Insomnia after stroke: understanding its impact, assessment, and treatment.

McLaren McTague, Declan Simon (2025) Insomnia after stroke: understanding its impact, assessment, and treatment. PhD thesis, University of Glasgow.

Abstract

Background: Insomnia – broadly characterised by difficulties with initiating or maintaining sleep – is common after stroke, and is associated with poorer outcomes and greater risk of stroke recurrence. Yet, it has historically received less attention than other post-stroke sequelae. Consequently, current understandings of insomnia’s aetiology, impact, assessment, and treatment after stroke are limited. Seeking to address this, the present studies set out to answer four key questions:

1. What is the experience and impact of insomnia after stroke?
2. What are stroke survivors’ experiences and preferences relating to treatment?
3. How can we accurately identify which individuals are living with insomnia after stroke?
4. How can we best go about treating insomnia after stroke?

Methods: This thesis adopts a mixed-methods approach, and comprises three studies and one study protocol. Study 1 (n = 10) employed semi-structured interviews and interpretive phenomenological analysis to explore stroke survivors’ experiences of insomnia, and their preferences surrounding treatment. Building on the findings of this, Study 2 (n = 180) used receiver operating characteristic (ROC) analysis to assess the discriminant validity of a self-report measure of insomnia after stroke. Study 3 systematically reviewed 15 studies examining the efficacy of stimulus control and sleep restriction, independently and combined. Due to an absence of relevant studies within the context of stroke, older adults were selected as an appropriate adjacent population. Finally, Chapter 5 integrates the findings of all previous chapters, and presents a protocol for a single-case experimental design study evaluating the feasibility, acceptability, and efficacy of a behavioural intervention for insomnia, adapted to meet the needs of stroke survivors.

Results: Findings from Chapter 2 suggest that post-stroke insomnia arises from a complex network of psychological, physical, cognitive, and social factors, each deleteriously influencing one another. Participants described shortcomings in current clinical understanding and management of sleep after stroke, and expressed a strong preference for non-pharmacological approaches to treatment; largely due to scepticism over the safety and efficacy of hypnotic medications. Results of Chapter 3 demonstrate that the insomnia measure effectively distinguished between stroke survivors with and without insomnia, though the optimal diagnostic cut-off (≤ 13) was lower than the conventional cut-off (≤ 16). Finally, stimulus control and sleep restriction significantly alleviated insomnia and depression symptoms, particularly when combined, with benefits observed in as few as two sessions. Collectively, these findings establish a robust point of departure for future research seeking to investigate sleep after stroke.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Additional Information: Supported by funding from the Scottish Graduate School of Social Science.
• Subjects: B Philosophy. Psychology. Religion > BF Psychology; R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Supervisor's Name: Harvey, Professor Monika, Baylan, Dr. Satu, Gardani, Dr. Maria and Evans, Professor Jonathan
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85359
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 22 Jul 2025 14:28
• Last Modified: 22 Jul 2025 14:54
• Thesis DOI: 10.5525/gla.thesis.85359
• URI: https://theses.gla.ac.uk/id/eprint/85359

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