Sleep Disturbance and TBI

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Head Injuries and Sleep DisordersIt is not abnormal for traumatic brain injury (TBI) patients to experience some type of sleep disorder. In fact, researchers believe that 30% to 70% of TBI patients experience a sleep-wake disturbance in some form or fashion. Why is this the case? Because as your body’s boss, your brain serves as an “internal clock” that tells you when to sleep and when to wake up, which means an injury to your brain can change how well it regulates your sleep schedule.

WHY WE NEED SLEEP

In general, sleep is necessary for the body and brain to recharge. After a TBI, sleep is especially important because it helps the injured part of your body heal. However, because sleep disturbances can interfere with your ability to sleep, they can interfere with your brain’s healing process following your injury. In fact, several studies have shown that disrupted sleep impairs the rehabilitation process and has a negative impact on a patient’s quality of life.

COMMON SLEEP DISORDERS

There are several common sleep disorders that TBI patients may experience, such as insomnia (difficulty falling and staying asleep), sleep apnea (interrupted breathing during sleep), and hypersomnia (excessive daytime sleepiness or prolonged nighttime sleep). It may seem obvious, but these types of sleep disturbances can be, well, tiring. Aside from the exhaustion, sleep disturbances can cause you to feel irritable, affect your brain’s functioning and ability to concentrate, and take a toll on your emotions.

In some cases, patients may experience a lot of anxiety following a TBI, which can also be a sign of a sleep disturbance. Anxiety and other changes in mood present a sort of “chicken or the egg” dilemma—does the change in mood cause the sleep disturbance, or does the sleep disturbance cause the change in mood? Regardless of which comes first (or if it’s really even that simple), it’s important to talk to your health care provider about the ways in which you can address any of the symptoms you’re experiencing related to changes in your mood and/or your sleeping habits.

DIAGNOSING SLEEP DISORDERS IN PATIENTS WITH HEAD INJURIES

Unfortunately, TBI patients’ sleep disorders often go undiagnosed, which means they might not be properly treated. One reason for the lack of diagnosis and treatment could be that several symptoms of sleep disturbances are similar to those you might experience after a TBI; because it appears as though the brain injury is responsible for the symptoms, they go without specific treatment. Also, treating patients with sleep disturbances and TBI presents additional challenges. For example, health care providers must take special care when prescribing any medications to help with your sleep disturbance because certain drugs meant to help you sleep can weaken your brain’s ability to repair and recover following your injury.

Overall, it is difficult to know how much sleep disturbances affect TBI patients. Still, no matter what research needs to happen, it doesn’t mean you have to go without help now. If you are a TBI patient experiencing any sleep disturbances, talk to your doctor about the ways your sleep issues can be evaluated and treated. If your sleep disturbance is recognized and treated early on, it’s possible you could have improved recovery outcomes.

About Rolf Gainer Ph.D.

Dr. Rolf Gainer is the founder of the Neurologic Rehabilitation Institute at Brookhaven Hospital in Tulsa, Oklahoma as well as the Neurological Rehabilitation Institute of Ontario, in Toronto, Canada. Dr. Gainer is a psychologist with more than twenty-five years of experience in the treatment and rehabilitation of individuals with brain injuries and a dual diagnosis. Dr. Gainer has designed and operated innovative rehabilitation programs in the United States and Canada for individuals who have been regarded as difficult to serve. He is currently involved in conducting two outcome studies related to the long-term issues faced by individuals with brain injuries and a dual diagnosis. He has presented papers throughout the United States and Canada in many professional conferences and educational forums.

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31 Responses to Sleep Disturbance and TBI

  1. Tom Waters August 28, 2011 at 1:12 pm #

    I have had TBI since 1997 when I fell 15 feet landing on a boulder with the top of my head. I have often told people my sleep problem is as if there is a switch to turn off to go to sleep and mine is broken. I go in streaks. Sometimes I sleep 4 hours per night. Sometimes 10 (very rare). Other times (and unfortunately much more common) I stay awake four or five days at a time and then sleep an hour or two. I have a VA appointment in a few weeks. Is there anything I should tell my doctor? I have had a pill that is expired at the moment codeine and something my current doctor tried on me as I also get woken up by my bad knees. That helps a little…for the knees but does nothing for the TBI sleep problem.

    • Craig (retired Army Officer) July 8, 2012 at 9:48 am #

      I just saw your post, you need to bring in the articles relating TBI with sleep apnea to show the link. Be persistent.

    • hank August 27, 2013 at 3:24 pm #

      Did you get service connected for this?

    • MD607 December 13, 2013 at 6:44 am #

      I too had an injury to the front of my skull. You can actually see a 3 inch split in my cranium at the center of my forehead, centered above my nose. First few years, didn’t correlated the two, because, at a higher weight, the split was unnoticed. After losing weight, it became pronounced, and you can feel it. Now, I have the same issue. I NEVER become “tired”. I will lay down, and never doze off. If I sleep, it isn’t until 3, 4, 5 am. Then, I can be awake an hour later, and not be sleepy the next night. I have had the sleep study done, and I stop breathing x times a minute. They determined that my brain forgets to breathe, then as soon as I fall asleep and stop breathing, I wake myself up. Only way to sleep is nose strips, Nyquil, Melatonin and Advil PM, and I mean ten 5 mg Melatonin, often twice, and at least 6 or eight 500 mg/50 mg Ibuprofen/diphenhydromine . But if I’m doped up to sleep and my brain is forgeting to breathe, isn’t that dangerous?? Also, REM is infrequent, so while forced to sleep, very little of it is restorative. Any coming back from this? What are the future complications as I degenerate further?

      • machine72872 February 3, 2015 at 10:02 pm #

        What your describing is central apnea. It is treatable. Central sleep apnea can be treated with Bipap ST or Bipap ASV. Consult a sleep doc.

      • David June 19, 2016 at 9:34 am #

        Same nightmare, different theater. Meditation has some limited long-term benefits, medication doesn’t appear to offer more than wilder imbalance over time. Or perhaps what the hypothalamus is capable of producing is in fact the only viable sustainable medication with benefit, and accessing this through physical method (meditation) is essentially the best we can hope to do.
        My story goes, injury, 35 yrs of psychiatric diagnosis’, episodes of vertigo prompt a look at my prefrontal lobe, which leads to a neurologist asking me if I’d ever had a lobotomy. I’m sorry to discover that my experience is so far from isolated.

    • Jeannie Quinn November 21, 2015 at 3:23 pm #

      I suffered a TBI due to a car accident in 2010. I have never fallen asleep since then. I had several sleep studies where they said the same. Finally was prescribed XYREM. i have the kind of trauma induced Narcolepsy that results in no sleep. A Man died before he could be treated. I survived more than a year; having several attacks of cataplexy; before finally getting the Xyrem. When I can’t get it–I don’t sleep at all for days and become very ill.

  2. ken switzer October 13, 2011 at 10:52 pm #

    got hit on the head at work at night by someone with a hammer I think but do not remember I I think 4 year ago. spit my head open. Got hit in the center of head. Was taken to Victoria BC canada. With hammer at work. I do not remember anything for a month or more my sister from Alberta came and at with me for month or longer.But I really don!t remeber that either.Afer I went home on my own. Could not take being in with the people that were dying in the Nanaimo BC hospital. Still under compentation in BC Canada today.I was doing ok. In May of last year someone ran into the back of car when I stop to let another car turn in front of me. It was thr car behind me who was wrong. Anyway I was taken to the Nanaimo hospital by medic. I got whip lash. I was improving befor the whip lash thing. But not doing to good now seem to not stay very cam. Seem to loss my temper very quick. I seem to be getting worse every day. I had car insurance they are senting me to another head doctor next week.Could you help me work thing out

    • Rolf Gainer Ph.D. October 14, 2011 at 9:03 am #

      Second brain injuries can exacerbate the problems from the first injury in addition to the issues related to the most recent injury. It is very important to seek help from a neurologist and/or neuropsychologist to address the problems related to both injuries. We responded to this email with support and direction to urgently seek specialized medical care from a professional with training and experience in brain injury rehabilitation.

  3. Craig (retired Army Officer) July 8, 2012 at 9:46 am #

    I had four improvised explosive devices blow up on vehicles I was in while in Iraq in 2006-2007. I came home with mild TBI and sleep apnea. I urge all veterans with TBI to get checked for sleep apnea, before I brought this to the VA’s attention they had told me the sleep apnea had nothing to do with my TBI.

    • Rob April 30, 2015 at 10:18 pm #

      QHow did you get it approved?

    • Guy McCardle August 8, 2016 at 11:02 pm #

      Did you ever get it service connected?

  4. Larry Nauta August 23, 2012 at 12:45 pm #

    1975 I had a Subdural Hematoma from a Motor Cycle Accident.
    1975 – 10 weeks of random episodes of “Blinking lights” that would make me collapse for 2 to 5 minutes. VERY SCARY!!!
    Brain scan showed a plum sized blood pocket up again the back of my brain.
    About 1990 I was told my sleepness was due to my breathing problems during my sleep.
    Very unusal …I was told. I could fall asleep in 2 minutes ANYWHERE!
    So now in 2009 I am told I have a rather nasty Central Sleep Apena. AHI = 92
    VA says that there is NO connection to my TBI injury and my Central (mixed) Sleep Apena.
    Is that true????

    Anyone else had these kinds of issues..?

    • machine72872 February 3, 2015 at 10:05 pm #

      One of the the most common side effects of TBI is central sleep apnea. VA is wrong. I am, at this minute performing a sleep study on someone with TBI. His manifest with RBD and sleep talking. Normal sleep apnea is an obstruction. Central sleep apnea has more to do with the trigger not working properly. Seen a lot in CHF and TBI.

  5. toni October 22, 2012 at 10:31 pm #

    Yes, your symptoms sound similar to some I had after two severe concussions in 9 months. I didn’t have sleep apnea, but disturbances. Could sleep for 14 hrs. or would be unable to sleep for 24hrs. I also had complete loss of memory for a few years, yet I must have kept my routines, as friends don’t comment that I changed. My menstrual cycle changed, and I started spotting, which lasted four years. I was extremely nauseated and could only tolerate small amounts of liquids for a few months. Easily became dizzy, and had frequent seizures. I believe there is much doctors don’t know about the brain yet, and any symptom is possible, since the brain is our main control! It’s been several years since the TBI, but I have never been the same, and I think the best thing I can do to help myself is to be patient, and realize I (we) need care and compassion, and to “let some things go”.

    • Joanna Lane January 14, 2015 at 10:00 am #

      Dear Toni, it sounds as if the concussions could have affected your pituitary gland, which stimulates your ovaries to produce oestrogen. If it is this, it’s something that can be put right by replacing the hormones you’re short of. Ask for your LH/FSH levels to be tested. Hope this helps http://www.headinjuryhypo.org.uk

  6. Denise October 31, 2014 at 12:26 pm #

    My husband suffered a diffuse axonal injury 3 months ago. About a month ago after giving him Amantadine and Fish Oil, he became more alert and responsive. But since last week he seems very lethargic. He still responds to commands but looks like he can hardly keep his eyes open whereas before he was awake for hours at a time. He is not on any medications that would make him drowsy. Does anyone know if this back and forth is common due to his TBI?

  7. JOSE ROCHA January 13, 2015 at 4:42 am #

    In OCT.’12 i had a motorbike accident, i suffered a strong Concussion that caused to me a strong headache for 3 days, also i suffered a Whiplash, some injuries on bottom of the Spinal and shortly after this accident was diagnosed a Severe Obstructive and Central Sleep Apnea. I never had any kind of Sleep Disturbances or Sleep Apnea before this accident, then i would like to know if this issue can be linked with this motorbike accident?

    • machine72872 February 3, 2015 at 10:07 pm #

      Yes they can.

  8. Kara April 10, 2016 at 12:01 am #

    My husband was hit in the back of the head with a package that fell off a shelf at work in the warehouse weighing about 30 lbs; but fell from above adding x amount of weight. Was knocked unconscious, also hit the cement when he passed out. He has TBI and is now experiencing Sleep Apnea along with snoring and he stops breathing 28 times in a 2 hour period.. the sleep study said it was obstructive and can be corrected with positional sleeping. The accident also ruptured his cervical disc 2&3 3&4 and 5&6 could this be where the obstruction is at? the Doctors can’t seem to give us any answers.and are saying the Apnea is not related and it shouldn’t be workmans comp related. I’m frustrated and need answers.

  9. Tmarie May 15, 2016 at 11:56 pm #

    I was in bad car accident in 2015, and it’s may 2016 almost a year, can’t sleep. Broke my beck coma 2 weeks, and head injury they told me had TBI. Does this go away?
    Will I ever be able to go to sleep like before. 10:00 roles around and I am up.

  10. Rudolph June 7, 2016 at 5:31 am #

    Was in car accident in 2014. Suffer from pre-existing severe sleep apnea compounded with excessive daytime sleepiness as well as bipolarism with auditory delusions. Severe features of each were in remission due to management with stimulants and antipsychotics. Immediately following the accident I began to experience a higher frequency of microsleeps behind the wheel and at work and voices in my head began to distract me. Also suffered impairment in memory, increased anxiety and decline in cognitive abilities and ability to maintain concentration and focus on complex mental tasks. I was diagnosed with Post Concussion Syndrome and am wondering if the concussion I suffered from the accident could have caused the return of the microsleeps and auditory delusions. Would appreciate commentary if anyone has a similar experience.

  11. JAS September 20, 2016 at 10:57 pm #

    This sucks. 10 years after my TBI from Assault. Someone(s) dropped the ball on my case/life. Received no care after wards. Left on my own essentially. Lived with single parent who would rather blame/deny anything related afterwards. Went from College education level to sixth grade level tested. How does one with terrible memory, and all the issues listed under TBI’s and seen here, help them selves when it is only them selves who can create change? As I recently read on a forums, “how does one remember to take their memory medication, when they have memory issues?” When one can not learn or build off the past days experiences and knowledge learned, how does one move forward? How does one again, get help? Disability benefits are greatly needed. 10 years have passed. My candle is completely exhausted now and still no gains. Ive tried to file disability, but when I get frustrated from reading, or not understanding something, my brain shuts down/off, retreats, and if I persist, I get incredibly angry with myself and eventually get extremely tired, and have to sleep/shut down and if I try to fight it, its inevitable. Much more I could say that stands in way, but just those three things alone, how does one get out of this catch 22 cycle of hell? Its similar to the metaphor used, or this one; I cant get a job with out a car, and I cant get a car without a job…

  12. Jenn_in_FL October 6, 2016 at 7:25 pm #

    I hit a telephone pole head-on September 2015 (wasn’t at fault as I swerved to miss a vehicle that stopped mid-turn & halfway in my lane). Felt fine but went to Emergency that night due to headaches, neck pain with popping, etc.
    Diagnosed with a concussion, whiplash, torn ACL left knee, fractured C5, fractured T4, several discs bulging and/or basically “out of whack”.
    Now almost a year and a month later – sleep disturbances (when I used to be asleep within 5 minutes of laying down). I can toss & turn from 9pm-2am, finally drift to sleep around 3am but apparently no REM sleep because I wake up even more tired than before!
    Dealing with neurosurgeons, MRIs, CT scans, ultrasounds, moving Xrays, etc. is exhausting!

    Can someone tell me…. is there a light at the end of the tunnel? Or should I just expect the headaches, memory problems, sleep issues, anxiety, dizziness, confusion & agitation to continue for the rest of my life??

    I’m 34 with 3 kids (youngest is 3 oldest 16) and I have a helpful and (somewhat) understanding husband.
    I’m just jumping through hoops so my case settles (against municipal employee/insurer/agent) so I can try to get on with my life.

    I’m sick & tired of being sick & tired!

    • Angie November 2, 2016 at 11:34 pm #

      Jen the more you stimulate your brain the more improvement you will have. I have a pretty severe TBI from an accident in Jan 2011. See a neurologist for the headaches. I had to go on migraine mess daily. As for the memory issues, I actually got a 4 the college degree. It was excruciating and very intense with my memory issues but, the challenges helped to make my memory stronger. None of these problems have ever gone away completely though, I have just learned to cope with them better. It certainly has been the most frustrating thing that ever happened to me in my life. I sympathize and I’m sorry that you are going through this too.

    • neurologic physical therapist November 13, 2016 at 9:37 pm #

      Unfortunately there is no real medically solid answer. Our brain and our own experiences are different between each other’s. For example I had multiple concussions within a span of an hour of each other and had sleep issues for years (and still do have some). It’s been 5 years, while my sleep isn’t the same as it was before hand it’s gotten remarkably better! Even had a dream for the first time a few months ago. So yes there is hope for you in terms of it getting better, but truth be told it’s not a sure thing because all of our brains heal (or lack of it) in different ways. Some people I’ve worked with take days and others can take years. Don’t give up hope, and don’t let it define you. There’s lots of things we can try to do to make it less frustrating of an experience in the short term but the only thing we know that can “heal” it as of now is time.

      Hopefully yours can lead you to a pre-TBI life again, it’s tough as we all know.

  13. linda February 13, 2017 at 9:46 pm #

    I began having a sleep disturbance after a car accident. I never went to the doctor for the wreck, I went because I felt like I was dying and he ask how I was sleeping. I also had pain running down my left arm and he finally figured out it was a neck injury and the arm pain was referred pain. I avoided pain medications or anything in the daytime because I needed to work, so I only took something to sleep at night. All these years later a doctor finally says, I know what your problem is. I even went to a sleep study and instead of trying to find out what the problem was the doctor told me it was because I was so psychologically traumatized from the accident (13 years later). Now I am just hoping it can be taken care of with hormones with no surgery. My thyroid is already out, and my pituitary is on the low side. I hope that is what it is and they can fix it.

  14. Sleep Disturbed After concussion March 19, 2017 at 8:42 am #

    male 21. I’ve had 3 concussions over 2 years.
    The last one affected my sleep greatly. Ive gone from someone who could fall asleep immediately to not getting to sleep until 3 or 4 am and having a restless sleep. Melatonin helped somewhat for a while but then stopped.Sleep study didnt show anything. I was referred to a psychiatrist and he of course diagnosed that my sleep was due to anxiety and even told me I had a history of anxiousness!!! What a crock of crap – I was confident and capable before the injury. I do have bad anxiety but that has been building for the last 1+ since I havent been able to sleep. Of course he wont consider that my sleep issues caused my anxiety and he really doesnt care since hes treating my sleep and axiety with medication. I guess this is normal for Phsyc docs since I read about so many other people with the same experiences with them.
    Ive been reading about hormonal imbalance cause by injury and that makes a lot of sense to me. Just from reading about hormone changes in women there’s similar affects so why is this not a possibility???? (sleep issues, irritability, anxiety, depression etc). The medical profession can be so clueless. I will say sometimes I get a little depressed reading these posts. PLEASE come back and repost when you do get better!!!!!!! !!!!!!!!!!!!!

  15. Alex Gautgier May 24, 2017 at 9:54 pm #

    Strangely, the toughest part about TBI are often the fact that the medical profession can be so clueless and will not care trying to help you if they can’t find a treatment for you rapidly. So, since TBIs can be so abstract, many of us, as I have read over many forums, can feel left alone and in the dark.

    I myself had an accident 17 year’s ago while on my bike when a car coming out if it’s driveway hit me. I was unconscious for a few hours. When I woke up, they simply sent me back home without any followup. And, because of that I continued my life as normal not understanding what was happening to me (I was to young back then and even my mom was clueless, not that was her fault). So, by trying to live normally I made my health go worse slowly and what was before only mild insomnia became chronic since my breakdown last year.

    Sometime, this and all the pain and symptoms of TBI & post concussion syndromes are making me weary and sometimes wishing that I could die so I could stop suffering.

    Got luck to all of you!

  16. Never the same July 27, 2017 at 4:51 am #

    I think the toughest part is having a doctor who 1) believes you and doesn’t write you off 2) a doctor that will listen and figure out the answer and the best solution. Millions of dollars worth of equipment out there. Millions of dollars worth of medication. What’s the point of having doctors that do nothing or write you off as being “depressed” or just have “anxiety” in my opinion too many doctors only know book knowledge when dealing with the majority of the population and do not have a clue on what it is like to suffer a physical injury due from car wrecks , falls, blows to the head, etc. no body truly understands unless they themselves have had a miraculous event that in all actuality you should have been dead but your not. They don’t understand the sufferage that we go through. While it is true that the body does heal itself it is my belief that some things are intact permanent if not corrected to allow the full healing. It’s mostly all a money game for them only a few out there actually care and have the ability to save a life in an instance without the means of surgery. It’s been 4 years since my car accident but most doctors I see won’t even validate the fact that I had TBI a series of mini strokes, lost complete use of my left arm did not have a pulse, lost the ability to fully talk for years I still have trouble reading writing and sometimes talking. My physical limitations are getting better but sometimes I go backwards instead of foward. Everything and everyday is therapy to just survive. The insomnia and all over pain kills me but I push foward everyday. I just want to sleep and live a normal life like before.

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  1. Sleep Disturbance and TBI | Debbie's Story - November 17, 2014

    […] Share on emailMore Sharing Services It is not abnormal for traumatic brain injury (TBI) patients to experience some type of sleep disorder. In fact,researchers believe that 30% to 70% of TBI patients experience a sleep-wake disturbance in some form or fashion. Why is this the case? Because as your body’s boss, your brain serves as an “internal clock” that tells you when to sleep and when to wake up, which means an injury to your brain can change how well it regulates your sleep schedule. […]

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