Stroke and sleeping issues

[Donna4764]

My husband who is 47 yrs old had two left cerebellar infarcts and a right occipital infarct 4 years ago.  They occurred simultaneously and despite all sorts of testing....they have never found a reason that this happened.  They were all considered embolic events.  His only medical history up to that point was that he developed migraine headaches a couple of years before the strokes, a history of peptic ulcer disease, and sleep apnea.  He was using CPAP prior to the strokes without a problem.  Since the strokes, the migraines are almost a daily occurrence (although he does take propranolol as a preventative med for them), he cannot tolerate the CPAP( we have had additional sleep studies and made changes to the CPAP without any improvement).  He complains daily of poor sleep, has memory problems, muscular jerking especially in the arms and hands during sleep, irritability, personality changes, complains periodically of numbness in the left side of his face, and is of course depressed.  The strokes left him with left sided peripheral vision loss and he always is unsteady upon rising.  He has tried Wellbutrin for the depression but seemed to make the headaches worse.  His physician gave him Cyclobenzaprine and Ambien to help with sleep but nothing seems to improve his sleeping.  His quality of life is poor needless to say and it affects our family as a whole.  I am consulting another neurologist next week to see if there is something we are missing or any treatments that might help his situation.  Any thoughts???

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Stroke and sleep disturbances are commonly found together. Sleep apnea has been suggested to predispose someone for a stroke and a stroke can predispose someone to sleep apnea (up to 70% of people in some studies). Headaches and sleep disturbances are also strongly associated. It is important that your husband continue to work with his sleep specialist to optimize his CPAP. Additionally, he will need to optimize his medical management, i.e., hypertension. A neurologist would be helpful in treating the headaches. (The management will depend on the type of headache he has). Lastly, he needs to see a psychiatrist for his depression. All of these syndromes/symptoms are related. It will take time to treat.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Donna4764]

Thanks for your response.  He has been consulting a neurologist for several years.  He has taken Triptans which he can no longer take because of the strokes.  He takes the Propranolol now as we have tried Depakote(sleepiness and weight gain) and Topomax (recurrent kidney stones).  He now uses Midrin and Indomethicin for migraine abatement which is sometimes helpful and at times has to use Stadol nasal spray.  He takes an aspirin a day as he was having recurrent TIAs and the risk on Coumadin was too great.  He tried Plavix(was allergic) and Aggrenox which increased the headache frequency.  We are just at a loss with his current neurologist and feel he is at a loss of what to do.  We are seeing a new neurologist on Thursday with the hopes of finding something that will help.  As far as the sleep apnea, I will hopefully get him convinced to try something new as I realize the CPAP is of great importance.  Just looking for any kind of suggestions of what to try.