Sleep Participation After a Neurological Injury

After a neurological injury, such as a stroke or TBI, sleep changes are common. Approximately 40% of individuals with chronic stroke and 70% of individuals with acute stroke have sleep-wake disorders, including insomnia, excessive daytime sleepiness, hypersomnia, fatigue, and sleep-disordered breathing, such as obstructive sleep apnea (Frange et al., 2023). Sleep disturbances such as insomnia,  fatigue, and sleepiness affect approximately 30-70% of individuals after a traumatic brain injury (Viola-Saltzman & Musleh, 2016).  

Issues with sleep can affect your health, quality of life and rehabilitation outcomes and should be addressed as early as possible. Balancing activity and rest, and prioritizing sleep are crucial for neurological recovery. 

Sleep disturbances may be due to a variety of factors and it is important to collaborate with a variety of providers such as neurologists, sleep specialists, mental health therapists, and your therapy team. It is especially important to rule out underlying sleep disorders, such as sleep apnea or restless leg syndrome. Sleep changes may also be due to changes in your bladder and bowel function and may benefit from a referral to a urologist, gastroenterologist and/or pelvic-floor therapist. Pain, anxiety and depression may also factor into your sleep quality.

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Importance of Sleep for Brain Recovery 

After a neurological injury, you may experience insomnia (difficulty falling or staying asleep), sleep apnea (interrupted breathing during sleep, often associated with snoring and gasping for breath), light sleep, frequent waking, and persistent daytime fatigue. As mentioned above, additional challenges that can impact sleep include pain, muscle tightness or spasms, stress or anxiety, nighttime bathroom trips, or medication side effects.

Sleep is crucial for rewiring the brain to support consolidation of new memories and skills, repair of damaged tissues, reducing inflammation, and emotional regulation and stress management (The Stroke Foundation, 2025)

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