Can you have a stroke during sleep?

A stroke is a medical emergency that requires immediate treatment. Unfortunately, a stroke can happen at any time, including while you are sleeping. Since a stroke occurs while you are asleep, you may wake up with stroke symptoms. These are sometimes called “wake strokes.”

Wake strokes are technically indistinguishable from other strokes. However, they can be more dangerous because treatment is delayed while you sleep.

This article discusses wake stroke, including risk factors associated with sleep stroke.

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, since the person had been sleeping, it is unclear when the stroke occurred. This is an important factor because the timing of stroke onset is unknown and stroke needs to be treated as soon as possible.

Prevalence of waking stroke

An estimated 8% to 28% of all strokes occur during sleep.

Causes and Risk Factors

A stroke is caused by interruption of blood flow to the brain.This can be blocking (called ischemic stroke) or blood leaks (called hemorrhagic stroke).

There are many well-known risk factors for stroke, including:

  • diabetes
  • hypertension
  • heart disease or failure
  • atrial fibrillation
  • pregnant
  • hormonal contraceptives
  • intracranial disease
  • high cholesterol
  • sickle cell anemia
  • brain Aneurysm
  • congenital heart defect
  • lack of exercise
  • certain autoimmune diseases and infections
  • cancer
  • previous stroke or transient ischemic attack (mini-stroke)

Although the causes and mechanisms of awake strokes are generally believed to be the same as other strokes, researchers have identified factors that may put you at greater risk for strokes awake than strokes while awake.


The risk of stroke increases with age. However, there is little evidence on the relationship between age and arousal stroke risk.

In a population-based study considered to be the highest quality of arousal strokes to date, the mean age for arousal stroke was 72 years, compared to 70 years for other stroke events.

However, in another study with a much smaller sample group, awake stroke survivors were significantly younger than awake stroke survivors.

sleep disorder

The role of sleep disturbances in causing or increasing the risk of arousal stroke is unclear, but it is an active area of ​​research.

A 2020 study found that, obstructive sleep apnea is a risk factor for stroke, but it is not more or less associated with conscious strokes than non-conscious strokes.

cause and effect

Obstructive sleep apnea and other sleep disorders are risk factors for stroke, but they can also be caused by stroke.

One study found that people who had a stroke while awake (90.5%) were more likely to snore than those who had a stroke while awake (70%).

lipid profile

High cholesterol is a risk factor for stroke. Some studies have shown that conscious stroke survivors have significantly lower blood lipid levels than unconscious stroke survivors.

blood pressure

High blood pressure (high blood pressure) is often a risk factor for stroke.Studies have found that high blood pressure is associated with increased risk of Cerebral infarction Stroke while sleeping.


Smoking increases the chance of stroke.In particular, smoking may increase the risk of intracerebral hemorrhagea type of stroke during sleep.

Signs and symptoms of stroke

The signs and symptoms of a conscious stroke are the same as a stroke that occurs during the day. The only difference is that these symptoms are not noticed until the person wakes up.

Symptoms of stroke include:

  • Sagging of the face, usually only on one side
  • arm or leg weakness
  • speech difficulties
  • Dizziness
  • Visual impairment
  • Puzzled
  • Incontinence (inability to control urine)

For example, someone who has had a stroke may notice decreased vision when they open their eyes in the morning. They may have wet the bed at night, or they may find that their arms are too soft to take off the comforter and sit on the bed.

If you notice signs of a stroke in yourself or someone else, call 911 right away.

How to Treat Arousal Stroke

Compared to strokes with known onset times, there are a few things to keep in mind when treating waking strokes.

Because the time of stroke onset is unknown, waking stroke survivors are often ineligible for reperfusion treatment with tissue plasminogen activator (tPA). This is a highly effective treatment that restores blood flow to the brain by blocking arteries, but it must be started within 4.5 hours of a stroke.

Because people with conscious strokes cannot take advantage of tPA, their outcomes may be worse.

Therefore, diagnostic neuroimaging, such as CT scans and MRIs, is an important part of stroke wake-up therapy. A growing number of experts have been urging the use of neuroimaging to help time stroke onset so that more conscious stroke survivors can participate in reperfusion therapy.

After the patient is stabilized, the treatment of a wake-up stroke is similar to the treatment of any other type of stroke. Physical therapy, occupational therapy, and speech therapy should be started within 24 hours and focused on a patient-centered plan.

recovery and results

Recovery and outcomes of arousal strokes follow a similar pattern to other strokes. The location in the brain and the degree of damage caused by the arousal stroke, as well as other factors, such as concurrent medical conditions, can affect your recovery process.

According to some studies, there is no difference in clinical features or outcomes between awake stroke and other strokes.

Other studies have shown that people with conscious strokes are more severely affected, but there is no difference in mortality. This may be due to the time delay between onset and treatment, and the exclusion of certain treatments such as reperfusion.

cause sleep disturbance

Some stroke patients experience sleep disturbances caused by the stroke. About two-thirds of stroke survivors develop sleep-disordered breathing.


A wake-up stroke occurs when a person goes to bed feeling normal and wakes up with symptoms of a stroke. The main difference between arousal stroke and other types of stroke is that the time of onset is unknown. This can delay emergency medical care and exclude waking stroke survivors from typical stroke treatment.

VigorTip words

There is still a lot to learn about wake-up strokes and how they differ from strokes that occur when people are awake. As we all know, arousal strokes are not uncommon. If you wake up feeling weak, with decreased vision, dizziness, incontinence, or confusion, it is important to seek medical attention as soon as possible.

Frequently Asked Questions

  • Can you have a stroke without knowing it?

    Yes, it is possible to have a stroke without knowing it. Usually, this is a TIA (also known as a mini-stroke), and evidence may be found later with neuroimaging.

  • How common are sleep strokes?

    An estimated 8%–28% of strokes occur during sleep.

  • What happens if the stroke is not treated?

    Having a stroke puts you at greater risk for a full stroke in the future. The danger of having an untreated stroke is that you do not receive medical care, treatment and education to help you change modifiable risk factors to reduce your risk of having another stroke.