While dealing with the aftermath of a stroke, individuals face severe sleep disturbances owing to medications and the severity of the stroke itself, say experts. They are prone to sleep disorders like insomnia, hypersomnia and many others. The damage caused by a stroke can affect the areas of the brain responsible for regulating sleep. As a result, people may feel tired and weak, severe lack of energy, irritability, mood fluctuations and cognitive impairment. Following sleep hygiene, rehabilitation regime and psychological support can help individuals overcome their sleep issues.
“The development of sleep problems can be related to medications for treating stroke or disruption of the sleep-wake cycle in intensive care unit and long term stay therein,” says Dr Sanjay Garg, consultant mental health & behavioural sciences, Fortis Hospital, Kolkata. Experts say that around 20% to 60% of the stroke survivors experience sleep disturbances and 20% of them have no history of sleep problems.
How stroke induces sleep conditions
33-year-old Ilika Ghosh, a postdoctoral fellow at Max Planck Florida recounts her father’s stroke episode in an interaction with Happiest Health. She says her father Dipak Kumar Ghosh experienced a brain stroke when he was 70. He spent over a month in the intensive-care unit in coma and was under a lot of medications. She says, “Post-hospitalisation, my father faced a lot of sleep disturbances and he also attempted sleepwalking at times.”
Prescribed medications helped him achieve sound sleep most nights. “Three years into recovery, he’s made progress in memory, mobility, and daily tasks through physiotherapy,” she added. While still talking in his sleep at times, his rehabilitation continues positively, with an average sleep duration of 10-12 hours.
The relationship between sleep disruptions and stroke recovery is bidirectional. “Sleep disturbances like insomnia after a stroke can exacerbate cognitive impairment, affect emotional well-being, and compromise physical health, hindering recovery,” explains Dr Poonam Chandrashekhar Awatare, consultant, neurology, Manipal Hospitals, Bangalore. Sleep disturbance is also a risk factor for further strokes, adds Dr Garg.
Common types of sleep disorders in stroke survivors
The common sleep disorder seen in individuals with stroke is insomnia. “Other than that hypersomnia, sleep related breathing disorders, circadian rhythm sleep-wake disorders, sleep related movement disorders and rarely parasomnias are also seen in post stroke patients,” says Dr Awatare.
Insomnia: Difficulty falling asleep or staying asleep is a prevalent issue for stroke survivors. Factors like pain, anxiety, or medication side effects can contribute to insomnia.
Breathing-related sleep disorders (BSDs): Stroke survivors may be at an increased risk of developing sleep apnea, a condition where breathing pauses during sleep. This is particularly true if the stroke has affected the part of the brain responsible for controlling breathing.
Hypersomnia: On the flip side, some individuals may experience excessive daytime sleepiness. This can result from interrupted night time sleep, medications, or changes in the brain affecting the sleep-wake cycle and sometimes the fatigue can stay for years.
Managing sleep issues post-stroke
Sleep hygiene and discipline: Experts advise, maintaining sleep hygiene is very important. Reducing distractions, especially noise and light before going to bed will help. Avoiding stimulants like tea or coffee and changing medications may be required.”
Medications and rehabilitation: Taking certain medications just before sleep time might require specialist’s evaluation hence should be discussed, advises Dr Awatare. On the other hand, rehabilitation can address challenges such as pain and discomfort that contribute to disrupted sleep post-stroke.
Psychological Support: Seeking psychological support, whether through counseling, support groups, or other therapeutic interventions, can help manage anxiety and depression which is very prominent in stroke survivors. “Cognitive behavioural therapy (CBT) has been found to be effective in this regard,” say experts.
“Besides, maintaining an active lifestyle, sleep hygiene, weight and eating right can go a long way in solving sleep issues post-stroke,” adds Dr Awatare.
Takeaways
- Sleep problems affect 20 to 60% of stroke survivors, worsening thinking, emotions, and physical health, highlighting the connection between sleep and recovery.
- Stroke survivors may deal with insomnia, sleep apnea, or excessive sleep, complicating their recovery and affecting mental, emotional, and physical well-being.
- Adopting a healthy lifestyle with good diet, sleep hygiene, medications, rehabilitation, and psychological support play key roles in effective management.
