Table of ContentsView AllTable of ContentsDefinitionCauses and Risk FactorsSigns and SymptomsTreatmentRecovery and OutcomesFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Definition
Causes and Risk Factors
Signs and Symptoms
Treatment
Recovery and Outcomes
Frequently Asked Questions
Strokescan occur at any time, including when you are asleep. It’s possible to wake up with stroke symptoms as a result of a stroke that happened while you were asleep. These are sometimes called “wake-up strokes.”
Wake-up strokes are not technically different from other strokes. However, they can be more dangerous because treatment is delayed while you are sleeping.
This article discusses wake-up strokes, including risk factors associated with strokes during sleep.
Verywell / Katie Kerpel
What Is a Wake-Up Stroke?
A wake-up stroke is a stroke that occurs during sleep. In these cases, the person goes to bed feeling normal but wakes up with symptoms of a stroke.
Unfortunately, because the person has been asleep, it’s unclear when the stroke occurred. This is an important factor, because the time of stroke onset is unknown, and strokes need to be treated as soon as possible.
Prevalence of Wake-Up StrokesIt’s estimated that anywhere between 8% and 28% of all strokes occur during sleep.
Prevalence of Wake-Up Strokes
It’s estimated that anywhere between 8% and 28% of all strokes occur during sleep.
There are many well-known risk factors for stroke, including:
Although a wake-up stroke is generally considered to have the same cause and mechanism as other occurrences of stroke, researchers have identified a few factors that might put you at greater risk of having a wake-up stroke compared to a stroke while you are awake.
Age
The risk of having a stroke increases the older you get.But there is minimal evidence on how age relates to risk of a wake-up stroke.
In one study, regarded as the highest-quality population study of wake-up strokes to date, the average age of wake-up stroke was 72, compared to 70 for other occurrences of stroke.
However, in another study with a much smaller sample group, wake-up stroke survivors were significantly younger than those who had strokes while awake.
Sleep Disorders
The role of sleep disorders in causing or increasing the risk of wake-up stroke is not well understood, but it is an active area of research.
A 2020 study found thatobstructive sleep apneais a risk factor for strokes, but it is not more or less associated with wake-up strokes than non-wake-up strokes.
Cause and Effect
One study found that those who had wake-up strokes were more likely to snore (90.5%) than those who had strokes while awake (70%).
Lipid Profile
High cholesterolis a risk factor for stroke. Some research indicates that wake-up stroke survivors have a significantly worselipid profilethan non-wake-up stroke survivors.
Blood Pressure
Hypertension (high blood pressure) is a risk factor for strokes in general. Research has found that hypertension is associated with an increased chance ofcerebral infarctionstrokes during sleep.
Smoking
Smoking increases your chance of having a stroke. In particular, smoking may increase the risk of having anintracerebral hemorrhage, a type of stroke during sleep.
Signs and Symptoms of a Stroke
The signs and symptoms of a wake-up stroke are the same as strokes that occur during the day. The only difference is that these symptoms are not noticed until the person wakes up.
Symptoms of stroke include:
For example, a person who is having a wake-up stroke might find they have vision loss when they open their eyes in the morning. They may have wet the bed during the night, or they might find their arm too limp to remove their bed covers and sit up in bed.
It’s essential to call 911 immediately if you notice the signs of stroke in yourself or someone else.
How Wake-Up Strokes Are Treated
There are some things to be aware of whentreatinga wake-up stroke, compared to a stroke with a known time of onset.
Because the time of stroke onset is unknown, wake-up stroke survivors are often ineligible for treatment withreperfusiontherapy withtissue-plasminogen activator(tPA).This is a highly effective treatment to restore blood flow to the brain through blocked arteries, but it must be initiated within 4.5 hours of stroke.
Because people with wake-up stroke cannot take advantage of tPA, their outcomes may be poorer.
Diagnostic neuroimaging, such asCT scansandMRIs, are therefore an important part of wake-up stroke treatment. Increasingly, experts have been urging the use of neuroimaging to help identify the time of stroke onset in order to include more wake-up stroke survivors in reperfusion treatment.
After the person is medically stable, treatment for wake-up stroke is similar to treatment for any other type of stroke. Physical therapy,occupational therapy, andspeech therapyshould begin within 24 hours and continue intensively with a patient-centered plan.
Recovery and outcomes for wake-up strokes follow a similar pattern as other strokes. The location in the brain and the extent of damage from a wake-up stroke, as well as other factors like co-occurring medical conditions, will all affect your recovery process.
According to some studies, there is no difference in clinical features or outcomes between wake-up strokes and other strokes.
Other research indicates people who had wake-up strokes are more severely affected, but there is no difference in fatality.This could be due to delayed time between onset and treatment, and exclusion from certain treatments like reperfusion.
Resulting Sleep DisordersSome people who have had a stroke develop a stroke-induced sleep disorder. About two thirds of stroke survivors will developsleep disordered breathing.
Resulting Sleep Disorders
Some people who have had a stroke develop a stroke-induced sleep disorder. About two thirds of stroke survivors will developsleep disordered breathing.
Summary
Wake-up strokes occur when a person goes to bed feeling normal and wakes up with symptoms of a stroke. The key difference between wake-up strokes and other types of stroke is that the time of onset is unknown. This can delay emergency medical treatment and exclude wake-up stroke survivors from typical stroke treatments.
A Word From Verywell
There is still a lot to learn about wake-up strokes and how they differ from strokes that occur when people are awake. What is known is that wake-up strokes are not uncommon. If you wake up and are experiencing weakness, vision loss, dizziness, incontinence, or confusion, it’s important to seek medical attention as soon as possible.
Frequently Asked QuestionsYes, it is possible to have a stroke and not know it. Usually, this is a TIA (also called a ministroke), and evidence may be discovered with neuroimaging at a later date.An estimated 8%–28% of strokes occur during sleep.Having a ministroke puts you at greater risk of having a full stroke in the future. The danger of having a ministroke that is not treated is that you don’t receive the medical treatment, therapy, and education to help you change your modifiable risk factors to lower your risk of another stroke.
Yes, it is possible to have a stroke and not know it. Usually, this is a TIA (also called a ministroke), and evidence may be discovered with neuroimaging at a later date.
An estimated 8%–28% of strokes occur during sleep.
Having a ministroke puts you at greater risk of having a full stroke in the future. The danger of having a ministroke that is not treated is that you don’t receive the medical treatment, therapy, and education to help you change your modifiable risk factors to lower your risk of another stroke.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mackey J, Kleindorfer D, Sucharew H, et al.Population-based study of wake-up strokes.Neurology. 2011;76(19):1662-1667. doi:10.1212/WNL.0b013e318219fb30John Hopkins Medicine.Risk factors for stroke.Tanimoto A, Mehndiratta P, Koo BB.Characteristics of wake-up stroke.Journal of Stroke and Cerebrovascular Diseases. 2014;23(6):1296-1299. doi:10.1016/j.jstrokecerebrovasdis.2013.10.021Barreto P et al.Obstructive sleep apnea and wake-up stroke – a 12 months prospective longitudinal study.Journal of Stroke and Cerebrovascular Diseases. 2020;29(5):104564. doi:10.1016/j.jstrokecerebrovasdis.2019.104564Northwestern Medicine.Stroke-induced sleep disorders.Turin TC, Kita Y, Rumana N, et al.Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a japanese population.ENE. 2013;69(6):354-359. doi:10.1159/000346124Rubin MN, Barrett KM.What to do with wake-up stroke.Neurohospitalist. 2015;5(3):161-172. doi:10.1177/1941874415576204
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mackey J, Kleindorfer D, Sucharew H, et al.Population-based study of wake-up strokes.Neurology. 2011;76(19):1662-1667. doi:10.1212/WNL.0b013e318219fb30John Hopkins Medicine.Risk factors for stroke.Tanimoto A, Mehndiratta P, Koo BB.Characteristics of wake-up stroke.Journal of Stroke and Cerebrovascular Diseases. 2014;23(6):1296-1299. doi:10.1016/j.jstrokecerebrovasdis.2013.10.021Barreto P et al.Obstructive sleep apnea and wake-up stroke – a 12 months prospective longitudinal study.Journal of Stroke and Cerebrovascular Diseases. 2020;29(5):104564. doi:10.1016/j.jstrokecerebrovasdis.2019.104564Northwestern Medicine.Stroke-induced sleep disorders.Turin TC, Kita Y, Rumana N, et al.Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a japanese population.ENE. 2013;69(6):354-359. doi:10.1159/000346124Rubin MN, Barrett KM.What to do with wake-up stroke.Neurohospitalist. 2015;5(3):161-172. doi:10.1177/1941874415576204
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mackey J, Kleindorfer D, Sucharew H, et al.Population-based study of wake-up strokes.Neurology. 2011;76(19):1662-1667. doi:10.1212/WNL.0b013e318219fb30John Hopkins Medicine.Risk factors for stroke.Tanimoto A, Mehndiratta P, Koo BB.Characteristics of wake-up stroke.Journal of Stroke and Cerebrovascular Diseases. 2014;23(6):1296-1299. doi:10.1016/j.jstrokecerebrovasdis.2013.10.021Barreto P et al.Obstructive sleep apnea and wake-up stroke – a 12 months prospective longitudinal study.Journal of Stroke and Cerebrovascular Diseases. 2020;29(5):104564. doi:10.1016/j.jstrokecerebrovasdis.2019.104564Northwestern Medicine.Stroke-induced sleep disorders.Turin TC, Kita Y, Rumana N, et al.Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a japanese population.ENE. 2013;69(6):354-359. doi:10.1159/000346124Rubin MN, Barrett KM.What to do with wake-up stroke.Neurohospitalist. 2015;5(3):161-172. doi:10.1177/1941874415576204
Mackey J, Kleindorfer D, Sucharew H, et al.Population-based study of wake-up strokes.Neurology. 2011;76(19):1662-1667. doi:10.1212/WNL.0b013e318219fb30
John Hopkins Medicine.Risk factors for stroke.
Tanimoto A, Mehndiratta P, Koo BB.Characteristics of wake-up stroke.Journal of Stroke and Cerebrovascular Diseases. 2014;23(6):1296-1299. doi:10.1016/j.jstrokecerebrovasdis.2013.10.021
Barreto P et al.Obstructive sleep apnea and wake-up stroke – a 12 months prospective longitudinal study.Journal of Stroke and Cerebrovascular Diseases. 2020;29(5):104564. doi:10.1016/j.jstrokecerebrovasdis.2019.104564
Northwestern Medicine.Stroke-induced sleep disorders.
Turin TC, Kita Y, Rumana N, et al.Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a japanese population.ENE. 2013;69(6):354-359. doi:10.1159/000346124
Rubin MN, Barrett KM.What to do with wake-up stroke.Neurohospitalist. 2015;5(3):161-172. doi:10.1177/1941874415576204
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