Sleep: A Guide for People with Physical Disabilities

How common are sleep problems in adults with physical disabilities?

A good night’s sleep can look different to people with physical and sensory disabilities.

University of Washington’s Rehabilitation Research & Training Center estimates that around 40 percent of adults with physical disabilities suffer from long-term sleep problems. ³

Furthermore, people with the following chronic disabilities are three times more likely to experience sleep disturbances than the general population:

Spinal cord injury

Traumatic brain injury

Multiple sclerosis

Parkinson’s disease

Post-traumatic stress disorder

Data from Oregon’s 2014 Behavioral Risk Factor Surveillance System (BRFSS) highlighted that adults with disabilities in the state tend to get less sleep than adults without disabilities in the region. ⁴

Average Sleep in 24 Hours, 2014 BRFSS Data

Meanwhile, researchers at the McMaster Children’s Hospital in Canada discovered in a survey that caregivers of physically-disabled children are more likely to experience sleep discomfort and safety issues at night, nighttime awakenings, daytime irritability, and interference with daytime activities. ⁵

Why sleep problems are common in people with physical disabilities

Difficulties winding down at night and getting a good night’s sleep can impact a person’s sense of well-being. It can lead to a host of problems like chronic pain, fatigue, irritability, anxiety, and depression. Sleep deprivation can also strain personal relationships, lead to poor work performance, and increase the risk of accidents.

For individuals with disabilities, the following are the most common reasons why they have trouble getting good quality sleep:

1 Physical pain

Physical pain is the most common reason why getting enough sleep can be difficult for people with disabilities.

Once they do fall asleep, waking up from the pain and discomfort is another challenge. In fact, frequent nighttime awakening is the top complaint of people with chronic pain. ⁶

Meanwhile, children and adults with physical disabilities may have difficulties changing positions at night or cannot do it themselves, resulting in skin ulcers. For instance, cerebral palsy patients in a wheelchair are more likely to develop skin ulcers or similar conditions aggravated by their inability to change positions at night. The constant pressure of their skin against the bed’s surface is often the culprit.

Finally, medications taken to relieve pain in patients with physical disabilities may also affect sleep quality. Opioid use to manage chronic pain is a good example. ⁷

2 Sleep apnea

Sleep apnea is characterized by abnormal breathing while asleep or multiple extended pauses of breathing while sleeping. Temporary lapses of breathing during sleep can negatively impact the body’s oxygen supply.

central apnea or when there’s a problem with the brain’s ability in controlling the muscles that are involved in respiration

low muscle tone in the mouth and upper airways

narrowed air passages in the throat

a relatively large tongue

enlarged adenoids and tonsils

Adults with the condition have 50 to 100 percent incidence of obstructive sleep apnea. Meanwhile, almost 60 percent of children with Down Syndrome have abnormal sleep studies when they reach 3.5 to 4 years. ⁸

In addition, sleep apnea has been observed in individuals with paraplegia (inability to move the lower limbs) at the Swiss Paraplegic Center (SPZ). The researchers further found out that these patients are at risk for high blood pressure and heart attack due to their nighttime breathing problems. Some of these patients felt that they slept well during the night yet complained of increased tiredness and “zoning out” during the day.

3 Sleep associations

Sleep associations are habits or behavior that lets you fall asleep — from using a specific pillow or lying on a particular side.

In individuals with physical disabilities, their sleep associations can affect their ability to get a good night’s sleep.

For example, a person with a disability may be living in a group home or a cramped, tiny apartment. Their bedtime routines could involve listening to someone snore in a group home, lying in bed watching TV, or browsing social media on their tablet.

The problem with these sleep associations is the individual’s brain will associate bedtime with increased mental activity. While a person with a disability is physically tired, they might end up having trouble sleeping mentally. The body wants to sleep, but the brain thinks otherwise.

4 Light exposure

Light exposure before and during sleep can make it more difficult to achieve deep sleep.

Deep sleep is when your body and brain waves slow down. Also known as slow-wave sleep, this stage of sleep is critical for hormonal regulation, physical renewal, and memory consolidation.

Light exposure is also implicated in frequent nocturnal awakenings, resulting in poor quality sleep and not feeling refreshed the next day.

People with disabilities often sleep with the lights on because of the following:

5 Urinary incontinence and bedwetting

Urinary incontinence and bedwetting is common in patients with spinal cord injuries. According to the National Association for Incontinence, a spinal cord injury may interrupt communication between the spinal cord nerves responsible for bowel and bladder function, resulting in bedwetting. ¹¹

Furthermore, individuals with spinal cord injury have been shown to produce less melatonin. ¹² This hormone regulates the sleep-wake cycle.

6 Psychological and emotional factors

Anxiety, depression, and other mental health concerns are often overlooked as possible reasons of sleep troubles in people with physical disabilities.

Studies and longitudinal surveys suggest that depression is 2 to 10 times more common in people with disabilities and chronic conditions. ¹³

Meanwhile, a cross-sectional study of 196 amputees in Malaysia published in 2019 revealed that almost half of the amputees have depressive symptoms, while 24.5 percent of the patients were diagnosed with major depression. Low perceived social support and the absence of other medical conditions were predictors of depressive symptoms. ¹⁴

For a physically-challenged individual experiencing depression and anxiety, one night of inadequate sleep means lying awake in bed the next night, and the vicious cycle continues.

Restful sleep tips for caregivers

Sleep-deprived caregivers are typical in people with physical disabilities. If you or someone you know is taking care of a physically-challenged individual, the following tips can help you get restorative sleep: