Imagine that an elder you are caring for wakes up one morning and has trouble getting out of bed because their right side is numb. They might even have trouble communicating what is wrong because they can't seem to formulate coherent sentences.

You call 9-1-1, and they are rushed to the hospital where the inform you that the elder is having an ischemic stroke—a blood clot is cutting off the supply of blood to part of their brain. They also tell you that there is treatment available to help reduce the damage done by the stroke and increase the elder's chances for survival. However, the doctor will not give it to them because their stroke started while they were sleeping.

If you find this scenario a bit unrealistic, you may be surprised to find that a recent study conducted by researchers at the University of Cincinnati has shown that this happens to approximately one in every seven stroke sufferers. If this figure were projected out among the stroke population of the United States, then around 58,000 people would face this quandary every year.

The rationale

Though there is no appreciable difference between strokes that occur while a person is sleeping versus while they are awake, clot-busting drugs, such as tPA (tissue plasminogen activator), are generally only be given to patients who have been awake at the onset of their stroke symptoms. This is because there is a small window of time during which tPA is most effective.

Over the years, doctors have found that, if a stroke has been occurring for longer than four-and-a-half-hours, the administration of a tPA can be more hazardous than helpful. It is due to this finding that those roughly 15% of people who have a stroke while they are sleeping are denied access to a potentially life-saving treatment. If a stroke starts while someone is sleeping there is no way for doctors to determine when it actually started, so they will refuse to use tPA.

Moving forward

The University of Cincinnati study also discovered that one-third of people who woke up with their stroke symptoms would have been eligible for treatment with tPA if not for the fact that their stroke started while they were asleep.

This is such a substantial percentage that further research is being done to try and pinpoint the time when a stroke occurred so that even people who experience wake-up strokes can obtain the most effective treatment possible.


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What all of this means to you

The findings of this study are important to the elderly and their caregivers because they highlight the importance of responding rapidly to the appearance of stroke symptoms. If an elder begins to experience any of the common symptoms of a stroke, they need to be taken to a hospital as soon as possible in order to ensure that they receive the most effective treatment available.

For more information on strokes:

How are Strokes Diagnosed and Treated?