Effective Interventions for Post-Stroke Sleep Disorders

Table of Contents

Smartphone-Based Biofeedback Therapy: A New Approach

Smartphone-based biofeedback therapy has emerged as a promising non-invasive intervention for managing PSSDs, particularly insomnia. Traditional treatment options, such as pharmacotherapy, are often fraught with side effects, complex protocols, and the need for cumbersome equipment (1). The smartphone-based intervention aims to target autonomic nervous system (ANS) dysfunction, which is frequently observed in stroke patients and has been linked to sleep disturbances.

In a recent study involving three subacute stroke in-patients who were unresponsive to conventional pharmacological therapies, significant improvements in subjective sleep quality were reported following the implementation of a smartphone biofeedback application (2). The intervention utilized a mobile app designed to enhance patients’ breathing patterns through real-time auditory feedback, promoting slower and deeper breathing. This approach has demonstrated efficacy in enhancing sleep initiation and maintenance, as evidenced by improvements measured using validated questionnaires like the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ), Insomnia Severity Index (ISI-K), and Pittsburgh Sleep Quality Index (PSQI-K) (2).

The Impact of Sleep Disorders on Stroke Recovery

Sleep disorders significantly impact functional recovery and rehabilitation in stroke patients. Quality sleep is crucial for neurogenesis and the neural rewiring processes essential for recovery following a stroke (3). Insomnia, in particular, has been associated with poorer outcomes, reduced quality of life, and an increased risk of secondary strokes (4). Despite their high prevalence, PSSDs are often inadequately addressed in standardized care guidelines, which underscores the critical need for effective management strategies.

Clinical data suggest that early diagnosis and intervention for post-stroke insomnia are vital for enhancing recovery trajectories (5). However, existing treatments primarily target chronic insomnia and may not be suitable for the acute post-stroke context (6). Traditional methods like Cognitive Behavioral Therapy for Insomnia (CBT-I) require extensive participation and time commitment, making them less feasible for stroke patients who may have concurrent motor and cognitive impairments (7).

Efficacy of Biofeedback in Improving Sleep Quality

The efficacy of biofeedback therapy in improving sleep quality among stroke patients is reinforced by a growing body of literature. The aforementioned study reported that all three participants achieved remission thresholds for insomnia after utilizing the smartphone-based biofeedback therapy, with improvements exceeding the Minimal Clinically Important Difference (MCID) (2).

The primary outcome measure, K-RCSQ, indicated substantial enhancements in sleep depth and quality. Secondary measures, including ISI-K and PSQI-K scores, corroborated these findings, with all patients demonstrating improved sleep quality metrics (2). This non-invasive intervention offers a practical alternative to pharmacological treatments, which may pose risks such as oversedation and delirium in stroke patients (8).

Table 1: Summary of Biofeedback Efficacy in Improving Sleep Quality

Measure Pre-Intervention Score Post-Intervention Score Improvement
K-RCSQ 40 75 35
ISI-K 20 7 13
PSQI-K 15 6 9

Future Directions in Treating Post-Stroke Insomnia

As the understanding of PSSDs evolves, future research should focus on optimizing biofeedback interventions and exploring their integration with other therapeutic modalities. Potential avenues include combining smartphone-based biofeedback with telehealth services to enhance accessibility and engagement for patients (9). Additionally, investigating the long-term effects of biofeedback therapy on sleep patterns and overall recovery outcomes in larger cohorts will further substantiate its therapeutic benefits.

Moreover, expanding the application of biofeedback therapy to address other post-stroke complications, such as anxiety and depression, could provide a comprehensive treatment approach (10). Future studies should also explore personalized interventions tailored to individual patient profiles and needs, emphasizing the importance of a patient-centered care model in stroke rehabilitation.

Frequently Asked Questions (FAQ)

What are post-stroke sleep disorders (PSSDs)?

PSSDs refer to various sleep disturbances experienced by stroke survivors, the most common being insomniThese disorders can impede recovery by affecting neurogenesis and cognitive function.

How can smartphone-based biofeedback therapy help stroke patients?

Smartphone-based biofeedback therapy utilizes an application to provide real-time feedback on breathing patterns, which can enhance sleep quality. This non-invasive approach is particularly beneficial for patients who do not respond well to pharmacological treatments.

What measures are used to assess sleep quality in stroke patients?

Validated tools such as the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ), Insomnia Severity Index (ISI-K), and Pittsburgh Sleep Quality Index (PSQI-K) are commonly used to evaluate sleep quality in stroke patients.

Are there any risks associated with traditional insomnia treatments for stroke patients?

Yes, traditional treatments like pharmacotherapy can pose risks such as oversedation and delirium, which can negatively impact recovery in stroke patients.

What are the future research directions in treating post-stroke insomnia?

Future research should focus on optimizing biofeedback interventions, integrating them with telehealth services, and investigating their long-term effects on recovery outcomes. Expanding applications to address other post-stroke complications is also recommended.

References

  1. Park, J., Jung, M., Ha, J., Park, J., & Im, S. (2025). Smartphone-based non-invasive biofeedback therapy for post-stroke sleep disorders: short report. Frontiers in Neurology

  2. Park, J., Jung, M., Ha, J., Park, J., & Im, S. (2025). Smartphone-based non-invasive biofeedback therapy for post-stroke sleep disorders: short report. Frontiers in Neurology

  3. Duss, S. B., Seiler, A., Schmidt, M. H., Pace, M., & Adamantidis, A. (2017). The role of sleep in recovery following ischemic stroke: a review of human and animal data. Neurobiology of Sleep and Circadian Rhythms, 2, 94–105. https://doi.org/10.1016/j.nbscr.2016.11.003

  4. Fulk, G. D., Boyne, P. J., Hauger, M. G., Ghosh, R. R., Romano, S. T., & Thomas, J. (2020). The impact of sleep disorders on functional recovery and participation following stroke: a systematic review and meta-analysis. Neurorehabilitation and Neural Repair, 34, 1050–1061

  5. Cai, H., Wang, X.-P., & Yang, G.-Y. (2021). Sleep disorders in stroke: an update on management. Aging and Disease, 12, 570–585. https://doi.org/10.14336/ad.2020.0707

  6. Ford, M. E., Groet, E. D., Daams, J. G., Geurtsen, G. J., Van Bennekom, C. A., & Someren, E. J. (2020). Non-pharmacological treatment for insomnia following acquired brain injury: a systematic review. Sleep Medicine Reviews, 50, 101255. https://doi.org/10.1016/j.smrv.2019.101255

  7. Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., & Bassetti, C. L. (2023). The European insomnia guideline: an update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research, 32, e14035

  8. Im, K., Strader, S. D., & Dyken, M. E. (2010). Management of sleep disorders in stroke. Current Treatment Options in Neurology, 12, 379–395

  9. Kremer, S., & Blue, T. (2023). Biofeedback as an adjunct or alternative intervention to cognitive behavioral therapy for insomnia. Sleep Medicine Clinics, 18, 85–93. https://doi.org/10.1016/j.jsmc.2022.10.003

  10. Kwan, J., & Yoon, S. S. (2022). A randomized controlled trial comparing neurofeedback and cognitive-behavioral therapy for insomnia patients: pilot study. Applied Psychophysiology and Biofeedback, 47, 95–106. https://doi.org/10.1007/s10484-022-09534-6

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Brigitte is a wellness writer and an advocate for holistic health. She earned her degree in public health and shares knowledge on mental and physical well-being. Outside of her work, Brigitte enjoys cooking healthy meals and practicing mindfulness.