Tackling Sleep Problems

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April Carmel Ferguson
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1 Tackling Sleep Problems Meningitis Now Conference Birmingham 12 th March 2018 Dr David Lee BSc PhD CertEd CPsychol AFBPsS CSci Clinical Director, Sleep Unlimited

2 Contents Implications for people with meningitis Sleep in people who have meningitis: Bidirectional impacts What do we know already What we are finding Physiology of sleep What can we do to help?

3 Sleep-Linked Problems Surrounding Meningitis Sleep Meningitis

The Impact of Sleep Problems in this Group Consequences often include: Irritability and challenging behaviour Reduced memory performance Reduced physical

4 The Impact of Sleep Problems in this Group Consequences often include: Irritability and challenging behaviour Reduced memory performance Reduced physical capacity - Increased fatigue Mood disturbances - Increased anxiety and depression Disruption of family / carer sleep - Daytime and rising to provide care

5 Impact of a Brain Injury on Sleep Problems getting comfortable Less active and so less tired Sleeping during the day Taking medications that interfere with sleep (e.g. NSAIDs, some pain mediations) Having nightmares Being anxious or depressed

pain when moving May have Restless legs syndrome (RLS), periodic limb

6 Impact of a Brain Injury on Sleep May have an asynchronous routine Maybe using drugs or alcohol that can be detrimental to sleep Wake-up because of pain when moving May have Restless legs syndrome (RLS), periodic limb movements (PLMs) or sleep apnoea May have endocrine imbalances or an injury to the brainstem

7 Length of time since onset Anoxia postinfection Acute care delivery Severity of pathology Rehabilitation trajectory Location of pathology Continuing care delivery Age & premorbid sleep history Sleep in people with Meningitis Frequency & type of interventions

(2008); Schretlen & Shapiro (2003) Psycho-behavioural interventions for sleep disturbances in people with brain injuries have efficacy -

8 What the general literature tells us Sleep is often disturbed after a brain injury and stroke - Prigatano et al. (1982); Bassetti (2005); Oullet et al. (2015) Excessive sleep post-injury is common and in concert with the 2- year rule - Ruttan et al. (2008); Schretlen & Shapiro (2003) Psycho-behavioural interventions for sleep disturbances in people with brain injuries have efficacy - Oullet & Morin (2004);) Current research in US military personnel is finding high incidence of insomnia and of sleep apnoea in MTBI / concussion (Holcomb, Nakase-Richardson IBIA 2016)

9 What the meningitis literature tells us Very little research on sleep in people who have had Meningitis. However, there are indications that there are increased sleep disturbances in both viral and bacterial meningitis Hasegawa et al., 1995; Milhaud et al., 1999; Schmidt et al., In viral meningitis, fatigue is a commonly experienced, especially in the first months after infection, and up to a year post-infection. Lepow et al., 1962.

10 Sleep Pressure

11 Circadian Timing

12 What can we do? Examine routines and tighten them Regularise bed, wake, meal and intervention times Consider pacing of activity Schedule rest period(s) Person with ABI Look at medications Including: dosages, timings of administration and side-effects

13 What can we do? Look for opportunities to adjust activity levels - Sometimes more, sometimes less! Encourage time spent outdoors - especially in the mornings Person with ABI Talk to the client, their family and everyone else involved - In order to ensure the suitability of interventions, and to assist with implementation and compliance

14 Good Sleep Practices Consistent schedule Seasonally appropriate bedding Restrict caffeine, alcohol, evening drinks Electronic devices out of bedroom Bedroom for sleep only Comfortable bed Low stimulus environment Time outdoors Thick curtains Treat / manage co-morbidities

, 2012): Sleep Restriction Therapy, Stimulus Control Therapy, Bright Light Therapy,

15 Beyond sleep practice advice: Psychological therapies CBT for insomnia (modified) (Ponsford, et al., 2012): Sleep Restriction Therapy, Stimulus Control Therapy, Bright Light Therapy, Shown Discrepancy Method, Vitamin D supplementation Pharmacological therapies Iatrogenic / side-effect issues Treat sleep as a co-morbidity Sleep interventions

16 Information on Sleep Assessment and Management

17 Your chance for questions Tel: (0191)

References Bassetti CL. (2005). Sleep and stroke. Seminars in Neurology 25(1): 19 32. Gardani M et al. (2015).

Hasegawa T, Kohyama J, Kohji T, et al. 1995. Impairment of respiratory rhythmogenesis and sequelae of bacterial meningitis. Pediatric Neurology 12:357 60. Lepow M, Coyne N, & Thompson L. 1962.

18 References Bassetti CL. (2005). Sleep and stroke. Seminars in Neurology 25(1): Gardani M et al. (2015). Evaluation of sleep disorders in Patients with severe traumatic brain injury during rehabilitation. Archives of Physical Medicine and Rehabilitation 96(9): Hasegawa T, Kohyama J, Kohji T, et al Impairment of respiratory rhythmogenesis and sequelae of bacterial meningitis. Pediatric Neurology 12: Lepow M, Coyne N, & Thompson L A clinical epidemiologic and laboratory investigation of aseptic meningitis during the four year period : II. The clinical disease and its sequelae. New England Journal of Medicine 266: Milhaud D, Bernardin G, Roger P, et al Central apnea with consciousness impairment due to Listeria rhombencephalitis sequelae. Reviews Neurologia 155: Ouellet MC, & Morin CM. (2004). Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study. Archives of Physical Medicine and Rehabilitation 85: Ouellet MC, Beaulieu-Bonneau S & Morin CM. (2015). Sleep-wake disturbances after traumatic brain injury. Lancet Neurology 14(7): Ponsford JL et al. (2012). Fatigue and sleep disturbance following traumatic brain injury The nature, causes and potential treatments. Journal of Head Trauma and Rehabilitation 27(3): Prigatano GP et al. (1982). Sleep and dreaming disturbances in closed head injury patients. Journal of Neurology, Neurosurgery and Psychiatry 45(1): Ruttan L et al. (2008). Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury. Archives of Physical Medicine and Rehabilitation 89(12 Suppl): S Schretlen, D.J., & Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry 15(4): Schmidt H, et al. (2006). Sleep disorders are longterm sequelae of both bacterial and viral meningitis. Journal of Neurology Neurosurgery and Psychiatry 77(4):

Sleep and Traumatic Brain Injury (TBI)

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