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By Blair Ames and Dominique Hoffman
Recovery after stroke is already hard enough.
However, trying to recover from a stroke while fighting your circadian rhythm just makes the challenge even more difficult.
Your body’s circadian rhythm — or its 24-hour internal clock — is a powerful mechanism that influences every aspect of health, most notably when you’re most alert throughout the day and when you’re ready to fall asleep.
For stroke survivors, a disrupted circadian rhythm can hurt neuroplasticity, the brain’s ability to form new neural connections to recover the skills that were lost due to stroke.
When recovering from a stroke, learning how to manage your day as it best aligns with your circadian clock can be a powerful tool to improve your well-being and reduce some of the fatigue that comes with recovery.
Why Your Circadian Rhythm is Important After Stroke
Nearly every cell in the body contains a 24-hour molecular clock that is programmed to perform essential functions throughout the day.
The “master clock” is an area of the brain known as the suprachiasmatic nucleus — you can think of it as the conductor leading an orchestra.
Unfortunately, a disrupted circadian rhythm can lead to negative short-term effects like fatigue, but it’s also been linked to weakening your immune system and aggravating or worsening pre-existing health issues.
In his book, The Circadian Code, Satchin Panda describes a disrupted circadian rhythm as “the mother of all maladies” since it’s present in many chronic diseases.
“In general, having a strong circadian rhythm helps you recover faster during a hospital stay because it improves tissue repair, reduces inflammation, helps regenerate damaged tissue, and minimizes stress on your body,” Panda writes.
Addressing Sleep Troubles After Stroke
Sleep disturbances are a common theme in neurological issues, including stroke.
According to a report from the American Heart Association, sleep and circadian rhythm disruption are frequently reported after stroke and post-stroke apathy – a lack of interest or enthusiasm – is more common in stroke survivors who experience sleep issues.
Maintaining a strong circadian rhythm can help improve some sleep issues caused by stroke and thereby support overall recovery efforts.
Additionally, our circadian rhythm is important in addressing health issues beyond sleep troubles. There’s evidence that these 24-hour molecular clocks are also located in muscle tissue and tendons, which can influence how quickly we recover from athletic injuries.
Being Mindful of Your Circadian Rhythm After Stroke
Dominique Hoffman is an occupational therapist who specializes in neurorehabilitation.
I recently attended a stroke survivor support group where Dominique was the guest speaker and toward the end of her presentation, she mentioned how she reminds stroke survivors of the importance of their circadian rhythm in recovery.
While working with patients, she’ll help them be more aware of the time of day by opening the blinds in their room or helping them to sit up in a chair rather than lie down in the afternoon.
She immediately grabbed my attention with these comments because not fighting my circadian rhythm was an important lesson I learned after stroke.
Instead, simply understanding your body’s internal energy rhythms and working with that rhythm rather than against it can help make life after stroke a little easier.
Unfortunately, this isn’t a piece of advice that you commonly see in stroke survivor resources.
Nearly four years after my stroke, Dominique might have been the first person I’ve heard who directly mentioned how leveraging your circadian rhythm can support recovery after stroke.
A Therapist’s Perspective on Healthy Circadian Rhythms After Stroke
After Dominique’s presentation, I reached out to ask her more about why a healthy circadian rhythm is important for stroke survivors. Here’s how she responded:
“Supporting a healthy circadian rhythm after a stroke can substantially enhance recovery, mood, and overall well-being, ultimately promoting greater functional independence.
Stroke survivors, particularly those undergoing prolonged recovery in the hospital or ICU, often face challenges such as limited natural light, frequent interruptions from staff and heightened stress – all of which make it more difficult to maintain a healthy circadian rhythm.”
Dominique pointed out how a strong circadian rhythm following a stroke is vital for several reasons, including its role in supporting our sleep-wake cycle.
“Adequate sleep is essential for brain healing, neuroplasticity, and hormonal balance,” she said. “Disrupted sleep patterns can impair these processes, potentially slowing recovery or increasing complications.”
If stroke survivors experience persistent sleep issues, Dominique strongly suggests they schedule an appointment to speak with their doctor. Medical evaluation or treatment options may help to restore restful sleep and support recovery.
Supporting a healthy circadian rhythm after a stroke can substantially enhance recovery, mood, and overall well-being, ultimately promoting greater functional independence.
Dominique hoffman
Five Habits to Support Your Circadian Rhythm in Stroke Recovery
Supporting your body’s internal clock through simple lifestyle changes can help offset some of the fatigue that comes with stroke.
It can also provide some consistency for when you’ll be most alert throughout the day – both mentally and physically.
Here are five simple habits that can help support your circadian rhythm and potentially improve overall well-being after stroke:
1) View Sunlight Each Morning
Spending time outside within an hour of waking up to view morning sunlight is a powerful tool that sets your circadian clock for the day.
Additionally, watching the sunset can help support your circadian rhythm by letting your brain know it’s time to wind down for sleep.
Dominique also suggests opening blinds or window shades during the day to allow natural light in.
2) Eat at Similar Times
In the Circadian Code, Satchin Panda describes eating around the same time every day as one of the most powerful ways to maintain a strong circadian rhythm.
He writes the following: “Just like the first sight of morning light resets the brain clock and tells it that it’s morning, the first bite or first sip of coffee of the day tells the clocks in our gut, liver, heart, and kidneys to begin the day. If we change our routine from day to day, our clocks get confused.”
3) Set a Consistent Sleep Schedule
Waking up hours later one day and then hours earlier the next disrupts your circadian rhythm and this inconsistency can hurt your energy levels after stroke.
Simply setting my alarm so I get out of bed around the same time every day – even on weekends – has been a huge help in addressing some of the sleep issues I experienced after stroke.
Additionally, Dominique suggests stroke survivors limit daytime napping, reduce screen time before bed, and avoid stimulants like caffeine in the evening to make falling asleep a little easier.
4) Temperature
Temperature is another way to support your circadian rhythm.
If you’re into cold showers, a cold shower in the morning can help kickstart your day, while a hot shower in the evening can help you wind down before bed.
5) Exercise
Regular exercise can also support your circadian rhythm, and for stroke survivors struggling with fatigue, afternoons might be a good option for therapy sessions.
Most track and field world records have been set in the afternoon hours, a possible correlation with when our energy levels peak due to our circadian rhythm.
Understanding Your Circadian Rhythm After Stroke
When I was having trouble with sleep after stroke, simply setting an alarm so I’d get out of bed around the same time every morning — regardless of how I slept the night prior or whether it was the weekend — made a world of difference for me.
I started to experience far fewer frustrating nights when I just couldn’t fall asleep.
But that’s only one example of how minding your circadian rhythm can impact recovery after stroke.
Spending more time outdoors and eating around the same time each day can also support your body’s natural energy rhythms to make life after stroke a little easier.
You don’t have to be perfect on these habits every day to support your circadian rhythm, but some level of consistency can prove to be a significant difference-maker in recovery after stroke.
These small shifts in timing can lead to bigger changes in how you feel post-stroke.
Stroke Recovery Rehab 