• Posted June 8, 2023

Insomnia Might Raise Your Odds for Stroke

After many nights of tossing and turning, you might have more to worry about than just feeling exhausted and less sharp at work.

Insomnia symptoms -- trouble getting to sleep or staying asleep, or waking up too early -- are also associated with higher risk of stroke, according to new research from Virginia Commonwealth University.

And the risk is greater if you're younger than 50, researchers found.

As a biological function, sleep is key for processing memories, repairing cells and releasing toxins accumulated during the day, said study co-author Dr. Wendemi Sawadogo, a doctoral candidate at the time of the study.

"It is a really huge important part of the body function,"Sawadogo said. "So, when it's happened that there's a disruption in the system, for sleep disturbance, trouble falling asleep, trouble staying asleep, this can lead to some adverse health outcomes."

Insomnia is common, affecting more than one-third of the U.S. population, the authors noted in background notes. Researchers aren't exactly sure how it affects stroke risk, but prior research suggests it may trigger harmful inflammation.

The study used data from the Health and Retirement Study of Americans over 50 and their spouses. It included more than 31,000 people, average age 61, and no history of stroke before the research began.

Researchers asked four questions about how often people had trouble falling asleep, awakened during the night or woke up too early and couldn't get back to sleep. They also asked people how often they felt rested in the morning.

The team then followed patients for an average of nine years. During that time, participants had a total of 2,101 strokes.

Knowing that other factors can contribute to strokes, researchers accounted for alcohol use, smoking and physical activity.

People with one to four insomnia symptoms had a 16% increased risk of stroke compared to those with no symptoms. Those with five to eight symptoms had a 51% increased risk of stroke.

This link between symptoms and stroke was stronger for the younger patients, who had almost four times the risk with five to eight symptoms than those with no symptoms. For those 50 and up, risk was 38% higher than those with no symptoms.

Patients who had diabetes, high blood pressure, heart disease and depression had greater risks, too.

People under age 50 tended also to report more insomnia symptoms, Sawadogo said. Those over 50 had more competing contributors to stroke risk, he added.

The findings were published online June 7 in the journal Neurology.

"You have good health when you have good sleep," said Sawadogo. Moreover, "when you get adequate sleep, it improves your memories and your learning capacity."

Dr. Rajkumar Dasgupta is a pulmonary critical care sleep specialist and an American Academy of Sleep Medicine spokesman.

"The results from this study suggest that if we can target people who are having trouble sleeping with cognitive behavioral therapies, it's possible that we could reduce the number of cases of stroke,"said Dasgupta, who was not involved in the study.

Limitations of the study are that people self-reported their insomnia symptoms, and that is not always reliable, he said.

"The American Heart Association has also stated that the risk of stroke may be much higher in people with insomnia compared to those who don't have trouble sleeping," Dasgupta said. "This was an important study to reinforce the importance of identifying and treating insomnia to help reduce the incidence of stroke."

The American Academy of Sleep Medicine offers some tips to set people up for healthy sleep:

• Keep a consistent sleep schedule, even on weekends and vacation days.
• Go to bed early enough that you can get seven to eight hours of sleep, but also don't go to bed unless you are sleepy.
• If you simply can't fall asleep within 20 minutes, get out of bed and do a quiet, dimly lit activity that doesn't include electronics.
• Establish a relaxing bedtime routine, with a comfortable temperature, and use your bed only for sleep and sex.
• Don't eat a large meal before bedtime, and avoid caffeine in the afternoon and evening.
• It also helps to exercise regularly, maintain a healthy diet, avoid alcohol before bedtime and reduce how much liquid you drink before you go to bed.

Sawadogo emphasized the importance of checking in with a doctor instead of ignoring insomnia.

"If you are experiencing insomnia symptoms, don't just think that is going to go away right away. It might not go away. It might stay for a long time period. So, that means that you need to take care of that,"Sawadogo said. "So, the advice is don't minimize insomnia symptoms, talk with a health care provider and try to find a solution."

More information

The American Stroke Association has more on stroke.

SOURCES: Wendemi Sawadogo, MD, PhD, MPH, member, American Academy of Neurology, and recent graduate, Virginia Commonwealth University, Richmond, Va.; Rajkumar Dasgupta, MD, spokesman, American Academy of Sleep Medicine, pulmonary critical care sleep specialist and clinical associate professor, medicine, Keck School of Medicine, University of Southern California, Los Angeles; Neurology, June 7, 2023