Sleeping Problems
Sleep problems are common after a stroke. The good news is there are ways to improve your loved one's sleep.
What Do You Need to Know?
Both old and young adults need about 7-9 hours of sleep. Poor sleep is not a normal part of getting older. But, after a stroke, your loved one may have more sleep problems. Sleep is important for good health. Everyone should expect to get a good night’s sleep.
What Might Be Causing Your Loved One's Sleep Problems?
More than half of stroke survivors have one of the following sleep problems:
Sleep Apnea
This is a serious condition. Sleep apnea increases the risk of having a second stroke. It is caused by abnormal breathing patterns. Loud snoring, choking and gasping sounds during sleep may mean that your loved one has sleep apnea. Tell your healthcare team about these symptoms. There are good treatments.
Change in Sleep-Wake Cycles
After a stroke, some survivors do not get sleepy at night. It may be difficult to wake the stroke survivor in the morning. This happens when the sleep-wake schedule is no longer affected by sunlight and the darkness of night. Talk with your healthcare team. Bright light therapy may help.
What Are Some Other Common Sleep Problems?
Here is a list of other reasons your loved one may have trouble sleeping.
- Frequently waking to use the bathroom – often due to prostate or bladder problems
- Pain or discomfort
- Stress, anxiety and depression
- Conditions such as asthma, arthritis or heart failure
- Medicines and certain foods or drinks
Why Is It Important to Get Help?
Poor sleep can slow your loved one’s recovery. Sleep problems can lead to depression, memory problems and night-time falls.
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Red Flag: Signs of a Serious Problem 
Contact your healthcare team right away if your loved one has the following symptoms:
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Your healthcare team can help resolve your loved one's sleep problems. Discuss the following sleep complaints with your healthcare team:
- Waking up many times a night
- Trouble falling asleep and staying asleep
- Feeling tired during the day. Taking frequent naps.
- Discomfort and tingling feelings in the legs at night. These are symptoms of restless leg syndrome.
- Jerking or kicking the legs during sleep. These are symptoms of periodic limb movement disorder.
Be Careful What Your Loved One Eats and Drinks
Certain foods and drinks can lead to sleep problems.
- Provide food and drinks that are caffeine-free. Avoid coffee, tea, certain soft drinks and chocolate after the late afternoon.
- Plan to eat the dinner meal three hours before your loved one goes to bed.
- Make sure your loved one is full or not hungry before bedtime. But, avoid heavy meals that can cause poor sleep.
- Talk about limiting drinks two hours before bedtime. Drinking fluids at night can lead to frequent trips to the bathroom.
- Discuss avoiding alcoholic drinks at night. Alcohol helps people fall asleep, but their sleep is often restless.
Watch the Medicines Your Loved One Takes
Check to see if medicines could affect your loved one’s sleep. Cold and allergy medicines that you buy over-the-counter (OTC) often cause sleep problems. Check with your healthcare team before taking OTC medicines.
Try to improve sleep before taking sleeping pills. Never give your loved one sleeping pills you buy over-the-counter. These pills may cause confusion and memory problems.
Your healthcare team may prescribe your loved one sleeping pills. These pills should only be taken for two or three nights in a row.
How Can You Help Your Loved One Relax at Night-time?
- Give your loved one a massage or backrub before going to bed.
- Suggest drinking a glass of warm milk at bedtime.
- Suggest ways to relax. Take slow, deep breaths in bed. Count the breaths. Block other thoughts that come to mind. Think of peaceful scenes, such as the beach.
What Are Some Bedtime Tips to Teach Your Loved One?
- Follow a regular sleep schedule. Go to bed and wake up the same time every day.
- Have a bedtime routine. For example, take a warm bath before bedtime. Listen to calm music or read a book.
- Use the bedroom only for sleep or sex. Do not eat food or watch TV in bed.
- Keep the bedroom quiet, dark and at a comfortable temperature.
- Get out of bed if not asleep in 15 to 30 minutes. Read or listen to soothing music. Go back to bed only when sleepy.
Helpful Tips
- Get plenty of exercise every day. Stop exercising at least three hours before bedtime.
- Try to get some natural light each afternoon.
- Nap for only 15 to 30 minutes or avoid napping. For some people, napping may cause sleep problems.
- Go to a sleep specialist or find a sleep clinic if problems continue.
Remember
- Talk with your healthcare team about your loved one’s sleep problems. Be alert if your loved one has loud snoring, gasping breaths and jerking, painful legs.
- Watch the medicines your loved one takes. Never use over-the-counter sleeping pills. Take prescribed sleeping medicines for no more than two to three days in a row.
- Help your loved one follow a regular sleep schedule. Go to bed and wake up the same time every day.
More Resources 
Additional credible resources on this topic can be found here. Website pages may change or update, therefore if a link does not work, you may also try to type the information into your internet search bar. This Resource List will be updated frequently.
References: NIH Senior Health. (2008). Sleep and Aging. Retrieved November 15, 2008, from http://nihseniorhealth.gov/sleepandaging/toc.html*; HelpGuide.Org. (2008). Sleeping Well as We Age. Retrieved November 15, 2008, from: http://helpguide.org/life/sleep_aging.htm*; Alessi, C. (2004). “Sleep problems.” Pp. 127-134 in Eldercare at Home. (2nd ed.), edited by P.S. Houts. New York, NY: The AGS Foundation for Health in Aging.
These materials were created for the project:
Web-Based Informational Materials for Caregivers of Veterans Post-Stroke
Project Number SDP 06-327 funded by VA HSR&D Quality Enhancement Research Initiative (QUERI)
