Sleep disturbances following traumatic brain injury

The authors of this article focused on how sleep patterns are affected by traumatic brain injuries. It is generally accepted that sleep is usually regular and predictable. For instance, when a person is about to go to sleep, neurons within certain parts of the brain (e.g., the brainstem, thalamus, hypothalamus, and basal forebrain) become more active and prepare the person for sleep. Other areas of the brain then become involved, and seratonin is released, which facilitates the sleep process even more.

When the brain is injured (the severity of the injury does not appear to matter), the person's sleep/wake cycle often becomes disrupted. Thus, many people who have sustained a brain injury experience difficulty getting to sleep, maintaining uninterrupted sleep, and subsequently remain quite tired during the day. Even those with mild TBI report sleeping difficulties. It has been found that when these individuals do sleep, their sleep is lighter, and less restful, where they often awake during the night. When a person is not getting enough sleep at night, they often become excessively tired during the day, and frequently experience depression. Unfortunately, while there are some studies that demonstrate particular sleep disturbances following TBI, there have not been any large studies that investigate the different ways in which such disturbances impact upon other areas of a person's life (e.g., cognitive impairments, psychological functioning).

Post-traumatic narcolepsy has also been reported in individuals who have sustained traumatic brain injuries. In particular, these people experience excessive sleepiness during the day, increased lethargy, and interrupted nighttime sleeping with frequent awakenings.

There are various tools that are used to assess sleep. The polysomnograrn and continuous EEG monitoring are widely accepted, though tend to be quite costly, and require that the individual be monitored in a seep lab. The actigraphy is another method that measures the person's movements over a 24-hour period. It costs less than other devices and is easy for the person to wear without being too disruptive. At present, this method is being used as an integral part of an ongoing study being conducted at Naval Medical Center San Diego. The study is looking at different causes of sleep disruption following mild TBI, the impact these alterations have on daily functioning, and possible treatments to address sleep dysfunction following TBI.

The article may be found at:
Drake, A., & Bradshaw, D. (1999). 'Sleep disturbances following traumatic brain injury'. Brain Injury Source, 3, Brain Injury Association: Alexandria, Virginia.

Jennifer L. McCain, Psy.D.
 Neuropsychologist,
 TBI Unit Jamaica Hospital Medical Center