Why Does Insomnia Occur After a Stroke?

Stroke is a frightening condition that leaves many residual effects for survivors, even if they are fortunate enough to survive the event. One common complication is insomnia following a stroke.

1. Why Does Insomnia Occur After a Stroke?

Insomnia is defined as insufficient sleep, which can be due to difficulty falling asleep or maintaining sleep. Some individuals with insomnia may nap frequently during the day, while others may be unable to nap despite feeling very tired.

Between 35% and 42% of stroke survivors experience insomnia, depending on the severity. The rate of insomnia is higher immediately after a stroke. More than one-third of individuals continue to struggle with insomnia even up to three months after a stroke. Many people are still affected by insomnia years after their stroke.

Insomnia can have several underlying causes beyond the stroke itself. These include environmental factors, such as a bedroom being too bright, too cold, or too hot. Consumption of caffeine or alcohol close to bedtime, certain medications, and chronic pain can also contribute to insomnia. Mental health conditions, including depression, may further exacerbate insomnia. Additionally, insomnia following a stroke can lead to depression and discouragement.

Sleep disorders related to limb movements are categorized into two types:

• Restless Legs Syndrome (RLS): Characterized by an intense urge to move your legs, it can also cause discomfort or tingling in your legs.
• Periodic Limb Movement Disorder (PLMD): Involves involuntary jerking or twitching of your legs or other limbs.

Those with these conditions may find it very difficult to fall asleep or maintain sleep. RLS is less common, affecting only 10% to 13% of stroke survivors, while periodic limb movements affect 27% to 42% of those with insomnia after a stroke.

2. Does Insomnia After a Stroke Increase the Risk of a Recurrent Stroke?

An analysis shows that individuals who have had a stroke or a transient ischemic attack (TIA) often experience more sleep disorders in the months following the event, which may increase their risk of a subsequent stroke.

According to research published in the American Heart Association’s journal Stroke, sleep issues—including insomnia, sleep apnea, and restless legs syndrome with involuntary leg movements—are observed more frequently in women, smokers, those with other specific health conditions, and older stroke survivors.

Sleep disorders, especially obstructive sleep apnea, where breathing stops and starts during the night, are considered independent risk factors for stroke. Given the high prevalence of sleep issues among stroke survivors, the AHA recommends evaluating sleep problems to prevent recurrent strokes.

In a recent review, researchers analyzed over 185 studies on sleep disorders among stroke survivors, including 64,047 individuals with interrupted or shallow breathing during sleep, insomnia, periodic limb movements, and RLS. They found that stroke survivors had a significantly higher prevalence of these conditions long after the stroke occurred.

3. How to Improve Insomnia After a Stroke?

• Maintain a Consistent Sleep Schedule: Even after a poor night’s sleep, try to wake up at the usual time. Sleeping in may make it harder to sleep well the following night. Set an alarm or keep a sleep diary to find a suitable sleep pattern.
• Increase Morning Light Exposure: If you have trouble falling asleep at night and waking up in the morning, increasing exposure to bright light in the morning can help. Conversely, if you fall asleep too early and wake up too early, evening light exposure may be beneficial.
• Exercise Regularly: Regular physical activity can help improve sleep.
• Relax Before Bed: Create a list of things you want to remember for the next day to “put them to sleep” mentally.
• Practice Relaxation Techniques: Try breathing exercises at night if you’re experiencing insomnia after a stroke.
• Create a Comfortable Sleep Environment: Ensure your room is dark and at a comfortable temperature.
• Avoid Napping: Napping can reduce your body’s natural sleep drive at night. If you must nap, do so earlier in the day and set an alarm to limit nap duration.
• Avoid Electronics Before Bed: The bright light from screens can affect your ability to fall asleep.

4. Key Points to Prevent Stroke Recurrence Due to Insomnia

The first step in addressing insomnia is for your doctor to identify the root cause of your sleep problems. If medication is causing insomnia, report this to your doctor so adjustments can be made.

In other cases, doctors may use specific techniques to determine the cause of post-stroke insomnia. They might ask you to keep a sleep diary or use monitoring devices to pinpoint issues. In severe cases, you may need to visit a sleep clinic for a more detailed evaluation.

Some sleep disorders are better treated with specific therapies. Cognitive Behavioral Therapy (CBT) for insomnia, for example, is used when insomnia is due to poor habits or abnormal thoughts, such as excessive worry about not being able to sleep.

Sleep apnea may improve with the use of a CPAP device. Lifestyle changes like increased exercise, quitting smoking, and reducing alcohol consumption can also be beneficial. In severe cases, surgery might be needed.

Additionally, there are medications available to treat certain sleep disorders. Your doctor can help you find the most appropriate medication for your condition.

References: Heart.org, Stroke.org.uk