Sleep And Strokes: What's The Connection?

can you get a stroke while sleeping

It is possible to have a stroke while sleeping, and this is known as a wake-up stroke. Wake-up strokes are dangerous because the time of stroke onset is unknown, and strokes need to be treated as soon as possible. Studies have found that wake-up strokes may account for a significant proportion of all stroke cases, with estimates ranging from 8% to 28%. The only treatment for ischemic stroke must be given within a few hours of the onset of symptoms, so people who wake up with stroke symptoms often go untreated during the first few crucial hours.

Characteristics Values
Proportion of all strokes 8% to 28%
Average age of occurrence 72
Average severity score 4 (out of 1 to 4 scale)
Risk factors High blood pressure, diabetes, smoking, medications, high cholesterol
Symptoms Numbness, weakness, difficulty speaking, confusion, vision problems, trouble walking, dizziness, severe headache, nausea, vomiting, dizziness, seizures, loss of consciousness

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Wake-up strokes, or sleep strokes, are strokes that occur during sleep

Wake-up strokes are particularly dangerous because treatment is delayed while the person is sleeping. The quicker the treatment for a stroke, the more complete the recovery. If a person gets to a hospital within 4.5 hours of a stroke's onset, doctors can administer clot-busting drugs or extract the blood clot that caused the stroke. However, when a person has a stroke during sleep, it is often unclear when the stroke occurred, and they may miss this critical treatment window.

Research estimates that anywhere between 8% and 28% of strokes occur during sleep, with one study placing the figure at 14%. Wake-up strokes are not technically different from other types of stroke, and they present with the same symptoms, including:

  • Numbness or paralysis on one side of the body
  • Difficulty speaking or slurred speech
  • Trouble understanding others
  • Confusion or disorientation
  • Vision problems
  • Trouble walking or loss of balance
  • Severe and sudden headache
  • Nausea, vomiting, or dizziness
  • Seizures or loss of consciousness

If you or someone close to you wakes up with these symptoms, it is important to seek medical attention as soon as possible.

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Sleep strokes are more dangerous because treatment is delayed

Sleep strokes, or "wake-up strokes", are a very real phenomenon, accounting for anywhere between 8% and 28% of all strokes. They occur when a person goes to bed feeling healthy but wakes up with stroke symptoms. The problem with sleep strokes is that it is difficult to pinpoint when the stroke actually happened—it could have been at any point during sleep, which means that by the time the person wakes up, several hours could have passed since the stroke occurred, delaying treatment.

The quicker a stroke is treated, the more complete the recovery. Doctors need to administer treatment within 4.5 hours of a stroke's onset to be able to use clot-busting drugs or extract the blood clot that caused the stroke. This significantly increases the likelihood of recovery and improves the patient's quality of life. However, because the time of onset is unknown for sleep strokes, doctors have to go by the rule of "when last seen well", i.e., before the patient went to sleep, which may have been 7 to 10 hours earlier and well after the window for effective treatment.

Research suggests that conditions like atrial fibrillation and obstructive sleep apnea may increase the risk of having a sleep stroke. Other risk factors include high cholesterol, hypertension, and smoking.

The symptoms of a sleep stroke are the same as those of a stroke during the day, but they are not noticed until the person wakes up. These symptoms include:

  • Numbness or paralysis on one side of the body, especially in the arm, leg, or face
  • Difficulty speaking or slurred speech
  • Trouble understanding others
  • Confusion or disorientation
  • Blackened, blurred, or double vision
  • Trouble walking or loss of balance
  • Severe and sudden headache
  • Nausea, vomiting, or dizziness
  • Seizures or loss of consciousness

If you or someone close to you wakes up with any of these symptoms, it is important to seek medical attention as soon as possible.

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Risk factors for sleep strokes include sleep disorders, snoring, obesity, and daytime sleepiness

Sleep disorders, snoring, obesity, and daytime sleepiness are all risk factors for sleep strokes. Sleep disorders are the most unrecognized modifiable risk factor for stroke. One-third of US adults report sleeping less than seven hours per night, and 50–70 million have a sleep disorder.

Sleep Disorders

Habitual snoring affects up to 40% of the adult population and is a cardinal symptom of obstructive sleep apnea (OSA). Epidemiological studies estimate that up to 17% of the adult population has OSA, with increased prevalence and severity in the elderly. The prevalence of central sleep apnea is influenced by several factors, including age, gender, the presence of heart failure, and certain metabolic disorders.

Snoring

Snoring is more strongly associated with stroke during sleep.

Obesity

Obesity is a clinical risk factor for OSA. The prevalence of OSA is influenced by age, gender, and craniofacial features that reduce upper airway size.

Daytime Sleepiness

Daytime sleepiness is one of the cardinal symptoms of OSA. It is also associated with all-cause mortality and cardiovascular death.

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Imaging studies are being used to determine when strokes occur during sleep

The problem is that about 25% of strokes occur during sleep. When doctors don't know the timing of a stroke, they must go by the rule of "when last seen well," which may be up to 10 hours earlier. This is frustrating because recent evidence suggests that many strokes occur at the time of waking. If the timing could be determined reliably, many more patients could benefit from clot-busting therapies and recover more fully.

The team is using an MRI method that captures images of sodium in the brain. They found that in the hours following a stroke, sodium gradually collects in damaged areas of the brain. By imaging patients who had a stroke while sleeping soon after they are admitted to the hospital, the researchers can begin to amass data about when strokes most often occur.

This technology and data will provide doctors with the information and tools they need to use advanced therapies on many patients who had a stroke while sleeping.

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Sleep strokes can be treated with clot-busting drugs if detected early

Sleep strokes, or ""wake-up strokes", are a serious medical condition that can delay life-saving treatment due to the difficulty in determining the exact time of onset. This delay can have detrimental effects on recovery, as the damage to the brain may continue to worsen without prompt treatment.

The quicker the treatment for a stroke, the more complete the recovery. If a patient arrives at the hospital within 4.5 hours of the stroke's onset, doctors can administer clot-busting drugs, also known as thrombolytics, to dissolve the clots that are causing the blockage and restore blood flow to the brain. This treatment option is critical for improving the likelihood of recovery and enhancing the patient's quality of life.

However, in the case of sleep strokes, determining the exact time of onset is challenging, as it occurs during sleep. This delay in detection can push the treatment window beyond the timeframe suitable for clot-busting therapies.

Recent advancements in brain imaging technology, such as the use of sodium-MRI techniques, offer hope in addressing this challenge. By understanding when during sleep strokes typically occur, doctors can make more informed decisions about administering advanced therapies, including clot-busting drugs, to patients who have experienced a sleep stroke.

While clot-busting drugs are not suitable for all patients, as they may increase the risk of bleeding, they have been shown to be effective in improving patient outcomes when administered by specialists within the appropriate timeframe. Therefore, early detection of sleep strokes is crucial to ensuring that patients can benefit from these treatments and increase their chances of a full recovery.

Frequently asked questions

A stroke that occurs during sleep is known as a "wake-up stroke".

It is estimated that anywhere between 8% and 28% of all strokes occur during sleep. Some studies suggest that this number could be even higher.

The exact cause of sleep strokes is not yet known. However, researchers have identified certain risk factors that may increase the likelihood of having a stroke during sleep, such as obstructive sleep apnea, atrial fibrillation, and high cholesterol.

The symptoms of a stroke during sleep may include numbness or paralysis on one side of the body, difficulty speaking, confusion, blurred vision, severe headache, and nausea.

If you or someone you know is exhibiting signs of a stroke after waking up, it is crucial to seek medical help immediately by calling for emergency services.

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