Stroke Recovery: Can Sleep Aid Rehabilitation?

Sleep is critical to stroke recovery, but unfortunately, it is estimated that around 8% to 28% of strokes occur during sleep, delaying life-saving treatment. This is known as a wake-up stroke, where an individual goes to bed feeling normal but wakes up with stroke symptoms. While wake-up strokes are not technically different from other strokes, the time of stroke onset is unknown, and strokes need to be treated as soon as possible to prevent permanent damage or death. As a result, wake-up strokes can be more dangerous and may lead to poorer outcomes.

Sleep plays a role in the brain's ability to create new pathways and strengthen connections

Sleep is critical to stroke recovery. Researchers believe that sleep plays a role in the brain's ability to create new pathways and strengthen connections, a process known as neuroplasticity. Poor sleep can negatively impact the recovery of motor control, including balance, dexterity, and sensation.

While the relationship between sleep and stroke recovery is not yet fully understood, it is clear that good sleep is essential for recovery, mood, and quality of life. Unfortunately, many stroke survivors experience sleep problems, with insomnia and sleep-disordered breathing being the most common. Insomnia, characterised by difficulty falling or staying asleep, affects 35% to 42% of stroke survivors, with higher numbers observed immediately after a stroke. Sleep-disordered breathing, also known as sleep apnea, occurs when the breathing pattern is disrupted during sleep due to a blocked airway or improper signals from the brain to the lungs. This condition affects 25% to 66% of stroke survivors and is linked to an increased risk of stroke and other health issues.

Addressing sleep problems is crucial for stroke recovery. Treatments for insomnia may include prescription sedatives, changes to bedroom environments or nighttime routines, and bright light therapy. Sleep-disordered breathing can be treated with Continuous Positive Airway Pressure (CPAP) machines, mouthpieces, and, in some cases, upper airway surgery. Additionally, general recommendations such as maintaining a regular sleep schedule, limiting caffeine and alcohol intake, and engaging in physical activity during the day can also improve sleep quality.

By managing sleep disorders and prioritising adequate sleep, stroke survivors can optimise their recovery and overall well-being.

Sleep-related breathing disorders, like sleep apnoea, are common after a stroke

Sleep is critical to recovery from a stroke, but unfortunately, sleep problems are common after a stroke and can slow down recovery. Sleep-related breathing disorders are one of the main sleep issues that stroke survivors experience. Two-thirds of stroke survivors suffer from sleep-disordered breathing (SDB), which is characterised by abnormal breathing patterns that interrupt sleep. Obstructive sleep apnoea is the most common type of SDB in stroke survivors, causing the person to stop breathing for 10 or more seconds, many times during the night. This is caused by an obstructed upper airway, and can lead to paroxysmal hypoxia, abnormal airway pressure change, and altered intrathoracic pressure, which can all induce a stroke. Sleep apnoea also increases the risk of a second stroke.

There are several ways to treat sleep-related breathing disorders. Continuous positive airway pressure (CPAP) is one of the most common treatments and involves using a machine to deliver short bursts of compressed air to prevent airway obstruction. A special mouthpiece can also be used to minimise symptoms, and in some cases, upper airway surgery may be required to relieve sleep problems.

Insomnia is another frequent sleep problem, with 35-42% of stroke survivors experiencing it

Sleep plays a crucial role in stroke recovery. Researchers believe that sleep is essential for the brain to create new pathways and strengthen existing connections, a process known as neuroplasticity. Poor sleep can hinder motor control recovery and lead to depression, memory issues, and falls at night. Unfortunately, sleep problems are prevalent among stroke survivors, with insomnia being a frequent occurrence.

Insomnia, characterised by difficulty falling or staying asleep, affects 35-42% of stroke survivors, with higher rates immediately following a stroke. Even three months after a stroke, over a third of individuals may still struggle with insomnia, and many continue to experience it for years. Insomnia can be caused by various factors, including environmental triggers, certain medications, physical and mental health conditions, and lifestyle choices. For example, a bright, hot, or cold bedroom, caffeine or alcohol consumption close to bedtime, depression, and long-term pain can all contribute to insomnia.

The good news is that there are ways to manage insomnia. Treatments may include prescription sedatives, changes to the bedroom or nighttime routines, bright light therapy, and melatonin, a hormone that acts as a sedative. Additionally, cognitive behavioural therapy (CBT) can be effective when insomnia is caused by unhealthy habits and negative thought patterns. Addressing insomnia is crucial, as it can hinder post-stroke recovery and lead to further complications.

It is important to note that sleep-disordered breathing, also known as sleep apnoea, is another common sleep issue among stroke survivors, affecting 25-66% of them. This condition can increase the risk of stroke and other health issues, so it should not be ignored.

Limb movement sleep disorders, like restless leg syndrome, can also occur post-stroke

Limb movement sleep disorders, such as periodic limb movement disorder (PLMD) and periodic limb movements during sleep (PLMS), can occur after a stroke. PLMD is a rare condition characterised by involuntary leg and/or arm movements during sleep, affecting 4% to 11% of adults and 5% to 8% of children. PLMS, on the other hand, often occurs alongside restless leg syndrome (RLS) and affects a larger proportion of people.

PLMS involves repetitive leg and/or arm movements during sleep, typically occurring every 20 to 40 seconds. These movements can disrupt sleep, leading to daytime fatigue and sleepiness. While the exact cause of PLMS is unknown, it is believed to be related to an issue with or malfunction of the spinal cord. Additionally, certain medications, such as antidepressants and antipsychotics, can worsen PLMS.

PLMS is often diagnosed based on medical history and an overnight sleep study, with adults experiencing more than 15 limb movements per hour and children having more than five. Treatment options for PLMS are limited, but medications used for RLS, such as dopamine agonists and gabapentin, may help. Furthermore, managing risk factors, such as physical inactivity, and addressing comorbidities like diabetes-related neuropathy, can potentially reduce the likelihood of developing PLMS.

Sleep problems can delay recovery, so it's important to seek help if you're struggling

Sleep is critical to stroke recovery, but unfortunately, sleep problems are common after a stroke. Research has shown that around half of stroke survivors experience sleep issues. If you are struggling with sleep after a stroke, it is important to seek help, as sleep problems can delay your recovery.

There are several types of sleep problems that can occur after a stroke, including:

• Sleep-disordered breathing, also known as sleep apnoea, which is caused by abnormal breathing patterns during sleep. This can be due to a blocked airway, the brain not sending the correct signals to the lungs, or other health complications such as smoking. Sleep apnoea can increase your risk of having a stroke and is quite common among stroke survivors, with one study finding that between 25% to 66% of survivors experience it.
• Insomnia, which is characterised by difficulty falling or staying asleep. Insomnia can be caused by environmental factors, such as too much light, noise, or extreme temperatures in the bedroom, or by consuming caffeine or alcohol too close to bedtime. Certain medications, physical or mental health conditions, and pain can also contribute to insomnia. Insomnia affects between 35% to 42% of stroke survivors, and can persist for years.
• Limb movement sleep disorders, including restless leg syndrome (RLS) and periodic limb movement disorder. RLS causes an overwhelming urge to move your legs and unpleasant sensations in your legs, while periodic limb movement disorder involves involuntary jerking or twitching of the limbs during sleep.

If you are experiencing sleep problems after a stroke, the first step is to consult your doctor. They may recommend changes to your routine or lifestyle, such as reducing caffeine and alcohol intake, quitting smoking, or increasing physical activity. In some cases, medication or therapy may be necessary to treat the underlying cause of your sleep issues.

It is important to address sleep problems as they can slow your recovery and lead to further issues such as depression, memory problems, and an increased risk of falling. By seeking help and making any necessary changes to your sleep habits, you can improve your sleep quality and support your recovery.

Frequently asked questions