- Everyone occasionally has problems sleeping, but chronic insomnia — persistent sleep disturbance — affects around 30% of the general population.
- Chronic insomnia can affect mental functioning and may increase the risk of depression and anxiety.
- It is also associated with health problems, such as heart disease, kidney disease, high blood pressure, diabetes, stroke, and obesity.
- Now, a study has found that people who report regular sleep disturbances are at higher risk of stroke than those who regularly get a good night’s sleep.
Trouble getting to sleep, or waking during the night are occasional problems for most of us. However, a good night’s sleep is an elusive goal for some people as they experience persistent sleep disturbance. According to the American Academy of Sleep Medicine, this chronic insomnia affects some 30% of the general population.
Chronic insomnia is associated with an increased risk of accidents, high rates of work absenteeism, and decreased concentration. It may also diminish the quality of life and increase a person’s use of healthcare services.
Studies have found an association with mental health conditions. A 2005 study found that people with insomnia are almost ten times more likely to have clinically significant depression and around 17 times more likely to have clinically significant anxiety than those without insomnia. However, the direction of the relationship between depression, anxiety, and insomnia is unclear.
The effects are not only mental. According to the National Institutes of Health, sleep deficiency is linked to many chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke, and obesity.
A new study has provided more evidence of insomnia’s link to stroke. In this study, people who reported the highest number of insomnia symptoms had a 51% greater risk of stroke than those who reported no insomnia symptoms.
The study is published in Neurology, the medical journal of the American Academy of Neurology.
The study used data from 2002 to 2020 from the Health and Retirement Study in the United States. Of the 31,126 participants, 92.5% were ages 50 and over, and all were stroke-free at the start of the study. They had a mean age of 61 years, 57% were female, and 63% were non-Hispanic white.
The participants recorded their insomnia symptoms by completing the adapted Brief Insomnia Questionnaire (BIQ), a validated screening tool assessing self-reported sleep complaints. They answered four questions about how often they:
- had trouble falling asleep
- had trouble with waking up during the night
- woke too early and were unable to return to sleep
- felt rested in the morning
For each, they had to answer ‘most of the time,’ ‘sometimes,’ or ‘rarely or never.’
The total score from their answers ranged from 0 – no insomnia — to 8, indicating severe insomnia symptoms. The researchers repeated the insomnia questionnaires during follow-up, and found that people’s insomnia symptoms were consistent.
The researchers recorded strokes from interviews every second year during a follow-up of up to 19 years (median 9.2 years), in which the participants were asked, ‘Has a doctor ever told you that you had a stroke?’.
Strokes linked to insomnia
Having adjusted for other factors that might increase stroke risk, including alcohol use, smoking, and level of physical activity, the researchers found that the higher the insomnia symptoms score, the greater the risk of having a stroke during follow-up.
People with the greatest number of insomnia symptoms (5–8) had a 51% higher risk of stroke than those than those with no insomnia symptoms.
The researchers found that the link between insomnia and stroke was strongest in those under the age of 50. People in this younger group with insomnia symptom scores of five to eight had almost four times the stroke risk of under-50s with no insomnia symptoms.
Dr. Wendemi Sawadogo, Ph.D., lead author of the study, commented: “We have noticed in this study that the mean age decreased with increasing insomnia symptom scores meaning that younger people experienced more insomnia symptoms than older people.”
“In addition, as people age, they develop additional risk factors for stroke (hypertension, diabetes, atrial fibrillation…) that may reduce the contribution of insomnia symptoms toward the development of stroke,” she told Medical News Today.
“The link between poor sleep and stroke in older patients is lower most likely because the risk of stroke in general is so much greater in the elderly across all domains. As patients get older, the relative influence of sleep diminishes in comparison to their other health conditions such as hypertension, diabetes, and heart disease.”
— Dr. Adi Iyer, neurosurgeon and interventional neuroradiology, of Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.
For all participants, the association increased further for people with diabetes, hypertension, heart disease, and depression.
Why might there be a link?
The authors emphasize that their findings do not show that insomnia causes stroke, but do highlight an independent association between the two. They also acknowledge that a limitation of the study was that insomnia symptoms were self-reported.
Sleep deprivation has been shown to contribute to endocrine and metabolic dysregulation, as Dr. Iyer explained:
“Poor sleep likely causes inflammatory and metabolic dysregulation that is associated with diabetes, heart disease, [and] high blood pressure, which are known risk factors for stroke.”
How to combat poor sleep
Discussing the study findings, Dr. Sawadogo emphasized that people should: “be aware of the potential adverse health outcomes associated with poor sleep and discuss any sleep issues with your healthcare provider.”
If you do experience insomnia, the following might help you get a better night’s sleep:
- Establish a routine by going to bed and waking around the same time each day.
- Avoid using screens just before bedtime and keep devices out of the bedroom.
- Avoid heavy meals, caffeine, or too much alcohol in the evening.
- Wind down before bedtime, perhaps by having a bath, listening to relaxing music, or doing breathing or relaxation exercises.
- Ensure your bedroom is dark with heavy curtains or blackout blinds.
When self-treatment does not improve sleep, Dr. Iyer, who was not involved in the study, recommended seeking further help:
“Sleep disorders should be treated like any other serious health condition as it has long-term implications on overall health, including stroke risk. The importance of this study is that clinicians can help optimize sleep patterns to reduce the risk of stroke, particularly in young patients.”
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