A study of 1,799 people, who had suffered and survived strokes at the average age of 62, found that stroke risk is markedly increased by sleep disturbance symptoms, poor sleep quality, napping for long periods, and sleep apnea symptoms (Neurology, May 23, 2023;100(21): e2191–e2203). The stroke survivors were compared to age-matched people who had not had a stroke and the results were adjusted for smoking, physical activity, depression, and alcohol intake.

The study suggests that you may be at an increased risk for a stroke if you consistently have:
• Difficulty falling asleep
• Difficulty staying asleep at night
• Daytime sleepiness
• Abnormal movements or sensations during sleep at night (such as restless leg syndrome)
• Sleeping too short or too long (not getting 5-9 hours of sleep each night). Getting less than five hours of sleep at night quadruples your chances of suffering a stroke, while requiring more than nine hours of sleep at night doubles your chances of suffering a stroke.
• Requiring naps lasting more than one hour almost doubles stroke risk, but short naps did not increase risk.
• Obstructive sleep apnea, in which you stop breathing for short periods during sleep, triples stroke risk.
• Snoring during sleep almost doubles stroke risk.
• The more of these sleep disturbance symptoms that you have, the greater your chances of suffering a stroke. Having five or more of these symptoms puts you at high risk for suffering a stroke.

Dealing with Commom Sleep Problems
Sleep problems are extremely common, and may have a fixable cause:
• an uncomfortable bed
• a bedroom that is too light, noisy, hot or cold
• stress and anxiety
• schedule factors such as jet lag or shift work
• drinking alcohol or caffeine before going to bed
Sleep problems can also be associated with serious health conditions such as high blood pressure, obesity, depression, diabetes, dementia, heart disease and strokes (J Sleep Research, 2021;30:e13395).

My Recommendations
If you have consistent sleep problems, check with your doctor to look for a cause. Hopefully you will not find new medical issues, but this check-up could lead to new efforts to solve any existing health problems.

Quality sleep is important for everyone, so I always recommend the following regimen:
• Make sure you have a comfortable mattress, pillow and bedding
• Make your bedroom a quiet, dark place
• Try to exercise every day
• Go outside during the day to get some daytime light exposure
• Do not nap for longer than an hour during the day
• Try to go to sleep at about the same time each night
• Avoid caffeine and alcohol in the last half of the day and in the evening
• You may want to try intermittent fasting where you do not eat in the evening
• Some studies suggest that we should reduce blue light exposure in the evening by not watching TV or using a computer or smart phone before you go to bed. I will look for more research on this.