Herbie Murray
Having a stroke while sleeping, also known as a wake-up stroke, is a dangerous occurrence because the time of stroke onset is unknown, and strokes need to be treated as soon as possible. Studies suggest that anywhere between 8% and 28% of strokes occur during sleep, and the delayed treatment can make wake-up strokes more severe than other types. The symptoms of a stroke that happens during sleep are the same as those that occur during the day, but they are not noticed until the person wakes up. For example, a person who has had a stroke during sleep might experience vision loss when they open their eyes in the morning, or they might find their arm too limp to remove their bed covers and sit up in bed.
| Characteristics | Values |
|---|---|
| Name | Wake-up stroke, sleep stroke |
| Occurrence | 8-28% of strokes occur during sleep |
| Risk factors | Hypertension, smoking, genetics, age, gender, sleep-disordered breathing, uncorrected sleep apnea, cholesterol plaques in the arteries in the neck |
| Symptoms | Numbness or paralysis on one side of the body, face drooping, arm weakness, speech difficulty, vision loss, wetting the bed |
| Treatment | Brain imaging, CT angiogram, thrombectomy, clot-busting drugs, blood clot extraction |
| Prevention | Regular exercise, healthy diet, adequate sleep, limiting smoking and alcohol consumption |
| Complications | Delayed treatment, exclusion from certain treatments like reperfusion, stroke-induced sleep disorders |
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What You'll Learn
- Sleep strokes are called \wake-up strokes\ and can be more serious due to delayed treatment
- Recognising symptoms like numbness or paralysis on one side of the body is crucial
- Risk factors like hypertension, smoking, genetics, age, and gender can increase the likelihood of sleep strokes
- Sleep-disordered breathing and sleep apnea can predispose individuals to cardiac issues and further reduce blood flow to the brain
- Treatment options for sleep strokes include brain imaging, CT angiograms, and thrombectomy procedures
Sleep strokes are called \wake-up strokes\ and can be more serious due to delayed treatment
Strokes can occur at any time, including when you are asleep. Sleep strokes, also known as "wake-up strokes", refer to strokes that happen while someone is sleeping. They are characterised by the onset of stroke symptoms upon waking up, such as numbness or paralysis on one side of the body, face drooping, arm weakness, and speech difficulties.
Wake-up strokes can be more serious due to delayed treatment. The time of stroke onset is uncertain in these cases, as the person was asleep when it occurred. This delay in identifying the stroke onset can result in a loss of critical time for administering lifesaving treatments, such as clot-busting drugs or clot extraction procedures. Studies suggest that wake-up strokes may account for approximately 8% to 28% of all strokes, with some estimates placing it at 20% or even higher.
The signs and symptoms of a wake-up stroke are similar to those of strokes that occur during the day. However, the symptoms of a wake-up stroke are only noticed when the person wakes up, which can lead to a delay in seeking medical attention. It is crucial to recognise the symptoms of a stroke and seek immediate medical assistance, such as calling 911, if you or someone close to you exhibits these symptoms upon waking up.
Research suggests that certain factors may increase the likelihood of experiencing a wake-up stroke. For example, hypertension (high blood pressure) has been associated with an increased risk of cerebral infarction strokes during sleep. Additionally, smoking has been identified as a risk factor, particularly for intracerebral haemorrhage strokes that occur during sleep.
While wake-up strokes share similar clinical features and outcomes with other types of strokes, delayed treatment can lead to more severe effects. The location in the brain and the extent of damage caused by the stroke influence the recovery process, along with other factors such as co-occurring medical conditions. Additionally, wake-up strokes may result in exclusion from certain treatments, further complicating the recovery journey.
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Recognising symptoms like numbness or paralysis on one side of the body is crucial
Wake-up strokes are not technically different from other types of strokes, and the symptoms are the same. However, the delay in treatment can make them more serious and affect recovery. As soon as someone wakes up and notices any stroke symptoms, it is important to seek emergency medical help immediately.
The FAST method can be used to recognise stroke symptoms:
- Face: Check for face drooping
- Arms: Check for arm weakness
- Speech: Listen for speech difficulties
- Time: Emphasise the importance of acting quickly
Other symptoms of a wake-up stroke include vision loss upon waking, wetting the bed during the night, and difficulty sitting up due to arm paralysis.
It is estimated that anywhere between 8% and 28% of strokes occur during sleep. Sleep-disordered breathing and sleep apnoea are also associated with wake-up strokes, as they can cause frequent episodes of reduced oxygen to the brain, increasing the risk of a stroke.
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Risk factors like hypertension, smoking, genetics, age, and gender can increase the likelihood of sleep strokes
Sleep strokes, or "wake-up strokes", refer to strokes that occur during sleep. They are estimated to account for 8–28% of all strokes, and they can be more dangerous than strokes that occur during the day because the delay in treatment while sleeping can make them more serious.
Hypertension, or high blood pressure, is a significant risk factor for sleep strokes. Research indicates that hypertension is associated with an increased likelihood of cerebral infarction strokes during sleep. Several factors can increase the risk of hypertension, including family history, age, diet, obesity, lack of exercise, alcohol consumption, sleep apnea, and smoking.
Smoking is another critical risk factor for sleep strokes. It increases the chances of intracerebral hemorrhage, a type of stroke that occurs during sleep. Smoking can damage blood vessels and cause a temporary increase in blood pressure. Even exposure to second-hand smoke has been identified as an independent risk factor for strokes.
Genetics also plays a role in stroke risk. Studies suggest that 15–52% of people who experience a stroke have a family member who has also had one. Having a parent or sibling who has had a stroke can increase the risk by 30–44%. Inherited genetic mutations can lead to conditions that increase the likelihood of a stroke, and certain genes may increase the chances of specific stroke risk factors.
Age is a factor in stroke risk, with older individuals generally facing a higher risk of experiencing a stroke. Sex is also a factor, with females being more prone to strokes, partly due to increased blood pressure during pregnancy and the use of estrogen-based birth control medication.
While some risk factors like genetics, age, and gender are beyond individual control, addressing modifiable risk factors such as hypertension, smoking, diet, exercise, and alcohol consumption can significantly reduce the likelihood of experiencing a sleep stroke.
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Sleep-disordered breathing and sleep apnea can predispose individuals to cardiac issues and further reduce blood flow to the brain
Strokes can occur at any time, including during sleep. A stroke that happens while sleeping is known as a "wake-up stroke". It occurs when a person goes to bed feeling healthy but wakes up with stroke symptoms. Wake-up strokes are more serious than other types of strokes because the delay in receiving treatment while asleep can worsen the condition.
Sleep-disordered breathing (SDB) and sleep apnea can predispose individuals to cardiac issues and further reduce blood flow to the brain. Sleep apnea, for example, obstructs breathing and causes the body to be oxygen-deprived. It has been linked to higher rates of hypertension, stroke, and coronary artery disease. Obstructive sleep apnea occurs when the soft tissue in the throat relaxes and makes breathing difficult. Central sleep apnea, on the other hand, is when the brain struggles to regulate breathing.
Obstructive sleep apnea has been associated with acute nocturnal hypoxic, adrenergic, and hemodynamic stress, which can trigger cardiac issues. It is also linked to increased arterial stiffness, early atherosclerosis, coronary artery calcification, coronary plaque instability, and plaque vulnerability. These factors can contribute to reduced blood flow to the brain, increasing the risk of stroke.
Additionally, sleep apnea can lead to left ventricular diastolic dysfunction, which increases the risk of heart failure. Sleep apnea has also been associated with higher rates of hypertension, which is a risk factor for strokes. The irregular breathing caused by sleep apnea can trigger arrhythmias, further increasing the risk of sudden cardiac death.
The relationship between SDB and cardiac issues is complex and bidirectional. While SDB can predispose individuals to cardiac issues, underlying cardiac conditions can also negatively affect sleep quality. This bidirectional relationship underscores the importance of addressing both sleep disorders and cardiovascular health to mitigate their cumulative impact on overall health.
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Treatment options for sleep strokes include brain imaging, CT angiograms, and thrombectomy procedures
Sleep strokes, or "wake-up strokes", occur when an individual goes to sleep healthy and without any stroke symptoms, only to wake up with stroke symptoms. This makes it difficult to pinpoint exactly when the stroke occurred, and it delays potentially life-saving treatment, making sleep strokes more serious than other types of strokes.
Brain Imaging
Neuroimaging plays a crucial role in stroke patients, especially those with acute ischemic strokes. Brain imaging helps differentiate stroke mimics, such as migraine headaches or seizures, from actual strokes. It also aids in the early detection of hemorrhagic strokes, distinguishing between irreversible and salvageable tissues, identifying vascular malformations, and planning treatments, such as intravenous thrombolysis and intra-arterial thrombectomy.
CT Angiograms
CT angiography is a valuable tool in stroke diagnosis and management. It can be performed quickly and reliably, producing high-resolution images of the brain. CT angiograms can easily show dissection flaps in the internal carotid and vertebral arteries, helping to diagnose arterial dissections. In acute stroke settings, CT angiograms are used to identify vessel thrombosis, occlusions, vascular malformations, and other issues.
Thrombectomy Procedures
Thrombectomy involves the removal of a blood clot from a blood vessel. In the context of stroke treatment, thrombectomy procedures may be used to reopen blocked arteries and restore blood flow to the brain. This can be done through intra-arterial thrombolytic drugs or mechanical thrombectomy techniques, improving patient outcomes and reducing the risk of severe complications.
It is important to note that while these treatment options are available for sleep strokes, the specific course of action will depend on the individual's unique circumstances and the expertise of their healthcare providers.
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Frequently asked questions
A sleep stroke, also known as a wake-up stroke, is a type of stroke that happens while a person is sleeping. A stroke occurs when a blocked artery prevents blood from flowing to the brain, or a blood vessel in the brain leaks or ruptures.
The symptoms of a sleep stroke are the same as those of a stroke that occurs during the day. These include numbness or paralysis on one side of the body, especially in the arm, leg, or face, as well as vision loss, bed-wetting, and speech difficulty.
If you notice the signs of a stroke in yourself or someone else, it is important to call emergency services immediately. The quicker the treatment, the more complete the recovery.
The exact cause of sleep strokes is unknown. However, risk factors for strokes include hypertension (high blood pressure), smoking, genetics, age, and gender.
People who have had a stroke may develop a stroke-induced sleep disorder, such as insomnia or sleep-disordered breathing, which is characterized by abnormal breathing patterns that interrupt sleep. To improve sleep, sleep-friendly adjustments such as limiting caffeine intake and following a regular sleep schedule can be made.
