Sleep is an important but often overlooked factor in stroke risk. Sleep is not a luxury. It is an important pillar of stroke prevention, alongside: • Blood pressure control • Physical activity • Healthy diet • Smoking cessation • Managing conditions such as atrial fibrillation and diabetes Research shows a U-shaped relationship between sleep and stroke risk.In simple terms, both too little and too much sleep are linked to a higher risk of stroke. Large population studies suggest that sleeping less than 6 hours or more than 9 hours regularly is associated with increased cardiovascular and stroke risk, with around 7–8 hours per night being the optimal range for most adults. 📉 Short Sleep (Less than 6 hours) Short sleep is associated with a higher risk of stroke and may contribute through: • Higher blood pressure • Increased inflammation and oxidative stress • Impaired blood vessel function • Increased risk of atrial fibrillation, diabetes, and high cholesterol 📈 Long Sleep (More than 9 hours) Long sleep is also linked to higher stroke risk. It is often a marker of underlying health issues rather than a direct cause, and may be associated with: • Poor sleep quality • Obstructive sleep apnoea (OSA) • Underlying medical conditions • Lower levels of daytime activity ⚠️ Sleep Is Not Just About Time Sleep quality matters just as much as sleep duration. Other sleep problems linked to stroke risk include: - Snoring and sleep apnoea - Insomnia - Excessive daytime sleepiness - Poor sleep quality - Irregular sleep patterns 🌅 Daily Habits to Improve Your Sleep ☀️ Morning - Set Your Body Clock • Get natural daylight within 30–60 minutes of waking • Wake up at the same time every day (even weekends) • Delay your first coffee by 60–90 minutes • Move your body even a 15–20 minute walk helps ☀️ Daytime - Protect Your Sleep • Stop caffeine by early afternoon (around 1–2 pm) • If you nap, keep it short (20–30 minutes) and before 3 pm • Take small breaks to manage stress during the day

8ú modern sense. It's not about: ❌ Calorie counting ❌ Cutting out entire food groups ❌ Drinking expensive green powders ❌ Surviving on lettuce Instead, it's a pattern of eating traditionally seen in countries such as Greece, Spain, and parts of Italy. It typically includes: ✅ Lots of vegetables ✅ Fruit ✅ Beans and legumes ✅ Nuts and seeds ✅ Whole grains ✅ Extra virgin olive oil as the main fat source ✅ Fish and seafood regularly ✅ Moderate dairy (often yoghurt) ✅ Limited ultra-processed foods ✅ Limited sugary drinks and sweets ✅ Less red and processed meat ✅ Social eating One of the most important studies ever performed on diet was the PREDIMED trial. Researchers studied over 7,000 people at high cardiovascular risk and put them on either: 🥄 A Mediterranean diet supplemented with extra virgin olive oil 🥜 A Mediterranean diet supplemented with mixed nuts 📋 A control low-fat diet Crucially, the nuts and Olive oil groups received a supply of the nuts or oil every month so we can be confident they ate more of these than their usual. After around 5 years of follow-up, the Mediterranean diet groups experienced roughly a 30% reduction in the combined risk of heart attack, stroke, or cardiovascular death compared with the control group. Stroke reduction was one of the strongest signals seen in the trial at nearly 40% reduction. And this isn't just one study. A major BMJ systematic review and network meta-analysis (essentially a study pulling together data from all the high quality research on the topic that could find to give very reliable results) examining randomised dietary programmes found that Mediterranean dietary programmes reduce death, heart attacks, and cardiovascular events in people at increased cardiovascular risk. Importantly, they also reduce stroke risk. Why might it work? The Mediterranean diet appears to improve many of the key drivers of stroke and cardiovascular disease: 🩸 Blood pressure 🧈 LDL cholesterol 🔥 Inflammation 🍬 Blood sugar control

💜 As it is Stroke Awareness Month, this week’s challenge is simple: Encourage one person to check their blood pressure. A parent, partner, friend, work colleague, neighbour, or someone from your community. Working in stroke services in the NHS, we hear these conversations far too often: 💬 “I didn’t know I had high blood pressure.” 💬 “I felt fine, so I never checked it.” 💬 “I stopped taking my medication because it didn’t agree with me, and I stopped checking my blood pressure too.” High blood pressure is one of the leading risk factors for stroke, yet it often causes no symptoms. Many people feel completely well while silent damage is happening to the brain, heart, and blood vessels. It is always working against you. Until one day it isn't silent anymore. When your blood pressure is creeping up, your body is sending you a message. It's not random. It's not just "getting older." "I'm asking for help, please don't ignore me". The positive message is that small actions can make a significant difference: ✅ Staying physically active ✅ Improving sleep and stress management ✅ Reducing salt intake ✅ Avoiding smoking and excess alcohol ✅ Regular blood pressure monitoring ✅ Taking medication as prescribed ✅ Speaking to a healthcare professional about side effects rather than stopping treatment Stroke prevention does not always begin in hospital. It begins with awareness, conversation, and simple preventative steps taken early. This week, take a moment to ask someone: 💬 “Have you checked your blood pressure recently?” One small conversation could help prevent a stroke. 💜

Yesterday I had the pleasure of attending the Warrington Moving On Stroke Group for their Make May Purple dinner. And, as always, I came away genuinely motivated. Groups like this do something incredibly powerful. They bring people together after one of the most frightening and life-changing events imaginable. They offer friendship, confidence, humour, shared experience, encouragement, accountability, and hope. They help people feel less alone. I don't see it as a “nice to have”. But as a real part of health, so I looked at the research this morning: Poor social contact and stroke risk A 2024 systematic review and meta-analysis pulled together date from 19 studies, including more than 1.6 million people, and found that poor social relationships were associated with around a 30% higher risk of stroke. The same review also found that poor social relationships were associated with increased post-stroke mortality. Lim, M. H., et al. (2024). Poor social relationships and the risk of stroke and post-stroke mortality: a systematic review and meta-analysis. BMC Public Health, 24, 2287.Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11373457/ There was another earlier major meta-analysis by Valtorta and colleagues, published in Heart in 2016, which found that loneliness and social isolation were associated with a 32% increased risk of stroke. In the same analysis, poor social relationships were also associated with a 29% increased risk of coronary heart disease. Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), 1009–1016. Available at: https://pubmed.ncbi.nlm.nih.gov/27091846/ There are several possible reasons for this. People who are socially connected are often more likely to stay active, eat better, attend appointments, take medication, notice changes in their health, and seek help earlier.

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