What should be done when an elderly person becomes agitated throughout the night after a stroke?

After a stroke, elderly patients who experience agitation throughout the night require treatment targeted at the underlying cause. Common contributing factors include circadian rhythm disruption, the acute phase of stroke, and depression.

1. Circadian Rhythm Disruption

If the nighttime agitation results from excessive daytime napping leading to insomnia at night—a manifestation of circadian rhythm disruption—active adjustment of sleep-wake schedules is generally recommended. When necessary, low-dose sedative medications may be prescribed under medical supervision; commonly used agents include estazolam and alprazolam.

2. Acute Phase of Stroke

If agitation occurs during the acute phase of stroke due to cerebral edema and elevated intracranial pressure, osmotic diuretics may be administered under physician guidance to alleviate symptoms. Frequently used agents include glycerol fructose and mannitol.

3. Depression

If agitation stems from post-stroke psychological distress—including feelings of oppression, anxiety, low mood, and pessimism—leading to clinical depression, management typically involves psychotherapy, self-regulation strategies, and, when indicated, antidepressant medication prescribed by a physician. Commonly prescribed antidepressants include fluoxetine and venlafaxine.