Improving Sleep After Traumatic Brain Injury
A traumatic brain injury (TBI) is a sudden jolt to your head that causes your brain to change the way it works. This can happen from a blow to your head, a blast, a sudden movement of your head that bounces your brain inside your skull, or a bullet or fragment entering your brain. Falls, fights, combat, sports, and motor vehicle accidents are other common causes. TBI is more common in men than women and more common in those younger than 25 years old.
TBI can cause many brain changes. Because everybody’s brain is different, your symptoms may be different from those of other people. Symptoms can include changes in the way you feel, act, think, and move. Having trouble sleeping is one symptom that affects many people with TBI. Studies show that about 60% of people with TBI have this problem.
Why TBI causes sleep problems
Having a TBI may cause a sleep problem for various reasons including direct trauma to the sleep areas in the brain, changes in melatonin, a brain hormone involved in regulating sleep, and other injury types. Other problems and some common TBI symptoms also can make sleep more difficult. These include:
Abuse of drugs and alcohol
Mental health problems, such as depression and anxiety
Daytime sleepiness (because you may end up napping during the day)
Headache and other types of pain
Types of sleep problems with TBI
If you are recovering from TBI, you may:
Have trouble falling asleep
Have trouble staying asleep
Wake up often and easily (you’re a “light sleeper”)
Not be able to fall back asleep
Have trouble getting enough oxygen while sleeping (called sleep apnea)
Develop narcolepsy, which is falling asleep suddenly and uncontrollably
Develop sleepwalking, which is walking or moving while asleep with no awareness of the action
Why sleep is important for TBI recovery
Your brain needs sleep to recover from a TBI. Not getting enough sleep can make many other TBI symptoms worse. These symptoms include:
Help for TBI sleep problems
Insomnia after TBI can persist. It may be accompanied by depression and trouble functioning during the day. If your symptoms get worse or last for more than a few weeks, reach out to your primary care healthcare provider or specialists for help. Behavioral therapy and medicines to keep you awake during the day or antidepressants are very helpful in some.
In most people, medicines that help you sleep are rarely the answer for sleep problems that a TBI causes. Many sleep medicines, including over-the-counter drugs, can make TBI worse. Don't take any sleep medicines or aids before checking with your healthcare provider.
The best way to treat TBI-related sleep problems is with what is called good sleep hygiene. That means:
Going to bed and getting up at the same time every day, including weekends
Avoiding caffeine, alcohol, and nicotine
Getting some exercise and sunshine every day to help reset your internal clock
Resting during the day, but not napping for more than 20 minutes
Avoiding heavy exercise and heavy meals for several hours before bedtime
Keeping your bedroom quiet, dark, and at a comfortable temperature
Keep stress and work out of the bedroom
Not watching TV or working on your computer while in bed
Not lying awake in bed; get up and do a relaxing activity for a short while
Sleep problems are common after a TBI. If good sleep hygiene is not solving your sleep problems, talk with your healthcare provider. You may need to learn some relaxation techniques or try talk therapy to help you through a mental health problem like depression or anxiety.
Sleeping well is one of the best ways to help your brain recover. Do everything you can to get the rest you need.
January 13, 2018
A brief and selective review of treatment approaches for sleep disturbance following traumatic brain injury, Sleep Disorders and Therapy, Concussion and mild traumatic brain injury. UpToDate
Hanrahan, John, MD,Jasmin, Luc, MD