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Stroke survivors' experiences of using an online sleep improvement programme

Why did we do this research?

After stroke, people often have problems with sleep. As bad sleep has been related to negative effects on mood, daily activities, and quality of life, it is important to look at ways to improve sleep. 

The current recommended treatment for sleep difficulty is Cognitive Behavioural Therapy for Insomnia, which can be done online using a sleep improvement programme called Sleepio. Although Sleepio has been shown to be helpful for many people, it has not yet been specifically tested in people with stroke.


What did we aim to find out?

In this study, the aim was to see what people with stroke thought about using the online sleep improvement programme, Sleepio. This included how useable it is, and any problems there are with it which could make it difficult for other stroke survivors to use.

By understanding the experiences of people with stroke using Sleepio, we can design future studies using the programme. 


Who did we include in the study?

11 stroke survivors who were interested in improving their sleep took part. 


What was involved in the study?

Participants used the Sleepio programme which consisted of 6 online sessions teaching about ways to improve sleep and a daily online sleep diary.

When participants had finished the programme, they were interviewed by the researcher about their experiences of using it. Some people had assistance from a partner and they were also interviewed about how they found the programme to use.


What did we find out?

From the interviews, there were 4 main themes identified:

1) Positive and negative experiences impacted engagement with the programme

  • Participants felt good and more engaged with the programme when they felt it was working
  • Participants gave suggestions about what could be improved. This was often wanting to be able to enter more information about their situation, and wanting more advice about other things affecting their sleep, like pain.

2) Motivation to follow programme was proportional to perceived severity of sleep problem

  • Some parts of the programme were noted to be difficult, and participants were more motivated to finish these when they felt they had a bigger need for it to work.

3) Impractical advice for people with stroke

  • Participants reported that some of the advice in the programme could be unsuitable for stroke specific issues. For example, advice about getting out of bed when they were struggling to sleep is harder for those with limited movement abilities after stroke.

4) Difficulty operating the programme

  • 3 participants had help from a partner when using the programme as cognitive difficulties after stroke meant they couldn’t do it alone.
  • 6 out of 11 participants found it hard to find how to start the second session on the system. A common reason for this was noted to be because of a lack of computer experience.
  • Fortunately, there were no clear physical issues with using the programme for participants with one-sided arm weakness.


What does this mean?

Overall, many of the participants found Sleepio educationally enjoyable and useful in improving their sleep, but there were some issues reported that could make it harder for people with stroke to complete the programme.

The feedback from this study can be used to improve the programme for people with stroke and, with some additional information, it is believed that Sleepio could be feasibly used by many stroke survivors.

We are now investigating how good the Sleepio programme is at improving sleep in people with stroke, which could lead to it being used as part of clinical care if it is found to work well.


Thank you to everyone who took part or helped us with this study.

Thank you to the Wellcome Trust for funding this research.

Our team