Sleep and Traumatic Brain Injury (TBI)

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1 Sleep and Traumatic Brain Injury (TBI) A resource for individuals with traumatic brain injury and their supporters This presentation is based on TBI Model Systems research and was developed with support from the National Institute on Disability and Rehabilitation Research (NIDRR). Visit for additional TBI resources. 1

2 Purpose of this resource This presentation summarizes research on sleep problems that people with TBI may experience. The information can help people with TBI who suffer from sleep disturbances recognize the symptoms and seek treatment. 2

3 Sleep and TBI Not sleeping well can increase or worsen depression, anxiety, fatigue, irritability, and one s sense of wellbeing. Sleep disturbance can lead to poor work performance and traffic or workplace accidents. Sleep disorders are three times more common in TBI patients than in the general population Nearly 60% of people with TBI experience long-term difficulties with sleep. 3

4 What are types of sleep problems? Insomnia: Difficulty with falling asleep or staying asleep; or sleep that does not make you feel rested. Insomnia can worsen other problems resulting from brain injury, including behavioral and cognitive (thinking) difficulties. Excessive Daytime Sleepiness: Extreme drowsiness. Delayed Sleep Phase Syndrome: Mixed-up sleep patterns. Narcolepsy: Falling asleep suddenly and uncontrollably during the day. 4

5 Common Sleep Syndromes Restless Leg Syndrome (RLS) Bruxism Sleep Apnea Periodic limb movement disorder (PLMD) Sleepwalking 5

6 What causes sleep problems after traumatic brain injury? 6

7 Causes of Sleep Problems Physical and chemical changes The internal clock in the brain controls when people sleep and wake every day. If injured, the brain may not be able to tell the body to fall asleep or wake up. There are chemicals in our body that help us to sleep. An injury can change the way that these chemicals affect the body. If brain mechanisms for starting and stopping sleep are injured, a condition called post-traumatic hypersomnia may result in which a person sleeps many hours more than normal. 7

8 Causes of Sleep Problems Changes in breathing control Sometimes the brain s ability to control breathing during sleep becomes altered after a TBI, resulting in periods of apnea (when breathing actually stops for long enough for blood oxygen levels to drop). Medications Medications taken after a brain injury may cause problems going to sleep or staying asleep, or can make people sleepy during the day and unable to participate in activities. 8

9 Causes of Sleep Problems Daytime sleeping (napping) and physical inactivity Napping during the day is likely to disturb sleep at night. Inactivity or lack of exercise can also worsen sleep. Pain Many people who have suffered brain injuries also experience pain in other parts of the body. This discomfort may disturb sleep. Medications taken to relieve pain may also affect sleep. Depression Depression is more common in persons with TBI than in the general population. Sleep problems such as difficulty falling asleep and early morning waking are common symptoms of depression. 9

10 Causes of Sleep Problems Alcohol Drinking alcohol before bedtime may cause drowsiness, but is likely to interfere with normal sleep rather than improve it. Caffeine and Nicotine Nicotine from tobacco may cause sleep disturbances and is often overlooked. Caffeine can disturb sleep when consumed in the afternoon or evening. 10

11 What can be done to improve sleep? 11

12 Daytime Suggestions Set an alarm to wake up everyday at the same time. Include meaningful activities in your daily schedule. Get off of the couch and limit TV watching. Exercise every day. Try to get outdoors for sunlight. Don t nap more than 20 minutes during the day. 12

13 Nighttime Suggestions Go to bed at the same time nightly. Follow a bedtime routine. Avoid caffeine, nicotine, alcohol and sugar 5 hours before bedtime. Avoid eating prior to sleep. Do not exercise within two hours of bedtime. Do not eat, read or watch TV while in bed. Keep stress out the bedroom. Create a restful atmosphere. If you don t fall asleep in 30 minutes, get up and do something relaxing or boring. 13

14 How to find help When receiving treatment: Discuss safe and effective solutions with your doctor. Expect an evaluation of sleep problems that includes a thorough history of such problems, medication review, an assessment of your bedtime routines, and a comprehensive medical exam. Explore a variety of possible causes for your sleep problems with your doctor, including pain or depression, before discussing options for action. If necessary, your doctor may recommend a polysomnographic evaluation. Based on your symptoms, medical history, and specific needs, he or she will be able to make a personalized treatment. 14

15 Some treatment options are: Treatment Options Non-pharmacological therapies: Alternatives to medications include counseling, sleep restriction, relaxation therapy, and phototherapy. Medications: Ask your doctor about medications that can help you sleep through the night or keep you awake during the day. Special care is necessary when choosing a medication to avoid daytime sedation or worsening cognitive and behavior problems. Natural remedies: Some consumers have found herbal teas, melatonin, and valerian useful for sleep problems. These are sold in health food and drug stores with no prescription needed. Consult with your doctor if you are using them. 15

16 For additional resources on living with a traumatic brain injury, please visit the Model Systems Knowledge Translation Center website at 16

17 The contents of this slideshow were developed under a grant from the Department of Education, NIDRR grant number H133A However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. 17

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