead to depression, memory problems and falls during the night. What are common sleep problems after stroke?

Common Sleep Problems After Stroke

Sleep problems may follow after a stroke. Patients may experience a change in their sleep patterns after stroke. Over half of stroke survivors experience insomnia, sleep-related breathing disorders, or sleep-wake cycle disorders.

(A) Excessive Daytime Sleeping After Stroke

After a stroke, some survivors don’t get sleepy at night making it difficult to wake up in the morning difficult. This happens due to Sleep-wake cycle disorders ie when the sleep-wake schedule is no longer affected by sunlight and the darkness of night. This results into the person being seen sleeping excessively during the daytime and leads to questions that we are discussing underneath.

Do stroke victims sleep a lot?

Not all stroke victims sleep a lot. There are many of them who may also have sleeplessness (read insomnia). If the stroke patients sleep a lot during day time it is due to a condition called Excessive Day Time Sleepiness (EDS) and there are many factors causing it. The person with EDS feels sleepy even after having a full night’s sleep.

Most common symptoms associated with Excessive daytime sleepiness include:

• Memory issues
• Irritability
• Decreased appetite
• Slow cognition or speech
• Anxiety
• Restlessness

Excessive daytime sleeping usually decreases after a few weeks of Stroke. However, studies point out that EDS can last for over six months in about 30% of stroke patients [1].

Why do stroke victims sleep so much?

Most frequent causes of excessive daytime sleepiness among stroke patients are:

• Sleep Apnea:

  It is a chronic condition that causes partial or complete cessation of breathing throughout the night, resulting in excessive daytime sleepiness. People with Sleep Apnea are most often advised to use C-pap machine

• Depression:

  Severe depression can cause excessive fatigue and drowsiness. Counseling, medicines and diet modification can be used to help persons with depression.

• Reversed Robin Hood Syndrome (RRHS):

  Reversed Robin Hood syndrome (RRHS) has recently been identified as one of the mechanisms of early neurologic deterioration in stroke patients. Simply put, when the brain attempts to redirect blood flow to body parts, the non-damaged cells and organs continue to remain rich with nutrients received via oxygenated blood. On the contrary, the organs and body cells that are damaged are unable to utilise these and hence get redirected elsewhere – making it appear that the poor has been robbed (Reverse Robin Hood)! This leads to excessive sleepiness.

(B)  Insomnia Causes Stroke Patients Not To Sleep

Patients experience sleeplessness or insomnia post stroke. Insomnia is a sleep disorder in which you have trouble falling and/or staying asleep. People with insomnia often have to deal with issues like

• Sleepiness during the day
• Fatigue
• Grumpiness
• Problems with concentration or memory

Failing to get enough sleep can delay your post-stroke recovery.

(C) Sleep Related Breathing Disorders

Sleep related breathing disorders affect breathing while we sleep and are characterized by disruptions of normal breathing patterns that only occur in our sleep. The most common sleep disorder is a serious condition called obstructive sleep apnea. Symptoms of sleep apnea include choking, snoring, and loud gasping sounds while sleeping.

Can lack of sleep cause a stroke?

The role of sleep disorders in stroke outcome and recurrence has become a pressing question. It is apparent that there is an association between Sleep Disorder Breathing and other sleep impairments with stroke. Sleep disturbances seem to be both a stroke risk factor for and worsened by a stroke, says medical research[2].

Is sleep good for stroke recovery?

A good sleep plays an important role in stroke recovery making sleep important after a stroke. Understand it like this:

Good sleep indirectly helps in the reduction of stress levels in the brain. When you sleep better, lesser Cortisol (body’s main stress hormone) is released. This helps regulate metabolism and minimise pH imbalances in the body leading to reduced or no inflammation in the body. This in turn, boosts the immunity of the body leading to better and faster recovery.

Tips for managing sleep problems after Stroke

If you have been witnessing sleeplessness, you can talk to therapist.  They can guide you with the interventions to have a good sleep. Some simple things you could try on your own are:

• Create a cosy environment (by keeping bedroom dark and at a comfortable temperature)
• Peaceful environment (prevent noise)
• Increase physical activity during the day
• Follow regular sleep schedule
• Practise stimulants which induce sleep, such as light music, reading at bedtime, warm water bath before you go to bed.
• Switch off your phone if it’s a source of distraction
• Avoid caffeine containing drinks late afternoon which interrupts your sleep
• Make sure you are not hungry before bedtime
• Limit water intake so that you limit your trips to washroom at night

At ReAble, an expert neuro physiotherapist will take a detailed assessment to understand the current condition and impairments of the stroke patient. A customised stroke rehabilitation plan will be designed based on the patient status and part of their body or type of ability affected by the stroke. Call us now or connect with us by filling the form below and we will be happy to help!

This article is based on the inputs from Dr Sruthi Jain (PT). Dr Sruthi is a highly experienced and senior professional in the field of Neuro Rehabilitation. She has worked with numerous patients aiding their recovery after stroke, paralysis and other neurological disorders.