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Sleep and traumatic brain injury

Bryn Mawr Rehab Hospital May 9, 2018 Sleep

People who have suffered from a traumatic brain injury (TBI) often deal with the repercussions of their injury in the months—and sometimes years—after their injury. These can include physical side effects like headache and chronic pain as well as cognitive problems like memory loss or changes in mood and behavior.

But an often-overlooked side effect of TBI is poor sleep. A 2016 study published in the journal Neurology found that even up to one year after their injury, TBI sufferers often slept less and had poorer quality sleep than a person who had not suffered a similar injury.

This makes sense, says Mithra Maneyapanda, MD, physical medicine and rehabilitation specialist at Bryn Mawr Rehabilitation Hospital, part of Main Line Health. “Traumatic brain injury can impact the brainstem and hypothalamus, the parts of the brain that regulate sleep-wake cycles,” explains Dr. Maneyapanda. “Like other side effects of brain injury, it can take some time before patients return to the sleep quality that they enjoyed before their injury.”

Common sleep disturbances can include:

  • Insomnia
  • Difficulty staying asleep
  • Nightmares
  • Waking up too early
  • Daytime sleepiness

You might suspect that changes like these are noticeable and could impact quality of life. But, according to the Neurology study, most people with TBI did not recognize increased sleep disturbances or worsened sleep quality. In fact, people who had suffered a TBI did not report feeling any sleepier during the day than those who had not suffered a TBI.

“We encourage our patients to be open and honest with us about changes to their TBI symptoms or their physical health, but the results from this study indicated that it’s important to have a conversation with a patient’s loved ones or caregiver, too,” says Dr. Maneyapanda.

If you’re caring for a person who recently suffered a TBI, pay attention to small changes to their sleep patterns or sleep quality, like going to bed at a much earlier or later time, sleepiness or daytime fatigue that interferes with everyday tasks or an increase in nightmares or sleepless nights. While your loved one may not notice these changes, there’s a greater chance you will.

Sleep disturbances are always important to address, but it is especially important among patients who have suffered a brain injury. Sleep is restorative and allows the brain to recharge, repair itself and rid itself of toxins.

“Sleep is critical for allowing patients with TBI to fully recover from their injury. As sleep improves, so will cognition and consciousness,” says Dr. Maneyapanda.

For this reason, it’s especially important for patients with TBI to create an environment that’s conducive to sleep. If you’re recovering from a brain injury or caring for someone who is recovering from a brain injury, try these techniques to create a healing sleep environment:

  • Avoid alcohol
  • Restrict nighttime sleeping to about eight hours
  • Avoid going to bed too early in the evening
  • Avoid stimulants, caffeinated beverages, power drinks and nicotine during the evening
  • Wake at a regular time in the morning
  • Abolish daytime naps or reduce them to less than 30 minutes each
  • Participate in physical and mental activities during the day (within the limits of the individual’s functional capacity)
  • Avoid stimulating activities like exercise, video games or television before bedtime

Changes like these can ensure you’re getting the best sleep possible and giving your brain the best chance for recovery.

Visit our website for more information about the Brain Injury Program at Bryn Mawr Rehab, including family support.