Sleeping issues after a brain injury
Sleeping disorders after a brain injury can be
another problem you don't need during your rehabilitation.
Lack of sleep has a negative effect on our cognition, mood,
energy levels and appetite. The average person needs eight hours of
sleep a night or will suffer from decreased concentration, energy
and many other problems. These effects are multiplied many times by
a traumatic brain injury, stroke and other types of brain
Unfortunately, brain injury can often lead to a sleep disorder.
The American Academy of Neurology reports that as many as 40 to 65
percent of people with mild traumatic brain injury complain of
This can be hard to detect because people with brain injuries
can also have a fatigue disorder. Although some may have problems
with getting too much sleep, the usual sleep disorder is trouble
sleeping at night, particularly problems with timing of sleep, then
feeling drowsy during the day.
After a brain injury many find it not only difficult to sleep,
but they are very easily awakened, sometimes dozens of times a
night. On top of this, they may find themselves unable to sleep at
all around 3 am, despite being desperately tired. Sleep will
usually be very light, so the smallest noise brings the person
instantly awake. Research suggests a major cause is disruption to
normal release of certain quantities of certain neurotransmitters
in the brain during sleep which causes "sleep fragmentation" due to
waking up so often.
There can be a variety of other causes disrupting sleep.
Discomfort from headache, neck pain or back pain will always make
it hard to get to sleep. Depression is a common feature after a
brain injury and survivors may find they fall asleep easily but
wake up several hours before dawn, unable to sleep again. Anxiety
and inability to handle stress are other problems for many.
Negative thoughts whirring through the mind will usually make it
very hard to fall asleep.
Sleeping your way to recovery
Sleep plays its part in not only helping the brain to recover
a brain injury, but in physical healing as well. In a traumatic
brain injury, there are often muscles damaged. During active sleep,
the brain stem secretes hormones that in effect paralyse our
muscles to prevent twitching. This can play a role in helping
muscles to heal, but poor sleep will hinder the process.
Medication and sleep
There are medications that can help you with sleep problems.
Some medications are designed to promote sleep but they are
typically avoided by physicians who treat brain injury. Many
physicians use small doses of antidepressant medications with their
head-injured patients and have found them to be very effective.
Typically, you take this medication a half hour before bedtime and
you will sleep straight through the night.
Sometimes this medication works too well and people sleep for 12
to 15 hours for the first 2 or 3 days. This is normal as your brain
is trying to "catch up" on the sleep that it's missed. However,
some people report side effects e.g. they may report that it's hard
to wake up in the mornings. But once you get going in the morning,
you will feel a lot better. You need to talk to your doctor about
any side effects.
Sometimes the medication may seem to stop doing its job after a
month and may need readjustment by your doctor.
Practical steps to good snoozing
Routine is vital for sound sleep. Go to bed at exactly the same
time every night-even on the weekend. Do not vary this by more than
15 minutes. That may sound extreme, but if you go to bed at the
same time and get up at the same time each day, your body will
adjust to that pattern.
Avoid caffeine and nicotine. These stimulants have a negative
effect on the brain, and for some people it may increase the
likelihood of seizures.
Don't get the body revved up with exercise late in the evening.
Make sure your bedroom is at the right temperature and that the
room is very dark. This can be very important because light plays a
critical role in your sleep pattern. Make sure it's quiet as well.
Talk with family members about respecting your need for a quiet
So what about naps during the day? Some find that afternoon naps
are essential due to the cognitive fatigue from a brain injury.
However afternoon naps can disrupt your night time sleeping so it
is important to experiment. It might be better to lie down and rest
without allowing yourself to sleep.
When stress, anxiety and negative thoughts are involved, cognitive
behavioural therapy can help. Your Brain Injury Association should
be able to help link you up with a psychologist.
References and further information