Question: I had a stroke last September and now I'm having problems sleeping at night. Do you have any suggestions as to what I can do to get to sleep?
Dr. Hibberd’s answer:
Sleep disorders are very common after a stroke. It’s best to seek an assessment by your physician who can help determine whether your sleep disruption relates to associated depression or anxiety disorder, or another disorder such as sleep apnea, blood glucose, thyroid, or cortisol disorder.
Meanwhile, try to establish a regular bedtime, free of disruption, in a well darkened room. Be sure to get adequate sunlight exposure during the day, and at least to start, allow for 10 hours of uninterrupted sleep if possible. Try to get some regular daily exercise, and avoid exercise within two to three hours of bedtime. Avoid antihistamines and stimulants, and eliminate caffeine from your diet, or at least abstain after 3 p.m.
You may try melatonin orally, but I would not bet on it being sufficient for you at this stage. Some will advise a glass of wine helps them sleep, but I recommend against it, mainly because a little wine at bedtime may lead to a little more, and then you have another problem to deal with, not to mention drug interactions that need to be considered, as well as the generally poor-quality sleep seen with alcohol. You might want to consider relaxation techniques and meditation, or asking your doctor to provide a short-term hypnotic for the next few weeks, then re-assess whether it is appropriate to use for a longer period.
You may use oral agents, but there is a new formulation available for use under the tongue that provides a rapid onset, and lower dosing than higher dose oral agents.
Remember the aim here is to reset your time clock with minimal side effects. While the sleep lab is always an alternative, most of us don’t need this unless we are dealing with a major sleep disorder associated with sleep apnea or other life-threatening conditions.
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