Gina Johnson
Having a stroke in your sleep, also known as a wake-up stroke, is not uncommon, with studies suggesting that they may account for upward of a quarter of all stroke cases. Wake-up strokes occur when a person goes to bed feeling normal and healthy but wakes up with stroke symptoms such as weakness, vision loss, dizziness, incontinence, or confusion. The key difference between wake-up strokes and other types of strokes is that the time of onset is unknown, which can delay emergency medical treatment and make wake-up strokes more dangerous and life-threatening.
| Characteristics | Values |
|---|---|
| Prevalence | 8% to 28% of strokes occur during sleep, with some studies reporting up to 44% |
| Risk Factors | Snoring, sleep apnea, obesity, daytime sleepiness, smoking, high cholesterol |
| Symptoms | Weakness, vision loss, dizziness, incontinence, confusion, difficulty speaking, difficulty moving one side of the body, facial droop |
| Treatment Challenges | Delay in receiving medical treatment, ineligibility for reperfusion therapy with tissue-plasminogen activator (tPA) due to unknown onset time |
| Research Developments | New MRI techniques to understand stroke timing during sleep, positive outlook for more active treatment of wake-up strokes |
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What You'll Learn
- Risk factors: snoring, sleep apnea, obesity, and smoking
- Treatment delay: the impact of not receiving immediate medical attention
- Sleep-disordered breathing: abnormal breathing patterns interrupting sleep
- Brain imaging: the use of CT scans and angiograms to determine treatment
- Recovery: the importance of timely treatment for a full recovery
Risk factors: snoring, sleep apnea, obesity, and smoking
Snoring, sleep apnea, obesity, and smoking are all risk factors for strokes that occur during sleep, also known as wake-up strokes. Wake-up strokes are not technically different from other strokes, but they can be more dangerous because treatment is delayed while the person is sleeping.
Snoring is a risk factor for stroke, particularly heavy habitual snoring, which has been linked to a higher prevalence of hypertension, ischemic heart disease, and stroke. Snoring is also a symptom of sleep apnea, which is a risk factor for stroke. Obstructive sleep apnea (OSA) is a condition where the soft tissue in the throat collapses inward during sleep, blocking the airway. This can cause inflammation and fluid retention in the upper airway, making it harder to breathe at night. Sleep apnea can lower oxygen levels during sleep, and is more common in older people, especially those over 60, and in males.
Obesity is a major independent risk factor for snoring and sleep apnea, and it is also a risk factor for stroke. People with a larger neck size are more likely to have OSA, and weight gain can lead to the development of sleep apnea. Type 2 diabetes, which is linked to obesity, has also been associated with sleep apnea.
Smoking is another risk factor for snoring and sleep apnea, as well as for stroke. Smokers are three times more likely to have obstructive sleep apnea than non-smokers, and smoking increases the risk of having an intracerebral hemorrhage, a type of stroke that occurs during sleep.
In summary, snoring, sleep apnea, obesity, and smoking are all interconnected risk factors for strokes that occur during sleep. Addressing these risk factors, such as by losing weight, quitting smoking, and treating sleep apnea, can help to reduce the risk of having a stroke while sleeping.
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Treatment delay: the impact of not receiving immediate medical attention
Wake-up strokes, or strokes that occur during sleep, can cause a delay in receiving emergency medical treatment. This is because the time of stroke onset is unknown, and the symptoms are only noticed once the person wakes up. The delay in treatment can have serious consequences and increase the risk of death.
Strokes occur when a blocked artery prevents blood from flowing to the brain, or when a blood vessel in the brain leaks or ruptures. It is crucial to receive medical attention as soon as possible after a stroke, as the longer the blockage, the greater the damage. Every minute that a clot cuts off blood flow to the brain, up to two million brain cells can be destroyed. This can result in neurological, cognitive, and physical disability or death.
Clot-busting medications, also known as thrombolytic therapy, are most effective when given within three to four and a half hours of stroke onset. Clinical studies suggest that cerebral ischemia persisting for more than six hours can result in permanent neurological damage. Therefore, early hospital arrival is critical to successful stroke treatment.
In addition to delaying treatment, wake-up strokes can also exclude survivors from typical stroke treatments, such as reperfusion therapy with tissue-plasminogen activator (tPA). This is because the time of stroke onset is unknown, which is a critical factor in determining the appropriate treatment.
The impact of not receiving immediate medical attention after a stroke can be severe and life-threatening. The delay in treatment can result in reduced treatment options, increased risk of disability, and higher chances of death. Therefore, it is essential to seek medical attention as soon as possible if you or someone else is experiencing stroke symptoms.
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Sleep-disordered breathing: abnormal breathing patterns interrupting sleep
Strokes that occur during sleep are called "wake-up strokes". They are not technically different from other strokes, but they can be more dangerous because treatment is delayed while the person is sleeping. Wake-up strokes are not uncommon, with studies estimating that they account for 8% to 28% of all strokes, or even more.
Obstructive sleep apnea (OSA) is a risk factor for strokes, and it is a common but manageable condition. OSA occurs when the muscles in the throat relax during sleep, causing the surrounding tissue to press on the windpipe and block the airway. This results in abnormal breathing patterns, such as fast breathing that gets deeper, then shallower, until breathing stops before starting again. OSA can prevent restful sleep and increase the risk of stroke by putting stress on the heart.
Sleep-disordered breathing refers to a range of conditions that result in abnormal breathing during sleep, with OSA being the most common. Other types of sleep apnea include central sleep apnea, where the brain doesn't control breathing as expected, and non-obstructive sleep apnea syndrome (non-OSAS), which can be caused by factors such as age, medications, or other health conditions. Sleep-disordered breathing can be diagnosed through a detailed sleep study, and treatment methods vary from person to person.
Lifestyle changes such as weight loss, reducing alcohol consumption, quitting smoking, and maintaining adequate sleep hygiene can help prevent sleep-disordered breathing. Additionally, a healthcare provider can create a treatment plan to manage symptoms and prevent complications. Successful treatment of sleep apnea has been shown to reduce morbidity and mortality due to cardiovascular causes.
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Brain imaging: the use of CT scans and angiograms to determine treatment
Strokes that occur during sleep, known as "wake-up strokes", can delay emergency medical treatment as the time of stroke onset is unknown. This can make them more dangerous than strokes that occur when awake.
CT scans are widely available in emergency rooms and can produce high-resolution images of the brain. The non-contrast CT (NCCT) is the first imaging technique used in all patients suspected of having a stroke, mainly to exclude hemorrhagic stroke. CT scans are also used to identify calcification, which is vital in the detection of lesions. CT angiography (CTA) is performed by administering an intravenous CT contrast through a line in the antecubital fossa. CT perfusion (CTP) involves a rapid intravenous infusion of contrast, and sections of the brain are repeatedly imaged. CT angiography of the brain can lead to intra-arterial thrombolysis, and CT angiography of the neck helps determine the best vascular route to the lesion. CT perfusion imaging can identify the penumbra, and has been used to guide the treatment of patients with an unknown time of stroke onset, such as wake-up strokes.
MRI is superior to CT in hyperacute and acute phases due to its higher soft-tissue contrast. However, CT is more widely available, faster, typically less expensive, and extremely sensitive in detecting acute hemorrhage. CT scanners are often located closer to emergency departments than MRI units, allowing easier access to support personnel and equipment.
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Recovery: the importance of timely treatment for a full recovery
Strokes that occur during sleep, known as "wake-up strokes", are particularly dangerous because treatment is delayed while the individual is asleep. Wake-up strokes are not uncommon, with estimates suggesting that between 8% and 28% of all strokes occur during sleep. This delay in treatment can have serious consequences, as an untreated stroke can continue to damage the brain and increase the risk of death.
The key difference between wake-up strokes and other types of strokes is that the time of onset is unknown, which can further delay emergency medical treatment and exclude survivors from typical stroke treatments, such as reperfusion therapy with tissue-plasminogen activator (tPA). This is a critical issue, as the quicker the treatment for a stroke, the more complete the recovery. If individuals get to a hospital within 4.5 hours of a stroke's onset, doctors can administer clot-busting drugs or even extract the blood clot that caused the stroke, greatly increasing the likelihood of recovery and improving quality of life.
Recent developments and studies provide hope for more active treatment options for wake-up strokes. For example, Dr. Christian Beaulieu and his team have developed a new magnetic resonance imaging (MRI) technique that captures images of sodium in the brain. This technique has been used to collect valuable data about sodium accumulations over time in stroke patients, which can help determine the timing of the stroke and inform treatment options.
Additionally, addressing harmful lifestyle behaviours can lower the risk of having a stroke in your sleep. This includes limiting smoking and excessive alcohol consumption, as well as managing other health conditions that increase stroke risk, such as high blood pressure, high cholesterol, diabetes, and atrial fibrillation.
Inpatient stroke rehabilitation programs are also available to help individuals regain independence and improve their quality of life after a stroke. These programs can be particularly important for the two-thirds of stroke survivors who develop sleep-disordered breathing, which can increase blood pressure and blood clotting and put more strain on the heart.
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Frequently asked questions
A wake-up stroke, or sleep stroke, is a type of stroke that happens while someone is sleeping. The person goes to bed feeling normal but wakes up with symptoms of a stroke, such as weakness, vision loss, dizziness, incontinence, or confusion.
Risk factors for having a stroke in your sleep include snoring, sleep apnea, obesity, and daytime sleepiness. Other risk factors include high blood pressure, high cholesterol, diabetes, and atrial fibrillation. Lifestyle behaviours such as smoking and excessive alcohol consumption can also increase the risk of having a stroke during sleep.
If you notice signs of a stroke in yourself or someone else, it is important to seek medical attention as soon as possible. Call 911 immediately if you are in North America or contact your local emergency services if you are elsewhere.
