Sleep and TBI

Does TBI lead to difficulty in falling asleep, problems staying asleep, increased leg movement, and daytime? Possibly so, according to a recent study done with traumatic brain injured patients that showed a higher incidence of an increased nighttime awakening and increase in time to fall asleep. Not surprisingly, the resulting lack of sufficient sleep can cause change in mood and depression.

In a study done at Epworth Hospital (Melbourne, Australia), participants were recruited from the hospital and the surrounding community. They were asked to keep a sleep diary for seven days, noting time they went to bed, sleep onset, number of awakenings, time they woke up, and use of alcohol or caffeine. Other tests and questionnaires were used in addition to the diary. Unlike previous studies, this research included a comparison group, matching participants in the community with traumatic brained injured patients in relation to age and gender. The researchers felt age was an important consideration because of the occurrence of age-related changes in sleep. Gender was chosen because women typically report more insomnia than men.

The results: patients who had milder traumatic brain injuries had higher levels of anxiety, a factor in awakening at night. Researchers also found that participants with TBI took significantly longer naps during the day on weekdays and also woke up later than the other participants. On weekends, there was no difference in nap duration between the two groups.

Although theTBI participants reported more sleep changes than did the participants without TBI, the researchers cautioned that response in the TBI participants might be less reliable because they were not always able to reliably describe their sleeping patterns before injury.

However, overall it was suggested that sleep disturbances due to increased anxiety and depression as a result of TBI might be remedied by psychiatric treatment. In addition, such basic “sleep strategies” as going to bed at a consistent time, using the bedroom only for sleep (as opposed to TV-watching or work), and doing relaxation exercises might lead to better-quality sleep.

For further information: “Self-reported changes to nighttime sleep after traumatic brain injury,” D. Parcell Dpsycha; J. Ponsford, PhDab; S. Rajaratnam, PhDa; J. Redman, PhDa, Archives of Physical Medicine and Rehabilitation, volume 87, issue 2, p.278-285, February 2006.