Objective To investigate the sleep quality and quality of life in elderly patients with hypermyotonia after ischemic stroke (IS), and to analyze the influencing factors for sleep quality. Methods Convenience sampling was used to screen 365 elderly patients with hypermyotonia during recovery period of IS admitted in First Affiliated Hospital of Air Force Medical University from January 2022 to June 2023. A survey was conducted on them, including demographic data, Pittsburgh sleep quality index (PSQI) and stroke specific quality of life scale (SS-QoL). The patients were divided into poor sleep quality group (PSQI ≥7 points, 176 cases) and good sleep quality group (PSQI <7 points, 182 cases) according to their PSQI score. SPSS 23.0 was used for data analysis. Based on data type, student′s t test or Chi-square test was employed for intergroup comparison. Logistic regression analysis was utilized to identify the influencing factors for poor sleep quality in elderly patients with hypermyotonia during recovery period of IS. Results There were 358 valid questionnaires collected from 365 patients, with an effective recovery rate of 98.08%. The average PSQI score was (7.20±1.46) points in the 358 valid participants. The poor sleep quality group had significantly lower scores of dimensions of energy, activity ability, self-care and upper limb function and total score of SS-QoL than the good sleep quality group (P<0.05). Logistic regression analysis showed that muscular tension grade 3 (OR=3.357,95%CI 1.766-6.381; P<0.05), severe dependence on daily activity (OR=4.121,95%CI 2.389-7.107; P<0.05), depression performance (OR=2.838,95%CI 1.425-5.652; P<0.05), and vitamin D deficiency (OR=2.606,95%CI 1.347-5.043; P<0.05) were risk factors for poor sleep quality in elderly patients with hypermyotonia during recovery period of IS. Conclusion Severely intensified muscular tension during recovery period of elderly IS, low daily activity, depression and vitamin D deficiency may lead to a decrease in sleep quality and affect the quality of life of the patients.