Sleep After Stroke: A Night-Time Plan That Supports Rehabilitation

Describe the sleep pattern before choosing a solution

Tell the team whether the problem is falling asleep, waking repeatedly, waking too early or sleeping at unexpected times. Note when it began, how it affects therapy and what the person’s usual sleep was like before the stroke. Difficulty sleeping should not be dismissed as an inevitable part of recovery.

Keep a short diary of bedtime, waking, naps, pain, toilet visits and daytime alertness. This is information for assessment, not a test the patient must pass. Include the caregiver’s observations if communication or memory makes a diary difficult.

Fatigue means a sense of exhaustion or reduced energy; sleepiness means a tendency to fall asleep. More time in bed does not necessarily resolve fatigue. The rehabilitation team should consider both rather than assume they have one cause. [1, 2]

Ask about treatable contributors and sleep apnoea

Pain, uncomfortable positioning, urinary symptoms, anxiety and depression can disturb nights. Ask the clinician to review symptoms and medicines, including the timing of prescribed doses. Do not stop a stroke-prevention medicine or add a sleeping tablet without advice. [1, 2]

Loud snoring, gasping or witnessed pauses in breathing can suggest sleep apnoea, particularly when accompanied by daytime sleepiness. A clinician decides whether sleep testing or specialist referral is needed. Not everyone who snores has sleep apnoea, and a family observation cannot establish the diagnosis. [3]

Sleeping tablets are not a universal solution. Ask about effects on alertness, falls and other medicines, and whether a non-drug approach or treatment of the underlying problem is appropriate.

Build a night-time routine around real assistance needs

Agree a regular waking routine, daytime light exposure and activity within the assessed rehabilitation plan. Discuss naps and evening caffeine if these seem to affect sleep. An exhausted patient should not be pushed through an unsuitable schedule merely to stay awake.

Before bedtime, check the agreed positioning, access to the call bell, glasses or communication aid, and the planned level of help for getting to the toilet. A weak or unsteady person should not attempt an unassisted night transfer because the room looks familiar.

• Ask the team about safe lighting and a clear route to the bathroom.
• Agree who helps at night and which equipment has been assessed.
• Record recurrent pain or toileting difficulties for review rather than repeatedly improvising.

Coordinate sleep, rest and therapy instead of cancelling automatically

If poor sleep is repeatedly affecting participation, tell the rehabilitation team. Sessions may need different timing, rest breaks or a review of demands. The goal is meaningful participation, not a fixed daily session count regardless of alertness. [1]

Before travelling for inpatient rehabilitation, describe night-time care needs as well as walking ability. Ask who assists after hours and how symptoms are reviewed. After discharge, share the sleep plan with the local team and arrange follow-up for persistent problems.