Due to Brexit- and Covid related issues we currently cannot ship internationally. For US orders visit Mysnoozle.com.

Sleep: A Guide for People with Physical Disabilities

Sleep is a superpower.

Getting enough sleep gives you more energy, improves mood, and boosts your immune system. In a nutshell, it makes you healthier and puts you in a better headspace.

However, people with physical disabilities tend to suffer from sleep problems and disturbances.

For the physically disabled, sleep deprivation can also evolve into narcolepsy, daytime sleepiness, and sleep apnea.

This guide will take a closer look at how people with different physical and sensory disabilities suffer from sleep deprivation and its impact on their overall well-being.

The second half of this guide lists down recommendations and assistive devices to improve sleep quality and quantity for physically-challenged people.

This piece is also written for caregivers or family members taking care of people with long-term, short-term, or temporary physical disabilities.

Key Facts


The World Health Organization (WHO) estimates that 1 billion people worldwide, or 15 percent of the world’s population, have a particular form of disability.

Due to aging populations and the rise of chronic health conditions, the number of people living with physical disabilities increases each year.


Individuals in countries with life expectancies of more than 70 years tend to spend an average of 8 years living with some form of disability, which accounts for 11.5 percent of their life span.

Forty percent of adults with physical disabilities suffer from long-term sleep problems.


Caregivers of people with physical disabilities also experience difficulties in sleeping and interference with daytime activities.

The most common reasons for sleep disorders in people with physical disabilities include physical pain, sleep apnea, lack of sleep associations, light exposure, urinary incontinence, and psychological factors like anxiety and depression.


Changes in behavior, habits, and sleep environment can help people with physical disabilities sleep better. Sleeping devices and accessories such as slide sheets, chair beds, and neck pillows can also significantly improve sleep quality in physically-challenged individuals.

What is a physical disability?

A physical disability is a condition where a person’s motor functions and physical abilities are affected. It can be long-term, short-term or temporary. Examples of a physical disability include:

  • Amputation
  • Cerebral palsy
  • Muscular dystrophy
  • Musculoskeletal injuries such as back injuries
  • Arthritis
  • Polio
  • Spinal cord injury
  • Spina bifida

Some disabilities may come and go while others experience gradual deterioration. Someone can be born with physical challenges or acquire it later in life through injury or an illness.

The World Health Organization (WHO) estimates that 1 billion people worldwide, or 15 percent of the world’s population, live with a certain form of disability. In addition, around 190 million people who are 15 years old and above are physically challenged1. Due to aging populations and the rise of chronic health conditions, the number of people living with physical disabilities is increasing each year.

Finally, individuals in countries with life expectancies of more than 70 years tend to spend an average of 8 years living with some form of disability or 11.5 percent of their life span.2

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

44.8 %

of adults with disabilities in Oregon get less than 6 hours of sleep compared to 27.1 percent of adults without disability in the state.

47.8 %

percent of adults with disabilities in Oregon get 7 to 9 hours of sleep compared to 70.7 percent of adults without disability in the state.

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

Reasons of sleep deprivation in disabled person

The most common reasons for sleep disorders in people with physical disabilities include physical pain, sleep apnea, lack of sleep associations, light exposure, urinary incontinence,and psychological factors like anxiety and depression.

Changes in behavior, habits, and sleep environment can help people with physical disabilities sleep better. Sleeping devices and accessories such as slide sheets, chair beds, and neck pillows can also significantly improve sleep quality in physically-challenged individuals.

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:

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

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.

There are different types of sleep apnea, and people with disabilities often suffer from obstructive sleep apnea. This happens when the airway at the back of the throat is physically blocked.

Obstructive sleep apnea is common in children and adults with Down Syndrome due to the following physical characteristics that are typical of this disability:

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.

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.

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:

It has developed as a need due to the disability.
For example, someone with arthritis may find it more challenging to get to the bathroom in the middle of the night. They'd rather have the lights on instead of fumbling for the light switch for every trip to the

It's a childhood habit that they've carried over to adulthood.

Caregivers may also leave the lights on to make it easier for them to watch over their patient or loved one with a disability.

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.

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.

Tips for sleeping better in patients with disability

Changes in behavior, habits, and sleep environment can help people with physical disabilities sleep better.

It's essential to work with your healthcare team and come up with a treatment plan. These include making lifestyle changes, adjustments to your sleep environment, using sleeping aids, taking certain medications, and undergoing surgery (particularly for sleep apnea).

Identify the underlying cause.

To determine the most appropriate intervention to improve sleep quality, it's worth figuring out what might be the cause of your sleep problems.

Aside from the reasons listed earlier in this guide, other common causes of sleep disturbance that can keep people from getting a good night's rest include caffeine intake and lack of physical activity.

Stick to a consistent sleep hygiene routine.

Good sleep hygiene means having daily routines and an environment that are conducive to consistent, uninterrupted sleep. The following sleep hygiene best practices are a good start:

Sleep in a cool, quiet, and dark room.
Use earplugs when street noise is a distraction. Blackout shades can also keep the light out. An eye mask is also a good alternative.

Go to bed and wake up in the morning at the same time every day, even on weekends.

Keep electronics out of your bedroom. If possible, do not use your phone, tablet, or laptop at least an hour before bedtime. The blue light emitted by these devices' screens can interfere with the body's ability to sleep.

Steer clear of caffeinated beverages after lunch.

Consider natural supplements for sleep, such as magnesium.

A double-blind, randomized clinical trial among the elderly revealed that magnesium supplementation improved subjective measures of insomnia - a decrease in ISI (insomnia severity index) and increased hours of sleep. 15 In the study, the placebo group took 500 mg of magnesium daily for 8 weeks.

Practice mindfulness meditation.

A randomized clinical trial of 49 older adults by scientists at Keck Medicine at USC and the University of California revealed that mindfulness meditation (focusing awareness and attention on the present moment) has positive effects not only on sleep quality but also depression and daytime fatigue that result from poor sleep. 16

Get the right sleeping aid and assistive device for your physical disability.

Individuals with cerebral palsy will benefit from a body pillow between the knees and around the torso to relieve back and muscle pain. Tilting the bed when sleeping is also more comfortable with an adjustable bed or mattress elevator.

Amputees with prosthetic limbs, on the other hand, must be careful with pillows.

If the amputation is above the knee, do not rest your limbs on pillows or between your legs. This can misalign the hips and lengthen one thigh and shorten the other, affecting balance while walking. Meanwhile, do not use blankets or pillows to cushion the knee if the amputation is below the knee. This helps avoid contracture.

The following sleeping devices and accessories for physical disabilities are also worth looking into:

Adjustable beds

Adjustable beds enable physically disabled individuals to adjust the angle of their beds via remote control.

Air mattresses

Unlike air beds, air mattresses help physically challenged individuals by allowing air in different parts of the bed. This feature helps prevent bedsores and improves circulation.

Anti-snoring mouthpieces

Anti-snoring mouthpieces are ideal in helping reduce snoring during the night, particularly for individuals with muscular dystrophy or cerebral palsy.

Bed rails and bed rail pads

Bed rails help physically challenged individuals from falling out of bed. They are attached to the side of the mattress or bed frame. Bed rail pads help make bed rails more comfortable.

Bed steps

Bed steps are a good alternative for low-rise beds.

Chair beds

A chair bed is a bed and a recliner rolled into one. They are ideal for physically disabled individuals who elevate a portion of their body to improve circulation.

Firm mattresses

A firm mattress is ideal for physically disabled individuals who weigh 230 pounds or more. It helps them get a more restful sleep by providing better support.

Floor pads

Floor pads are cushions placed around the floor to prevent injuries during falls. They are ideal for individuals who are at risk of falling out of bed.

Grab handles

Grab handles are attached to nearby bedroom walls or the bed itself. They can help change position from upright to horizontal in bed, getting in and out of bed, or transitioning into a wheelchair.

Hand blocks

Hand blocks are small weighted handles attached to the bed frame or both sides of the headboard. It allows the physically challenged individual to lift themselves, particularly if they’d like to use the bedpan.

Headboard pads

Headboard pads are placed against the headboard for physically challenged individuals who would like to sit up in bed. They help prevent head or neck injuries.

Low-profile beds

Low profile beds are typically 10 inches tall and are designed low to the ground for ease of access. These beds are perfect for physically disabled people who have challenges getting in and out of bed and those who may fall out of bed.

Mattress elevators

Mattress elevators are an affordable alternative to adjustable beds. They are often installed underneath the head or foot of the mattress.

Memory foam mattress

Memory foam mattresses are designed to adhere to the body’s shape. In physically challenged individuals, they provide pressure point relief.

Neck pillows

Ideal for patients with neck or spinal cord injuries, neck pillows (often made of memory foam) help provide additional support for the head.

Pillow elevators

Pillow elevators benefit physically-disabled individuals who want to elevate their head, neck, or knees. They are an excellent alternative to mattress elevators.

Rope ladders

A rope ladder is often attached to one end of the bed. It helps physically challenged individuals in gradually pulling themselves up.

Slide sheets

Slide sheets help ensure smooth transfers for caregivers. They also help physically disabled individuals move around their beds without assistance.

Turning beds

Turning beds are ideal for physically challenged individuals who can’t move in bed and want to transition between sleep positions. They can also help avoid circulatory issues.

Waterproof mattresses

Waterproof mattresses are of great benefit for individuals who have urinary incontinence and nighttime bedwetting. These mattresses are typically made of polyurethane, making them easy to clean for caregivers.

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:

Ask other family members to take a few nights a week so you can get uninterrupted sleep. If possible, hire a professional caregiver. A schedule of 4-nights on, 3-nights off is ideal.

If you are woken by the person with physical disability or wake up on your own, it can be a challenge to get back to sleep. Try not to get up or avoid doing anything mentally stimulating.

A power nap lasting 15 to 30 minutes between 1 pm and 3 pm can help your body make up for nighttime sleep loss. Avoid longer naps, which can make it difficult for you to sleep at night.

Find ways to increase your heart rate during the day. Mild to moderate cardio activities can help you sleep better. Take a brisk walk for 15 minutes or ride your bike for at least half an hour.

Seek support about your worries and anxieties. Instead of worrying while you're in bed, pick a time during the day when you can write about your thoughts or speak to a family member or friend.

Conclusion

There's no best way to improve sleep quality in people with physical disabilities because each individual is unique. If you're still having trouble sleeping due to a physical disability or if you're a caregiver, speak to your healthcare team and ask for recommendations on how you can sleep better.

Medical disclaimer:

The information on this website is obtained from authoritative websites and medical journals, and the content creators have a healthcare background. The team behind Snoozle intends to present information that is as thoroughly researched and accurate as possible.

The data and information we present is intended for general knowledge sharing and doesn't replace a one-on-one relationship with a qualified healthcare professional. We encourage you to make healthcare decisions in partnership with your doctor or preferred healthcare provider.

Resources:

1. Disability and health. (n.d.). Retrieved December 19, 2020, from https://www.who.int/en/news-room/fact-sheets/detail/disability-and-health

2. Journal: Disabled World. Language: English. Author: Disabled World. Last Revised Publication Date: 2020-03-30. Reference Title: "Disability Statistics: Information, Charts, Graphs and Tables", Source: Disability Facts and Statistics. Abstract: World health and disability statistics including data and facts on age, area, types, and population numbers of people with disabilities. Retrieved 2020-12-19, from https://www.disabled-world.com/disability/statistics/ - Reference Category Number: DW#42-17.172.98-5c.

3. MP and Terrill, A. (2012). How to Sleep Better [Factsheet]. Aging and Physical Disability Rehabilitation Research and Training Center. University of Washington. Retrieved December 15, 2020, from http://agerrtc.washington.edu/

4. Oregon Office on Disability and Health (2014). Sleep for Oregonians with Disabilities. [Factsheet]. Retrieved December 15, 2020, from https://www.ohsu.edu/sites/default/files/2019-01/Sleep%20Data%20Brief.pdf

5. Wright M, Tancredi A, Yundt B, Larin HM. Sleep issues in children with physical disabilities and their families. Phys Occup Ther Pediatr. 2006;26(3):55-72. PMID: 16966316.

6. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. *The journal of pain : official journal of the American Pain Society*, *14*(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007

7. Morasco, B. J., O’Hearn, D., Turk, D. C., & Dobscha, S. K. (2014). Associations between prescription opioid use and sleep impairment among veterans with chronic pain. *Pain medicine (Malden, Mass.)*, *15*(11), 1902–1910. https://doi.org/10.1111/pme.12472

8. Shott, S. R., MD. (n.d.). Obstructive Sleep Apnea & Down Syndrome. Retrieved December 22, 2020, from https://www.ndss.org/resources/obstructive-sleep-apnea-syndrome/

9. Stockhammer, E., Dr. (n.d.). Sleep laboratory: Sleep heals. Retrieved December 24, 2020, from https://www.myhandicap.com/en/information-disability-chonical-illness/health/therapies/sleep-laboratory/

10. Cho JR, Joo EY, Koo DL, Hong SB. Let there be no light: the effect of bedside light on sleep quality and background electroencephalographic rhythms. Sleep Med. 2013 Dec;14(12):1422-5. doi: 10.1016/j.sleep.2013.09.007. Epub 2013 Oct 16. PMID: 24210607.

11. Spinal Cord Injury and Urinary Incontinence - URINARY INCONTINENCE EDUCATION: NATIONAL ASSOCIATION FOR CONTINENCE. (n.d.). Retrieved December 30, 2020, from https://www.nafc.org/spinal-cord

12. Thøfner Hultén, V. D., Biering-Sørensen, F., Jørgensen, N. R., & Jennum, P. J. (2018). Melatonin and cortisol in individuals with spinal cord injury. *Sleep medicine*, *51*, 92–98. https://doi.org/10.1016/j.sleep.2018.07.008

13. Thompson, K., Ph.D. (n.d.). Depression and Disability: A Practical Guide. Retrieved December 22, 2020, from https://fpg.unc.edu/sites/fpg.unc.edu/files/resources/other-resources/NCODH_Depression.pdf

14. M, M., Mohamed, S., & Mohamad, M. (2019, June 28). Depression and Its Associated Factors among Lower Limb Amputees at Hospital Kuala Lumpur and Hospital Sultanah Bahiyah: A Cross Sectional Study. Retrieved December 24, 2020, from https://www.longdom.org/abstract/depression-and-its-associated-factors-among-lower-limb-amputees-at-hospital-kuala-lumpur-and-hospital-sultanah-bahiyah-a-43972.html

15. Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. *Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences*, *17*(12), 1161–1169.

16. Black, D.S., O’Reilly, G., Olmstead, R., Breen, E. and Irwin, M.E. (2015). “Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances” JAMA Internal Medicine Published online Feb. 16, 2015 jamanetwork/2015/imd/02_16_2015/ioi40149pap