Stroke And Sleep: Exploring The Connection

can a stroke extended sleepiness

Sleep disturbances are common after a stroke, and can have a significant impact on a person's life and recovery. Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors, with an estimated prevalence rate of between 18% and 72%. EDS can be caused by a variety of factors, including sleep-disordered breathing, reversed Robin Hood syndrome, and depression. It can also be a side effect of certain medications. The impact of EDS on stroke survivors is significant, as it may reduce their cognitive functioning, daytime functional performance, and overall well-being. It is also a risk factor for stroke and can contribute to an increased number of accidents. Addressing EDS is crucial for stroke survivors to optimise their recovery and improve their quality of life.

Characteristics Values
Prevalence 18% to 72% of stroke survivors experience excessive daytime sleepiness (EDS)
Persistence EDS may persist and become a chronic problem in 34% of stroke survivors
Duration EDS can last for over six months in 30% of stroke survivors
Impact on daily life EDS may interfere with stroke rehabilitation and recovery, as well as one's mood, relationships, and daily activities
Impact on health EDS is an independent risk factor for stroke and contributes to an increased number of driving and industrial accidents
Causes Sleep-related breathing disorders, reversed Robin Hood syndrome, depression, chronic partial sleep deprivation, disorders of the central nervous system, psychological conditions, neurological disorders, medications, dopaminergic and noradrenergic impulse disruption
Treatments Addressing underlying conditions (e.g. using a C-PAP machine for sleep apnea), improving sleep hygiene, pharmacological treatments (e.g. modafinil, amphetamines, Ritalin), psychotherapy, support groups, healthy lifestyle changes (e.g. healthy diet, regular exercise)

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OSA is more common in men than women and is often underdiagnosed. Risk factors for OSA include obesity, which is one of the major contributors to the condition. Snoring, gasping or choking during sleep, and excessive daytime sleepiness are key symptoms of OSA. If left untreated, OSA can lead to serious health complications. However, there are effective treatments available, such as continuous positive airway pressure (CPAP) therapy, which can help improve sleep and reduce symptoms.

Sleep-related breathing disorders, including OSA, can have a significant impact on stroke survivors. These disorders can cause extended sleepiness and affect stroke recovery. It is important for healthcare professionals to recognise and address these disorders to improve outcomes for stroke patients. Treatments such as CPAP can help manage sleep-related breathing disorders and improve sleep quality, which is crucial for stroke recovery.

In addition to OSA, other sleep-related breathing disorders can also contribute to extended sleepiness after a stroke. Central sleep apnoea (CSA), for example, occurs when there is a lack of effort to breathe during sleep due to issues with brain signalling or respiratory muscle response. CSA is less common than OSA but can have similar symptoms and consequences. Addressing the underlying causes of CSA, such as cardiovascular problems or the use of certain medications, is a key focus of treatment.

Overall, sleep-related breathing disorders, particularly OSA, play a significant role in extended sleepiness after a stroke. The impact of these disorders on sleep quality and oxygen levels can lead to excessive daytime sleepiness, affecting stroke survivors' recovery and quality of life. Early recognition and effective treatment of these disorders are crucial to managing sleepiness and optimising outcomes for stroke patients.

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Sleep-wake cycle disorders can occur after a stroke, causing difficulty falling asleep at night and waking up in the morning

Sleep-wake cycle disorders can be treated in a variety of ways. Bright light therapy, administered in the morning and lasting about 30 minutes, can help. Melatonin, a hormone taken at night, can also help induce sleep. Sleep-wake cycle disorders are usually not permanent.

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Insomnia, or difficulty falling or staying asleep, is common after a stroke and can lead to daytime drowsiness

Insomnia is a common problem after a stroke, affecting 20-56% of patients. Insomnia is defined as the inability to fall or stay asleep. After a stroke, insomnia is usually caused by environmental factors or comorbidities such as depression. However, it may also be directly associated with brain injury. For example, insomnia has been linked to strokes in the ponto-mesencephalic region, thalamus, and brainstem, including the pontine tegmentum and thalamo-mensencephalic region. Additionally, certain drugs used to treat stroke or its comorbidities can disrupt sleep. Beta-blockers, clonidine, diuretics, and selective serotonin reuptake inhibitors (SSRIs) are among the medications that can induce insomnia and cause early morning awakenings, nightmares, or painful calf cramps during sleep.

Insomnia can have negative consequences for stroke recovery. It can increase anxiety, impair daytime energy levels, concentration, and memory, and hinder performance during rehabilitation. Therefore, it is important to address insomnia in stroke patients to optimize their recovery.

Treatments for insomnia in stroke patients include cognitive-behavioral therapy (CBT) and pharmacological therapy. While CBT can be beneficial for long-term management, its physical and mental benefits may not be apparent in the short term. As for pharmacological therapy, benzodiazepines are not recommended as they can aggravate breathing-related sleep disorders and induce the reappearance of motor deficits. Antidepressants such as mianserin and zolpidem have shown some promise in improving insomnia after stroke. Zolpidem may increase brain-derived neurotrophic factor (BDNF) secretion and protect the neurovascular unit in acute stroke. However, it is important to note that hypnotics have been associated with an increased risk of stroke, especially at higher doses or with prolonged use. Acupuncture has also been suggested as a promising treatment for insomnia after stroke, with some studies showing positive outcomes.

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Post-stroke fatigue is a common condition that can cause a feeling of early exhaustion and lack of energy

Post-stroke fatigue is a common condition, affecting 38 to 73% of stroke survivors. It is often under-recognised and can occur at any point during recovery. Post-stroke fatigue is characterised by a feeling of early exhaustion, weariness, lack of energy, and aversion to effort. This fatigue is not usually ameliorated by rest and can be classified as either objective or subjective. Objective fatigue is defined as the observable and measurable decrement in performance occurring with the repetition of a physical or mental task, while subjective fatigue is simply the feeling of early exhaustion, weariness, and aversion to effort.

Post-stroke fatigue can last for some time and have a big effect on your life. It can happen after any type of stroke, big or small, and even a transient ischaemic attack (TIA, or mini-stroke). It can start soon after a stroke or appear some time later. It is more common in people who had fatigue before their stroke.

There are different reasons why someone might feel exhausted after a stroke. The physical impact of the stroke on the brain and body can trigger fatigue, as the brain and body are healing in the early weeks and months after a stroke. The rehabilitation process can be tiring, especially if it involves learning new ways of doing things or doing exercises. A loss of fitness and strength while in hospital or as a result of the stroke can also lead to fatigue, as can muscle weakness, which can make movement more tiring.

Fatigue shares some of the signs of depression, such as feeling low, having anxiety, sleep problems, and tiredness, but it is not the same thing. It is not always easy to tell these symptoms apart, and people can experience both at the same time.

Sleep changes after a stroke can also cause fatigue. Sleeping problems such as insomnia and sleep apnoea (interrupted breathing) can make you feel tired during the day. Sleep apnoea is when your breathing stops and starts during sleep, and it can lead to an increased risk of stroke if left untreated.

If you think you have fatigue, speak to your GP or therapist. They may be able to help find out if something like a medication or infection is causing the fatigue, or if it’s more likely to be due to the stroke. They may also be able to suggest ways to manage your fatigue.

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Depression and other mental health disorders can develop after a stroke and cause fatigue and drowsiness

The exact biological mechanism behind PSD is not yet fully understood, but it is believed to be related to biological changes in the brain caused by the stroke. PSD can manifest as a depressed mood, reduced interest or pleasure in activities, changes in appetite and weight, sleep disturbances, psychomotor agitation or retardation, loss of energy and fatigue, feelings of worthlessness or guilt, and difficulty concentrating.

In addition to PSD, other mental health disorders such as anxiety disorders, post-traumatic stress disorder (PTSD), and psychotic disorders can also develop after a stroke. These disorders can share similar symptoms with PSD, and it is not uncommon for stroke survivors to experience multiple mental health disorders simultaneously. The development of these disorders can be influenced by various factors, including genetic background, family history, demographic factors, and external stressors.

The treatment of PSD and other post-stroke mental health disorders typically involves a combination of pharmacological and non-pharmacological approaches. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line pharmacotherapy. Non-pharmacological approaches include psychotherapy, such as cognitive-behavioral therapy (CBT), as well as mind-body interventions like yoga and tai chi, which can help improve mood and quality of life.

It is important to recognize and address post-stroke mental health disorders early on, as they can have a significant impact on a person's recovery and quality of life. Counseling or therapy with a licensed mental health practitioner is often recommended as one of the best treatments for depression and anxiety after a stroke. Additionally, interventions such as mindfulness-based stress reduction and graduated exercise schedules can help improve fatigue and overall well-being.

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Frequently asked questions

EDS is a prevalent symptom among stroke survivors, with an estimated prevalence rate of 18-72%. It is characterised by a constant need for sleep during the day, even after a full night's rest.

EDS can be caused by a number of factors, including sleep-related breathing disorders, reversed Robin Hood Syndrome, and depression. It can also be caused by medications, or be a side effect of the stroke itself, as the brain requires extra energy to heal, leaving less energy for staying alert.

Treatment options for EDS include addressing underlying conditions, such as sleep apnea or depression; pharmacological treatments, such as stimulants; and improving sleep hygiene, such as maintaining a consistent sleep schedule and limiting technology use before bed.

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