Research Feedback and Discussion - Sensitivity and Specificity of the Sleep Condition Indicator When Screening for Insomnia Post-Stroke

Acting on feedback from forum members we have been contacting researchers that promoted research studies to ask what happened as a result. Our latest update is from the University of Glasgow.

On behalf of the researcher team, thank you very much for anyone in the forum that contributed towards our study.

We are very grateful for your support with our research, and towards improving understandings of insomnia after stroke.

We have now concluded the study and are happy to share the findings below.

Sensitivity and Specificity of the Sleep Condition Indicator When Screening for Insomnia Post-Stroke: A ROC Analysis

Declan M. McLaren [1], Jonathan Evans [2], Satu Baylan [2,3], Monika Harvey [1],

Megan Montgomery [1], Maria Gardani [4]

[1] University of Glasgow, School of Psychology & Neuroscience

[2] University of Glasgow, Institute of Health & Wellbeing

[3] Regional Neuropsychology Services, NHS Greater Glasgow and Clyde

[4] University of Edinburgh, School of Health in Social Science


Insomnia is common after stroke, more so than in the general population. Recent research suggests that between roughly 33% and 50% of stroke survivors will experience symptoms of insomnia after their stroke (1,2). Despite this, researchers have only recently begun exploring the best ways to detect insomnia after stroke. To date, no study has explored the best method to detect insomnia after stroke in English-speakers.

The Sleep Condition Indicator (SCI; 3) is a short questionnaire designed to detect symptoms of insomnia disorder. Total scores on the SCI can range from 0-32, with lower scores suggesting poorer sleep. In the general population, a score of 16 or less is generally thought to indicate the presence of insomnia disorder (3,4).

This study aimed to assess how accurately the SCI could discriminate between stroke survivors with and without insomnia, and at what cut-off score it performed best.

What we did:

We recruited 180 people who had experienced one or more strokes via social media adverts, and with support of the Stroke Association and other third sector organisations. Participants completed an online questionnaire that asked them questions about their stroke, their mental health, themselves, and their sleep. Researchers examined the data provided by participants and placed them into three categories: ‘insomnia disorder’, ‘insomnia symptoms’, and ‘no insomnia’. We were then able to compare the scores on the SCI and see how accurately it could detect which participants had insomnia, and which didn’t. We could also determine which cut-off score brought about the greatest overall accuracy.

What we found:

Our study was the first to examine the accuracy of an insomnia screening tool is a sample of English-speaking stroke survivors. Overall, the SCI demonstrated ‘excellent’ diagnostic accuracy; showing that it is a valid tool for detecting insomnia after stroke. We did find, however, that the SCI was most accurate when we used a cut-off score of 13 or less; lower than the traditional cut-off score of 16 or less. If the traditional cut-off score were used, the SCI would have incorrectly classified roughly half of people who did not have insomnia, as having insomnia. Therefore, clinicians and researchers interested in using the SCI to detect insomnia after stroke should consider using the lower threshold of less than or equal to 13 to indicate insomnia disorder.

Next steps:

Our hope is that this research will improve how accurately and efficiently insomnia is detected in practice, leading to timely diagnosis and treatment, allowing people to return to having a better relationship with their sleep.

We now intend to use the SCI to assess how effectively a new treatment can improve the symptoms of insomnia in people who have had a stroke.

Further information:

If you’d like to read about our study in more detail, you can access the pre-print at: OSF


  1. Baylan S, Griffiths S, Grant N, Broomfield NM, Evans JJ, Gardani M. Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis. Sleep Med Rev. 2020 Feb;49:101222.

  2. Hasan F, Gordon C, Wu D, Huang HC, Yuliana LT, Susatia B, et al. Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2021 Feb;52(2):655–63.

  3. Espie CA, Kyle SD, Hames P, Gardani M, Fleming L, Cape J. The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder. BMJ Open. 2014 Mar 18;4(3):e004183.

  4. Espie CA, Farias Machado P, Carl JR, Kyle SD, Cape J, Siriwardena AN, et al. The Sleep Condition Indicator: reference values derived from a sample of 200 000 adults. J Sleep Res. 2018 Jun;27(3):e12643.


That is superb that this sort of info is coming through. Thanks for making it happen


Hi Lorraine here not been posting for a long time now as had a lot of problems when the website changed . As interesting as the article is. I’m interested to know if anyone out there has had any success with helping there insomnia . It’s 3 and a half years since my stroke and hardly ever sleep ( if I was asleep it would be a nightmare) I struggle to function most days and even when the doctor relents an gives me some sleeping tablets i only get about 2 hours at the most . Have tried everything I know so any further advice would be so appreciated. Thank you.

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Hi @Lorraine_Langham
I’ve found success with simple mindfulness of subtracting 7 from 1000repeatly - took a month or more but now it’s reliable
@Nigelglos has had success with treatment for sleep apnea (if I’ve understood correctly)

There’s a LOT of stuff on routine, stuff on techniques on YouTube too - but I guess you’ve tried “it all”?

Are there any days when you are to be good or typically bad? Have you tried analysing what happened in the days before to avoid or repeat?

Do you have any coping strategies - eg snoozing during the day, resting without sleep.

Have you tried

The 6wk NHS program?


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Have tried most of the things you mentioned I can’t nap in the day either but do lie down and rest with my eyes closed. Thank you though for your reply will try the counting thing again tried the Paul McKenna one once of counting backwards from 300 maybe didn’t give it enough time to help thank you again.


3rd day in a row now without sleep in the day but sounds like Lorraine needs sleep, whereas I had miles too much until last sat but such low quality.
Both clearly leave you so tired.

Was there a genuine thing about trying not to fall asleep as one of the solutions to falling asleep ?
Reading always worked for me in the past if I did have a problem


There are a number of oft repeated bits of advice:
Have a routine, get up and repeat it if you wake to early and don’t fall asleep easily
No screens like laptops and fones
Don’t use the bedroom for work, TV ,etc
Think the Horlicks idea is supported in some stuff I’ve read !

Getting up for 10 mins worked quite well when I was worst. I slept in the spare room for those months so as not to have the ‘anxiety’ of disturbing Lea when I was awake & not laying motionless but awake for hours


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Yes I have slept in our spare room since the stroke for same reasons but such a long time to be in separate rooms really hope will not always be the case luckily I have the most understanding husband.


Seems a bit odd that the sleep clinic only seem to be focussed on Apnea but don’t appear to help with insomnia.


Yes that’s what I thought only one private sleep clinic where I live and that’s all they deal with.