Sleep And Stroke Recovery: How Much Rest Is Needed?

Sleep is critical to stroke recovery, but it's common for survivors to experience sleep problems and excessive daytime sleepiness. While the brain normally uses 20% of the body's energy, this increases during the initial recovery phase as it needs extra energy to heal, leaving less energy for staying alert. Sleep plays a vital role in neuroplasticity, memory, and learning, all of which are essential for recovery. However, too much sleep can also be a sign of underlying complications and can interfere with rehabilitation.

Sleep-related breathing disorders, such as sleep apnea, can increase the risk of a second stroke

Sleep is critical to recovery after a stroke, but sleep problems are common and can slow down the healing process. Sleep-related breathing disorders, such as sleep apnea, are a serious concern for stroke survivors. Obstructive sleep apnea (OSA) is the most common type of sleep disorder, caused by abnormal breathing patterns. It is estimated that between 18% and 72% of stroke survivors experience excessive daytime sleepiness (EDS), which is often a symptom of OSA.

OSA is characterised by a cessation or reduction in breathing during sleep, resulting in frequent awakenings and fragmented sleep. This can lead to excessive daytime sleepiness, where individuals feel a constant need for sleep despite getting a full night's rest. EDS can negatively impact a person's quality of life, cognitive functioning, and daily activities, including their ability to engage in rehabilitation and socialise.

The link between OSA and stroke is bidirectional. OSA is a risk factor for stroke, and stroke can lead to OSA. This is because stroke can cause a reduction in cerebral perfusion and impair the respiratory control centre in the brain, resulting in periodic breathing or nocturnal hypoxia. Additionally, OSA can cause nocturnal hypoxia, further increasing the risk of stroke.

The treatment for OSA includes the use of Continuous Positive Airway Pressure (CPAP) machines, which deliver pressurised air to prevent airway obstruction. Other treatments include special mouthpieces to minimise symptoms and, in some cases, upper airway surgery to widen the airway.

In summary, sleep-related breathing disorders such as OSA are common after a stroke and can increase the risk of a second stroke. They cause fragmented sleep, leading to excessive daytime sleepiness, which can negatively impact recovery and quality of life. Treatment options such as CPAP machines and mouthpieces can help manage OSA and improve sleep quality, aiding in stroke recovery.

Sleep-wake cycle disorders can cause difficulty falling asleep and waking up

Sleep-wake cycle disorders can be treated in various ways. Bright light therapy, typically administered in the morning for about 30 minutes, can help. Melatonin, a hormone taken at night, acts as a sedative and can induce sleep. It's important to note that sleep-wake cycle disorders are usually not permanent.

Additionally, there are several self-care strategies that can help manage sleep problems:

• Keep your bedroom dark, quiet, and at a comfortable temperature.
• Limit noises at night.
• Increase physical activity during the day.
• Expose yourself to daylight.
• Maintain a consistent sleep schedule by going to bed and waking up at the same time each day.
• Establish a relaxing bedtime routine, such as taking a warm bath, listening to calming music, or reading a book.
• Avoid using electronic devices like phones or watching TV in bed.
• Limit caffeine intake, especially in the afternoon and evening.
• Avoid heavy meals close to bedtime, and try to finish dinner at least three hours before sleeping.
• Limit fluid intake two hours before bedtime to reduce the need for frequent bathroom trips.
• Refrain from consuming alcoholic beverages at night, as they can disrupt sleep quality.

Insomnia may be treated with prescription sedatives or changes to one's bedroom or nighttime routine

Sleep is critical to stroke recovery, but many survivors experience insomnia, which can slow down their recovery and lead to depression, memory problems, and falls at night. Insomnia is characterised by the inability to fall or stay asleep. While some people sleep too much, it is more common to struggle with sleep at night and feel drowsy during the day.

• Keep your bedroom dark, quiet, and at a comfortable temperature.
• Avoid noises at night.
• Increase physical activity during the day.
• Expose yourself to light during the day.
• Follow a regular sleep schedule by going to bed and waking up at the same time every day.
• Establish a bedtime routine, such as taking a warm bath, listening to calm music, or reading a book.
• Avoid eating, watching TV, or using your phone in bed.
• Limit caffeine after the late afternoon.
• Avoid heavy meals and limit drinking fluids two hours before bedtime to prevent frequent trips to the bathroom.
• Avoid alcoholic drinks at night, as they can cause restless sleep.

Excessive daytime sleepiness (EDS) may be caused by stroke, sleep-disordered breathing, reversed Robin Hood syndrome, or depression

Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors. The reported prevalence of EDS varies widely, anywhere between 18% and 72% of all stroke survivors. EDS usually decreases after a few weeks, but it can last for over six months in about 30% of stroke survivors.

EDS can be a primary disorder or a secondary condition caused by medications, behaviours, or other sleep disorders. Here are some potential causes of EDS:

Stroke

The disruption of dopaminergic and noradrenergic impulse pathways in the brain after a stroke can lead to EDS. Paramedian thalamic stroke, bilateral thalamic infarcts, subcortical stroke, and diencephalic stroke are associated with higher rates of EDS.

Sleep-disordered breathing

Sleep-disordered breathing, particularly obstructive sleep apnea (OSA), is a common cause of fragmented sleep, which can lead to EDS. OSA is an independent risk factor for stroke and is often associated with EDS in the general population. However, the relationship between OSA and EDS in stroke survivors is not well understood.

Reversed Robin Hood Syndrome

This syndrome occurs when the brain redirects blood flow from damaged areas to healthy ones. The decreased blood flow to the ischemic areas of the brain and increased blood flow to non-affected regions can lead to significant daytime sleepiness.

Depression

Mental health disorders, such as depression, are commonly associated with EDS. Depression can cause fatigue and drowsiness, leading to excessive daytime sleep. Additionally, treating depression with stimulating antidepressants may help improve EDS.

Sleep promotes neuroplasticity, which is the brain's ability to adapt and rewire itself

Sleep is critical to recovery after a stroke, but it is common for survivors to experience sleep problems, including insomnia and sleep-wake cycle disorders. These issues can slow recovery and lead to depression, memory problems, and other negative outcomes.

While the amount of sleep needed may vary, it is clear that sleep promotes neuroplasticity, which is the brain's ability to adapt and rewire itself. This process allows healthy areas of the brain to take over functions that have been impacted by damage. By getting enough quality sleep, individuals can support their brain's ability to recover and adapt after a stroke.

• Neuroplasticity and Learning: Sleep has been shown to improve learning and memory, which are crucial for stroke recovery. Memory consolidation facilitated by sleep enables individuals to apply their memories to learning new skills. This is especially important for rehabilitation, which may involve relearning cognitive and motor functions.
• Brain Healing and Reorganization: After a stroke, the brain needs to heal and reorganize its functions. Sleep provides the necessary rest for this process, allowing the brain to recharge and figure out how to adapt to the changes caused by the stroke.
• Neuroprotection: Research in both animals and humans suggests that promoting healthy sleep and treating sleep disorders can have a neuroprotective effect during the acute phase of a stroke. This means that adequate sleep may help reduce the impact of the stroke and promote the brain's ability to recover.
• Molecular Mechanisms: While the exact mechanisms are still being studied, it is believed that sleep plays a pivotal role in neurorehabilitation. Sleep may act as a "plasticity state," supporting the reorganization of neural networks and improving functional recovery.
• Cardiovascular Strength: Post-stroke, individuals often experience a decrease in cardiovascular strength, which can contribute to fatigue. Getting adequate sleep can help improve cardiovascular function and reduce fatigue, providing the energy needed for rehabilitation and daily activities.

To support neuroplasticity and enhance recovery, it is important for stroke survivors to prioritize quality sleep. This may involve addressing sleep disorders, creating a restful environment, and seeking medical advice for any underlying conditions or medication side effects that may impact sleep.

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