Sleep Deficiency

Please help me in my endeavor to help my brother who suffered a massive stroke five yrs ago. He immediately received therapy and was doing great. He could talk although his speech remained a little distorted. He could walk but with a slight drag of the right leg. He even began to drive. However, he has recently began to fall into a depression that has affected him intensely and he has lost all interest in any activity, being around others, has become weak and is suffering anxiety attacks, does not have an appetite and has lost his sleep completely. Could you please enlighten me as to what we can give him to help him sleep? He was on Ambien for sleep and they took him off of it because the long term use of this med began to attack his sense of taste and his ability to swallow including episodes of nausea. Please help me or inform me of what I can do for him.

Answer: This question is out of my realm as a therapist, however, I do have some resources that I can recommend. The National Stroke Association in Colorado, US has a publication called Stroke Facts. There is one that addresses sleep disorders after stroke that can be viewed by clicking here. The publication discusses breathing disorders, sleep/wake cycle disorders, and insomnia after stroke. You might consider evaluation by a sleep clinic which could help identify the specific reason your brother is not sleeping. If you do a search on the web for sleep disorders after stroke, you can gain a wealth of information.

You also mentioned depression which is common after stroke. In order to determine if your brother is experiencing clinical depression or other similar problems, have an evaluation performed by a physician. I would look specifically for a neuropsychiatrist who will have experience in dealing with post stroke depression and anxiety. The neuropsychiatrist may be able to help with the sleep disturbance as well.

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Sleep Problem

Question:My father had a stroke eleven weeks ago. It was a block stroke, and he cannot balance very well. He has lost the use of his left side and is unable to walk. He hasn't slept for longer than three hours at a time ever since. Any sleeping tablet me has taken seems to have a bad effect. He becomes hyperactive and behaves in a very strange manner (plucking things out the air saying, they need to be picked) and constantly trying to get out of bed. My mum is his main caregiver. She is 78 years old and suffering badly with lack of sleep. All the care he needs during the day is manageable by my mother and sister, but mum needs a night's sleep! What could help my Dad sleep? Nytol, rescue remedy, diazepam, phenegan,etc. just don't work. Any advice would be really appreciated.

Answer: I recommend reading the following http://www.stroke.org/site/DocServer/NSAFactSheet_SleepDisorders.pdf?docID=1002. I also recommend talking to a sleep specialist or even having a sleep study done to determine if anything can be done to help address the issue.

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Sleep Disorder

by Rose

Question: My mother had a second stroke. She is 77 years old. She is having trouble sleeping at night and yelling and talking constantly. Doctor gave her 25 mg. Atarax to sleep. She also having trouble eating. She doesn't want to eat. She drinks some water that's all. She is also having trouble taking medicines. She refuses to take them.

Answer: It sounds as if your mother has had some cognitive changes due to her stroke. If the second stroke is recent, it may be that you just need to give her a little time to recover. If it has been over a couple of months since this second stroke and these behaviors have remained consistent, then you may want to consider some type of schedule. I would make sure she is getting plenty of activity during the day and not sleeping too much so that she can sleep better at night. You can try making the bedtime routine relaxing. Some examples may include a warm shower, music, and lightly massaging lotion on to her skin. I would make sure she goes to bed at the same time each night. If she sleeps any during the day, keep that time consistent as well. I would also try to schedule feeding at the same times each day, and make sure you include some of her favorite foods at each meal. If she won't each much, you can try supplementing with drinks or puddings such as Ensure (or whatever her physician recommends).

For the medication issue, check with her physician and see if it's okay to crush her medicines and put them in something more tasty like ice cream or pudding. I would also check with the physician and see which medicines are mandatory or the most important to make sure you try to get those down first. If the stroke has affected her cognition and reasoning abilities, you may not be able to convince her to take food and medicines. If this is the case, then I would make sure she has some cognitive retraining with a speech therapist. Let the therapist know the areas in which your mom is having trouble so goals can be set accordingly.

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Sleep

by Malachy Ó Casaide
(Cork, Ireland)

Question: What would cause a resident to sleep on and off at night and to be getting agitated after a stroke?

Answer Sleeping difficulty and agitation are not uncommmon after stroke and can be a direct result of the stroke. The patient's MD may be able to give medications that can help with sleep and agitation so I recommend consulting with the physician. If the stroke was recent, the patient may just need time to heal and stabilize into a more regular sleep pattern which in turn may also help with agitation.

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Sleep

Question: I had a stroke 10 months ago but find I still sleep a lot. My right side leg,arm and speech was affected but have all come back. I sleep in the evenings but wake up at 4:00 in the morning. I work full time from 7:30 am to 5:00 pm but start getting sleepy at about 2:00 and then go right to sleep at home around 6:00

Answer: It is not uncommon to want to sleep more or become more fatigued at the end of the day after stroke. I would definitely mention the fatigue to your MD. Some things to consider that might be causing fatigue would be medicines that you are taking, the total amount of sleep you are getting (or not getting), any issues with blood work (e.g. anemia), and your diet. If you can't contribute fatigue to any other factors, then it is probably just a side effect from your stroke. If approved by your MD, it would be good to do some type of cardiovascular exercise which in turn may improve your endurance. Since you work, you don't have the luxury of taking a short afternoon nap, but I do often tell patients that experience sleepiness/fatigue to take a nap in the afternoon if needed.

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How does a CPAP machine help?

by Akida
(East Africa)

Question: How does a CPAP machine help?

Answer: CPAP stands for continuous positive airway pressure, and a CPAP machine is used to help a person who has obstructive sleep apnea (OSA). Obstructive sleep apnea is a serious condition that causes people to stop breathing when they are sleeping. A person with OSA is two to four times more likely to have stroke. Sleep apnea is often managed with the use of a CPAP machine. By controlling sleep apnea, one can help reduce their risk of stroke.

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