Better sleep to boost rehabilitation after brain injury

Rehabilitation is an important part of the patient pathway for recovering from a brain injury. The World Health Organisation describes rehabilitation services as “a bridge between isolation and exclusion – often the first step toward achieving fundamental rights.” Rehabilitation services are a huge area of policy challenge, with the current NHS rehabilitation services stretched and variable across the country. In the current economic climate, expanding services or increasing the number of healthcare staff is difficult, and so policy improvement suggestions must offer practical solutions to the problem.

Insomnia, a sleep disorder characterised by difficulties falling or staying asleep, is reported in 30-60% of people with brain injury. There are many possible reasons for this; for example, the injury to the brain could directly affect the sleep/wake cycle, people may struggle with anxiety or depression which may indirectly influence sleep, or changes to their daily routine could affect sleep rhythms.

Sleep is very important for function and repair of the body. Dr Melanie Fleming, a Researcher in WIN’s Plasticity group, has shown that sleep disruption during rehabilitation is associated with worse outcomes. Mel said “There are multiple reasons why poor sleep may lead to worse rehabilitation outcomes. It may be because it’s harder to engage with therapy after a bad night sleep. We think it could also be because sleep is important for brain processes underlying memory and formation, which are important for making progress between rehabilitation sessions.” 

Dr Mel Fleming, along with Prof Heidi Johansen-Berg and Prof Charlie Stagg, submitted written evidence for the Department of Health and Social Care’s Acquired Brain Injury strategy, requesting that sleep screening should be integrated into the clinical pathway after brain injury. They suggested that digital cognitive behavioural therapies, which are recommended for treatment of insomnia, should be embedded in the acquired brain injury treatment pathways to help patients sleep better and improve rehabilitation outcomes.

“Screening and treating sleep after brain injury is a relatively cheap and simple way that the NHS could improve quality of life and potentially reduce the level of disability in patients after brain injury” says Mel. “We are looking to continue exploring how improvements to sleep can influence rehabilitation outcomes in our research and will work to feed this information into policymakers so that their decisions can be informed by scientific evidence."

To continue this project, Mel was awarded an OPEN (Oxford Policy Engagement Network) seed fund to work collaboratively with policy partners. Partners included the charity Different Strokes, a clinician from Oxford’s Integrated Stroke Delivery Network and a clinician who has sat on the National Institute for Health and Care Excellence Stroke Rehabilitation guidelines committee.

Key stakeholders with influence across healthcare, charities, academia, and policy organisations were brought together, alongside stroke survivors, in a workshop to discuss practical barriers and solutions to screening and treating sleep in the stroke care pathway, and to develop a strategy to influence policy and change in the future. The workshop was very successful and informative resulting in key points of influence being identified. 

Mel said ''Our policy partners were instrumental to achieving the project goals and will be key to any future policy engagement work.  We are very grateful to everyone who attended the workshop for their contributions and to the Oxford Policy Engagement Network for funding this project.’’

Please visit our Sleep after Stroke page for information about ongoing studies and research updates.