Loud snoring, prolonged sitting and even certain yoga poses could carry hidden risks. Here’s what you need to know.
When busy mother-of-three Claire Arnopp retreated to the bathroom for a few minutes to pre-order her daughter’s school dinners, it never crossed her mind that she would emerge incapable of moving one side of her body and barely able to talk.
“I felt a strange ripple travel up my back, almost like a shiver,” recalls Arnopp, from Welwyn Garden City, Hertfordshire. She was 39 at the time. “The next thing I knew, the phone I had been holding was on the floor by my feet. I remember feeling confused because I didn’t see or hear it fall, but when I bent down to pick it up, I couldn’t make a fist. My arm was limp and the left-hand side of my face felt numb. Then I realised my speech was slurred, too. The overwhelming feeling was terror.”
The now 41-year-old reveals she recognised her symptoms as signs of a stroke, but was still shocked when doctors confirmed she’d had a cerebrovascular accident (the medical term for a stroke).
“I thought a stroke was something that happened later in life, not something that could affect a woman in her 30s,” she says.
The rise in younger people having strokes
Arnopp is far from alone. According to the National Institutes of Health (NIH), there has been a 44% rise in strokes among young adults of working age (18-65 years) over the past decade.
“More research is needed,” asserts Maeva May, director of policy and research for the Stroke Association, who has spent the past 14 years working across policy and research in the field.
“Major risk factors, including high blood pressure, diabetes and obesity, are rising, but this isn’t specific to one age group. It’s important not to assume that someone who has a stroke in their 40s has been living an unhealthy lifestyle.”
Professor of stroke medicine at the University of Lancashire and medical director at the Stroke Association, Deb Lowe, agrees. “Stroke is more common the older we get, but one in four strokes now happen in the under-65s,” she says. “It’s difficult to pinpoint a cause – it can be a surprising combination of factors.”
While Arnopp had displayed some of the most recognisable stroke symptoms – facial drooping, arm weakness and slurred speech – she has since learnt that she experienced another, more surprising warning signal far earlier. “Leading up to my stroke, I had a migraine with an aura that lasted for three days,” she says. “I didn’t realise it could be connected.”
Here, we reveal some of the lesser-known factors that can contribute to strokes in midlife.
Experiencing migraines with aura
According to research published by Neurology Today, midlifers who have a history of migraine with aura (defined as visual changes, such as flashing lights, sensations or difficulty speaking) are almost twice as likely to have an ischaemic stroke (when a blood clot cuts off oxygen to the brain) than those who do not suffer from migraines. Those who have migraines without aura do not share the same risk.
While the reason behind this link is unclear, risk seems to increase further in “women who smoke, have other risk factors for stroke, or take oestrogen-containing contraception”, says May.
Snoring loudly
Excessively loud snoring can be a sign of obstructive sleep apnoea – a disorder that the European Stroke Organisation has linked to an increased risk of having a stroke.
“Obstructive sleep apnoea repeatedly interrupts breathing during sleep, causing oxygen levels to fall and putting the body under stress. Over time, those repeated episodes can contribute to high blood pressure, inflammation and changes to the blood vessels and heart, which are all relevant,” says May.
“It is strongly associated with excess weight, so midlife can be a time when it becomes more apparent. It’s also important to recognise that risk increases in women around and after the menopause. Because people are asleep when it happens, many don’t realise they have it. Loud snoring, witnessed pauses in breathing and persistent daytime tiredness are all reasons to speak to your GP.”
Getting whiplash
“A neck injury – [whether from] minor neck trauma, heavy lifting or sudden neck movements – can cause a carotid or vertebral artery dissection, which is a tear in the inner lining of the blood vessel,” says Professor Lowe. This tear can occur while playing high-intensity sports, weightlifting, riding high-impact roller coasters or even overextending your neck in extreme yoga poses, and has been linked to strokes in younger adults, states the NIH.
“This is particularly [relevant] when someone who is not accustomed to intense activity suddenly undertakes vigorous exercise,” adds Dr Suzanne Wylie, a GP at IQ Doctor.
Living in a city
According to the Stroke Association, air pollution is now estimated to account for 14 per cent of all stroke deaths and roughly 11,000 heart and stroke deaths in the UK each year. The link? “Both short- and long-term exposure to air pollution can cause fine particles to travel deep into the lungs and even enter the bloodstream, where they can contribute to inflammation and damage to the cardiovascular system,” explains May. “Air pollution is also associated with raised blood pressure – the biggest modifiable risk factor for stroke.”
However, she is keen to stress that “this isn’t about individuals eliminating their own exposure”. Instead, she argues that “air pollution is a population health issue – reducing it requires action at a societal level”.
Being desk-bound
Studies show that sitting for long periods of time – typically 13 hours a day or more – can increase your risk of having a stroke by 44%. What’s more, researchers found that sitting for more than 17 minutes at a time increases that risk compared with those who sit for short periods (defined as eight minutes or less). So, what does all this mean for office workers shackled to their desks?
“Prolonged inactivity affects the way our bodies regulate things such as blood sugar, blood pressure and fats in the blood – all of which matter for our long-term cardiovascular health,” says May.
“For many people, midlife coincides with years spent in desk-based jobs, so it’s worth thinking about movement as something you build into the working day rather than something that only happens at the gym. If you’re desk-bound, regularly getting up, taking the stairs or breaking up long stretches of sitting with some light activity all count. Across the week, adults should aim to do around 150 minutes of moderate physical activity.”
How to reduce your risk
Both experts are keen to point out that most strokes are the result of a combination of medical and lifestyle factors, not one particularly disastrous yoga class. However, they also advise that 90% of strokes are preventable – and making lifestyle changes may help to mitigate your risk in midlife.
“Getting regular exercise, not smoking or vaping, not drinking more than the recommended amount of alcohol, and following a Mediterranean diet can all help to reduce the risk,” says Professor Lowe.
“If you have high blood pressure, high cholesterol, diabetes or atrial fibrillation, effective treatment of those conditions is stroke prevention,” adds May. “But not every stroke is preventable: they can still happen to people who may appear to have done everything ‘right’. Only more research will help us to fully understand why.”