Alexandra Stephenson, BS – East Carolina University, Clinical Health Psychology PhD Program
Traumatic brain injury (TBI) is a major cause of death and disability in the United States, where an estimated 1.4 million individuals sustain a TBI annually, resulting in more than 50,000 deaths, 280,000 hospitalizations, and 2.2 million emergency department visits (CDC, 2010). Up to 80% of TBI cases are classified as mild and often do not necessitate any further specific acute care, while the remaining cases are equally divided between moderate and severe categories (Vermaelen, Greiffenstein, & deBoisblanc, 2015).
A myriad of sleep problems, including insomnia, fatigue, and pleiosomnia (i.e., increased sleep need) are common complaints following TBI, affecting approximately 30-70% of individuals (Viola-Saltzman & Watson, 2012). Regardless of severity, all TBI patients are at risk for developing sleep problems, however; some studies have suggested greater rates among mild TBI compared to severe TBI (Rao, Neubauer, & Vaishnavi, 2015). The origins of these sleep disturbances are not yet fully understood, but are thought to be multifaceted, likely involving direct damage to key brain structures involved in sleep-wake regulation (Baumann, 2016). Further, it is also possible for undiagnosed pre-existing sleep issues to be misattributed to TBI. Regardless, sleep-wake problems may substantially influence recovery and health outcomes and should be addressed. The following resources focus on the sleep-related problems associated with TBI and the potential implications they may have on rehabilitation for survivors.
Abstract: Sleep disruption and the sequelae associated with traumatic brain injury (2015).
“Sleep disruption, which includes a loss of sleep as well as poor quality fragmented sleep, frequently follows traumatic brain injury (TBI), impacting a large number of patients each year in the United States. Fragmented and/or disrupted sleep can worsen neuropsychiatric, behavioral, and physical symptoms of TBI. Additionally, sleep disruption impairs recovery and can lead to cognitive decline. The most common sleep disruption following TBI is insomnia, which is difficulty staying asleep. The consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration. There are several theories for why sleep is necessary (e.g., glymphatic clearance and metabolic regulation) and these may help explain how sleep disruption contributes to degeneration within the brain. Experimental data indicate disrupted sleep allows hyperphosphorylated tau and amyloid β plaques to accumulate. As sleep disruption may act as a cellular stressor, target areas warranting further scientific investigation include the increase in endoplasmic reticulum and oxidative stress following acute periods of sleep deprivation. Potential treatment options for restoring the normal sleep cycle include melatonin derivatives and cognitive behavioral therapy.”
Lucke-Wold, B. P., Smith, K. E., Nguyen, L., Turner, R. C., Logsdon, A. F., Jackson, G. J., ... & Miller, D. B. (2015). Sleep disruption and the sequelae associated with traumatic brain injury. Neuroscience & Biobehavioral Reviews, 55, 68-77.http://www.ncbi.nlm.nih.gov/pubmed/25956251
What Physical and Cognitive Rest Really Mean After a Concussion (2013)
In this short clip, Dr. Robert Cantu (Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine) talks about the definition of “rest” after a concussion.
Baumann, C. R. (2016). Sleep and traumatic brain injury. Sleep Medicine Clinics: Sleep in Medical and Neurological Disorders, 11(1), 19-23. http://www.ncbi.nlm.nih.gov/pubmed/26972030
Chen, P. Y., Tsai, P. S., Chen, N. H., Chaung, L. P., Lee, C. C., Chen, C. C., ... & Chiu, H. Y. (2015). Trajectories of sleep and its predictors in the first year following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 30(4), E50-E55. http://www.ncbi.nlm.nih.gov/pubmed/25119653
Imbach, L. L., Valko, P. O., Li, T., Maric, A., Symeonidou, E. R., Stover, J. F., ... & Baumann, C. R. (2015). Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: A prospective controlled clinical trial. Brain, 138(3), 726-735. http://brain.oxfordjournals.org/content/early/2015/01/13/brain.awu391
Mazwi, N. L., Fusco, H., & Zafonte, R. (2014). Sleep in traumatic brain injury. Handbook of Clinical Neurology, 128, 553-566. http://www.sciencedirect.com/science/article/pii/B9780444635211000352
Ouellet, M. C., Beaulieu-Bonneau, S., & Morin, C. M. (2015). Sleep-wake disturbances after traumatic brain injury. The Lancet Neurology, 14(7), 746-757. http://www.ncbi.nlm.nih.gov/pubmed/26067127
Wickwire, E. M., Williams, S. G., Roth, T., Capaldi, V. F., Jaffe, M., Moline, M.,… & Lettieri, C. J. (2016). Sleep, sleep disorders, and mild traumatic brain injury. What we know and what we need to know: Findings from a national working group. Neurotherapeutics, 13(2), 403-417. http://link.springer.com/article/10.1007%2Fs13311-016-0429-3