Importance of Sleep in Stroke Recovery

In one sense Dr. Jill Bolte Taylor died the morning of her cerebral hemorrhage when the burst blood vessel flooded her left hemisphere and destroyed a large section.   The neural connections that governed the language centers not only eliminated speech – both the ability to speak and comprehend the speech of others, but also her ability to create and comprehend her thoughts in the way she had known (Taylor, 2008, p. 66).  The circuitry that allows one to think linearly and abstractly, to move, to recognize physical boundaries, to comprehend visual stimuli, as well as to make and comprehend speech were all affected by damage to the middle cerebral artery (pp. 18-19).

Having  lost her left brain’s ability to process incoming sensory stimuli – to note, record, and categorize in a  systematic way, she was assaulted by the sheer chaotic force of it all.  For all intents and purposes, she became “an infant born into a woman’s body.  And oh yes, the brain wasn’t working” (p. 65).  Her limbic system now no longer had the “higher” functioning cerebral cortex to linearly process sensory input; in her earliest post-stroke days, information was processed in much the same way as it is for a newborn.

The limbic system, from the first, takes sensory input and processes it as emotion.  The neural connections are based upon linking of these emotions.  As the higher cortical cells mature, the connections are integrated into the existing emotionally based limbic processes.  Thoughts are made in a more linear fashion as the new, more complex system takes any new input and compares it to and integrates it into the existing emotional landscape of the limbic “worldview”.  In a safe and calm environment, the higher functioning “thinking” mind can override the reactive limbic mind and can choose a more rational, reasoning response (pp. 17-18).

Sleep becomes imperative for both the infant and the post-stroke patient.  The brain needs to rest from all the physical work of creating new neural pathways.  The post-stroke patient, like the newborn, feels assaulted, but is physically unable to move away from the stress.  The only solution is to fall asleep!  Here one can see that sleep performs two functions: that of restoration of the brain during slow-wave sleep (Himmanen, 2012) and as a means of controlling one’s environment.  REM sleep allows the brain to sort out stimuli and to try and make sense of new input.  Learning to think IS exhausting.

Psychologically, the ability to tune out overwhelming stimuli is quite important, I believe, to our wanting to grow and develop.  Learning that one can have an impact on one’s surroundings is an extremely important developmental milestone in the development of consciousness. Tuning out  serves to create a safe environment.  A safe environment allows the amygdala to remain calm and to keep from triggering a hyper-vigilant. reactive response to possible danger.  When the amygdala is calm, the hippocampus can learn and memorize new information – a vital task for the stroke patient as well as the newborn (Taylor, 2012, pp. 18-19).

Often, sleep does not come easily to the newborn nor to the stroke patient.  In the newborn, the regulatory centers are still developing.  In those who suffered a stroke, the regulatory centers have been compromised and must be rebuilt.  Too much raw stimuli disrupts sleep and overloads the circuits.  Sleep, which is necessary to break the stressed, wakeful cycle, is not easy for the overly stressed body to achieve.  Having a loose schedule that has naps planned into it seems to help in learning to self-regulate.

The rhythm of an ordinary, low-key day has an ebb and flow that fits the needs of the individual and is probably good for all of us, but it is vital for the stroke patient as well as the newborn for healthy development of new neural pathways.

References

Himmanen, S. (2012). The function of sleep [Video lecture].  Retrieved from Psy 229: Introduction to Biological Psychology – Cedar Crest College: http://frameset.next.ecollege.com/%28NEXT%289bf3457d0f%29%29/Main/AllMode/FramesetHybrid/NavigateView.ed?courseItemType=CourseContentItem&subItemID=201109219&expandUnit=36866818

Taylor, J.B. (2008).  My stroke of insight: A brain scientist’s personal journey. New York: Viking Penguin.

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15 thoughts on “Importance of Sleep in Stroke Recovery

  1. clopez231 says:

    I did not know that people who have a stroke need more sleep or that they can have sleep problems. I learned a lot of information from your blog. I decided to research a little more about this problem. I found an article about people who have sleep disorders after strokes. In the article it said that after a stroke people need sleep but some times they can’t get enough of it. One sleep disorder they talked about was called Sleep-disorder breathing (SDB). This is where you have a problem breathing and you wake up a lot during the night. They also say this can cause other health problems it can increase blood pressure, heart stress and blood clotting. (NSA) It was also said that it can cause obstructive sleep apnea this is when you are sleeping and you stop breathing for a certain amount of minutes.
    If you think about it this is scary what if you stop breathing and never wake up. They say there are ways to treat theses sleep disorders, one is to use this devise they put in your mouth it is like a retainer it helps to open the airway. You can read more about this I have attached the link as well as a link to a video of a man who has SDB.

    http://www.telegraph.co.uk/science/science-video/9002038/How-Obstructive-Sleep-Apnoea-affects-people.html

    http://www.stroke.org/site/DocServer/NSAFactSheet_SleepDisorders.pdf?docID=1002

    • chad f says:

      I suffered a ischematic stroke immediately followed by a burst anuerism in the right side of my brain at age 41.i am very blessed to be alive. I suffered mainly a lazy left arm and hand. The doctors and therapists were all wrong about sleep.they did everything they could to keep me awake. Now 1.5 yrs later I can sleep as much as I want and my fingers are starting to move on my left hand! My wife was my care giver and since I just wanted to sleep and the therapists said I had to stay awake to exercise to regain my left side.my wife believed it was my fault I didnt recover faster and it ruined my marriage. So now I am divorced, disabled and unemployed.but starting to recover thanks to extra sleep. People, please let stroke survivors sleep!

  2. hrwilli says:

    Sue,
    Very neat topic as well as explanation! I absolutely love the study of stroke victims. While I was volunteering at Pocono Hospital as a Physical Therapist assistant, I encountered numerous stroke victims. Most were not as mentally unstable as you described in your post due to seeing them almost a month after their stroke occurred. Once seeing them though you could still vividly see the side effects in which the stroke had on their body. Also, after performing physical therapy for only a half hour, they were aboslutely exhuasted and fell asleep the moment in which i returned them to their room.
    One patients in which I had was an older male individual. His stoke disabled him from fully moving the right side of his body for example he had a slouched right cheek, his right arm was lazy as well as his right leg. After two months of physical therapy I had one of the most rewarding moments of my life. Not only was the man walking and able to toss a balloon back and forth to each other, he was able to smile with a full smile on his face with no drooping gesture. That was probably one of the most rewarding moments of my life. I’ve learned that a little sleep and exercise can do alot for the body.
    I wish there was more that we could do for stoke patients. I understand that physical therapy is essential to their rehabilitation success but their damage within the brain that they suffer is something which is hard to reverse. For example memory loss, mental degeneration and retardation.

  3. jpdankel says:

    I have always felt that sleep is good for our bodies for one to rest them, to process the days information and more less do a functions check. I may sound corny when i think of our brains as computers. And when we sleep our brains file information, thus i believe what our dreams are about, and also to do functions checks, ( LOL, why we get the blinking eyes in our sleep or the twitches in our legs) all part of our bodies making sure all systems are OK. So when you have a lot of stimuli around when you are trying to sleep, you are not goign to have a full recovering sleep. Even though we are still asleep our bodies are still taking input or stimuli from enviroment.

  4. phouston12 says:

    Hi Sue,
    I think that the ability of the brain in events such as the one you mentioned is not quite yet clear as to why some people make it through the condition and other die despite the severity of the stroke. To me it is not so clear why the outcomes could be unexpected in the way some people survive and other such as Dr. Jill Bottle Taylor die, which was the same situation that happened to my dad.

    To give you just an example, around four or three years ago my grandmother had a severe stroke. When this happened I remembered waiting for the doctors to let us know how she was doing. Hours passed by and a doctor came out. He said, the stroke was severe and she had a hemorrhage in her left hemisphere, and everything that they could had done was already done, so the only thing we were left was wait to see if the hemorrhage stopped, and if not to expect the worse. To summarize the story, the hemorrhage stopped, however she was still hospitalized for about a month because she lost her movement, speech, cognition and others things that I do not remember well. Then she went to a rehabilitation facility were she spent a good amount of time there.

    After all, my grandmother made out really well. Now she is 83 and she is probably better than before she had the stroke, thank God. So, since I know that her stroke was really severe, how come she made it through, while other people who seem to be healthier and younger are not as lucky as she was? I am not sure yet.

    • Oops…I guess it wasn’t too clear – actually Dr. Taylor is alive and well – it took her 8 years to recover fully. In her book she talks about how her old self, the extremely left-brained oriented person “died” when the neural circuitry was destroyed by the bleeding into her left hemisphere.

      She had to recreate those connections between the bits of information that were still stored, but had lost their ties. In remaking the connections, had to make new ones… Dr. Ramachandran has done some amazing stuff with this. The T.E.D. video in wk #4 doesn’t exactly talk about what happens in making those reconnections, but he DOES give us a lot to think about in terms of our separation and connection with all other humans around us.

      Eastern philosophy also comes into play regarding quantum physics. There are Buddhist priests who are also quantum researchers. The boundaries do start to blend the closer we look at the brain and also at matter/ energy at the sub-molecular level!

  5. Jaime says:

    Very interesting blog choice. I didn’t realize that stroke patients need more rest. I know that the older you get the more sleep you need, its very much like our bodies grow from infancy peak out and then slowly retract back to that of childhood. One of the areas I will discuss is sleep since that is the topic of discussion. I have noticed not only in elderly, but also people who are physically sick as well as mentally sick, and in people recovering from surgery or any truama to the physical body. Why is it when a body is deteriorating and dying you go unresponsive basically you go to sleep for a period of time before your organs stop working. I don’t believe researchers have the information needed yet to understand the full intensity of sleep, to begin to provide an answer. If you think about it our bodies are amazing and do extraordinary things.

  6. kjballon says:

    This week’s blog is extremely informative for me. I was unaware of how important sleep was to an infant or to someone recovering from a stroke and this helped teach me about both. I really like how you explained how sleep allows us to escape our problems and our stress, it truly is the “ultimate” escape. It makes me wonder however..

    To add on to this topic, is sleep truly the MOST efficient method for helping a stroke patient fall into that state of brain restoration or establishing control of environment? I decided to do a little bit of research on some therapy that is used to help stroke victims and came across something rather interesting.

    Considering stroke victims are left “literally speechless” due to the damage that prevents them from communicating as they used to, singing therapy has shown to improve such communication. According to an article I read (referenced at bottom) it has been known for over one-hundred years that people that have been left inable to speak are still able to sing. Due to this realization it has become quite popular to undergo “singing sessions” that allow for stroke victims to “speak again” or feel relieved in communicating vocally through singing. This type of therapy is referred to as “melodic intonation therapy” and is showing rapid growth of the original idea that people unable to speak can indeed still sing. Debra Meyerson is shown in this article as a volunteer for the therapy and is displaying very successful results: she is actually beginning to talk again! I found it absolutely moving because this woman is portrayed to have been a very successful speaker before her aphasia took over and now a quite unfair irony has tainted her reality.

    Apparently it is crucial to the therapy that the words of the music are very much slowed (sounding it out syllable by syllable) because of the fact that if the right side of the brain is the part that is learning to speak again, it may interpret melody and pitch well but fail when it comes to interpreting language on the left side of the brain-particularly in Broca’s Area (Singing Therapy Helps Stroke Patients Speak Again).

    Your blog allowed for me to not only learn more about a topic I previously knew little about, but to then further research it and come across this article which is also fascinating!

    To help produce more discussion, I would like to pass on a thought I had from the very beginning of reading this blog. As I am a woman of voice; I feel empowered when it comes to speaking and leading a group of people with my thoughts through verbally expressing them, I would be absolutely distraught if I were unable to communicate them because of an injury. Now if you are born with it, that is quite different because you have already adapted. I just would like to know if any of you would participate in this new singing therapy to perhaps improve your speech? I know that I would, most definitely!

  7. kjballon says:

    cut off my reference, sorry!

    REFERENCES:

    Knox, Richard. “Singing Therapy Helps Stroke Patients Speak Again.”
    NPR’S Health Blog. 26 December 2011. http://www.npr.org/blogs/
    health/2011/12/26/144152193/singing-therapy-helps-stroke-
    patients-speak-again

  8. adilaanwari says:

    Your blog was very interesting. I have gained so much from your blog. I didn’t know how sleep can be very important in our lives. I didn’t know how important sleep was to someone that had a stroke. My blog was also about sleep too, and it is very important. Before doing my research I didn’t know what problems sleep can cause as well. I did my blog on narcolepsy , and people with narcolepsy are very sleepy during the day, and they fall asleep without being aware. I always imagined how rough it can be for people knowing they are asleep while doing something important. Imagine going for an interview and during your interview you fall asleep without being aware of it. It can be very distracting and scary. I can imagine how rough it is for individuals that had a stroke. I also agree with your statement where you said the brain needs to sleep more, so that it can process more pathways for us. I really enjoyed reading your post, you have provided so many information.

  9. cawest04 says:

    I too was unaware that stroke patients needed to sleep a lot in order to do well in recovery. I decided to do more research on what are the exact benefits that sleep has on individuals who suffer a stroke. Sleep can have many benefits for stroke patients, including improving memory, strengthening the brain, and decreasing the risk of another stroke.
    Sleep may provide stroke patients with the ability to improve their memory, particularly their short term memory. Short term memory is defined as “a system for temporarily storing and managing information required to carry out complex cognitive tasks such as learning, reasoning, and comprehension” (MedicineNet.com, 2011). In a study completed at Harvard Medical School, researchers looked at stroke patients and the impact of sleep on newly learned facts. The researchers found that when the patients slept between the newly learned facts and the testing on these new facts that the individuals who did not sleep did worse than those who did sleep. Sleeping allowed the participants to “digest” what they had learned and to improve their rehabilitation process.
    Another way sleep may help stroke patients is by strengthening the brain. Rapid eye movement sleep or REM sleep is vitally important to human life and a required amount of it is needed on a nightly basis. What has been discovered is that REM sleep produces sleep spindles, which are spurts of brain waves at high frequencies for only one to two seconds (Stroke Rehab Online, 2011). These help with long term memory and long term memory is defined as “a system for permanently storing, managing, and retrieving information for later use” (MedicineNet.com,2012). The sleep spindles are also active when the brain begins to take information learned and store it in long-term memory. Sleeping even aids in improving problem solving abilities, remembering abilities, and performance abilities with the help of neurotransmitters.
    The final way sleep helps stroke patients is by decreasing the risk of having another stroke. One way this was tested was at the University of Chicago. Researchers looked at stroke patients who have diabetes and high blood pressure. From the research they conducted they concluded that individuals with these ailments who get the proper amount of sleep decrease their risk of having another stroke.
    I found you blog to be quite helpful because as a PCA I work with a lot of residents who have many health issues and some have sadly suffered from strokes. Knowing the importance of sleep and how it can aid in recovery is very beneficial. I always find it so important to learn new things and this is information I can take with me when I work with these residents. Hopefully, the information I came across is helpful to you as well.
    References
    MedicineNet.com. (2012. Definition of long-term memory. Retrieved from: http://www.medterms.com/script/main/art.asp?articlekey=15299.
    MedicineNet.com. (2011). Definition of short-term memory. Retrieved from: http://www.medterms.com/script/main/art.asp?articlekey=7142.
    Stroke Rehab Online. (2010). Sleeping and sleep for stroke recovery speed up. Retrieved from: http://strokerehabonline.com/tag/sleep-for-stroke-recovery/.

  10. mesully says:

    Importance of sleep
    Sleeping is a necessity to a healthy life, yet, it is probably the one thing or activity that the general population young and matured, seem to not get enough of. Studies have been pounding this conclusion to the public at large because so many of our health problems, accidents, quality of life are affected by the lack of sleep. Sleeping and resting is restorative. It helps the brain and the bodies function adequately and it’s a rejuvenating process.

  11. anhuff says:

    Sue,

    I really enjoyed reading your blog. I had no idea just how important sleep was to a stroke patient. After some thought it makes sense. In one of my other psychology classes that I took last semester, the professor did a lecture about how important sleep is to the body. He mentioned that the best type of sleep is REM. During this time is where the body does most of its healing. This is because this is the time when there is the least activity occur to make the body work harder and to make us more stressed. During sleep the the heart rate decreases as well as the body temperature and breathing. It allows the body to take over and fight off any type of disease that is occurring and is the reason why sleep is so important. A stroke takes a massive effect of the brain. The person who suffered also has to relearn things that came naturally. It takes a lot of work as you said and is exhausting. Again Sue, this was a great blog and really opened my eyes to just how important sleep really is.

  12. john verghese says:

    really greateful to learn abt this sleep requirement. i no longer will fight off drowsiness .. god bless !

  13. Maria says:

    Attracttive ection oof content. I just stumbled upopn your blog annd iin accesdsion cwpital
    to asserrt hat I acquire actully enjnoyed accpunt yolur blog posts.
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