Sleep

Sleep disturbances and lack of sleep are common problems that many people with a brain injury face. Multiple effects of brain injury make it harder for people to get the sleep they need. This can include, but is not limited to:

  • Depression and anxiety experienced because of the injury
  • Chemical changes. Our brains moderate the release of chemicals that help with sleep, and this can be impacted after brain injury
  • Sleep disorders and sleep syndromes
  • Changes to breath control
  • Physical pain/discomfort

Topics in this section include:

Sleep problems can also come from sleeping too much, causing mixed up sleep cycles. In general, people with a brain injury do need a bit more rest after their injury, which can make some sleep problems difficult to spot.

You can also experience sleep disturbances. There are a variety of reasons for this. For example, if your friend or family member needs to get up in the middle of the night frequently and require your help, your sleep will naturally be interrupted. Many caregivers also experience stress related to their situation, and stress can interrupt sleep.

Addressing sleep problems for both of you can be done by developing a sleep routine made up of good habits (also called sleep hygiene) and by working with a healthcare team if the sleep problems are medical in nature.

Importance of sleep in brain injury recovery

Sleep problems can make recovery more difficult. If the person with a brain injury can’t focus, gets tired quickly or is unable to complete rehabilitation exercises, progress in recovery can be slower.

A great way for them to monitor sleep and understand how it is affecting them is to keep a sleep journal. This can not only help identify potential sleep problems, but it can be shared with the medical team.

There is also technology specifically designed to help monitor sleep. For example, some fitness trackers have sleep functions. They are designed to be as easy on the eyes and brain as possible (little-to-no blue light) and can tell you important information about periods of sleep, if the person with a brain injury were restless, and if they woke up. Some even monitor heart rate.

Sleeping problems can become a cycle that can be difficult to break. But as sleep improves, so does brain injury recovery, and vice versa. The key is finding ways to understand the person’s relationship with sleep and developing methods to help the survivor support healthy sleeping patterns.

Common sleep problems after brain injury

Changes in breathing
The brain helps regulate breathing, and damage to the part that controls breathing can lead to challenges. In some cases, a person with affected breathing control may stop breathing for short periods of time. This is commonly called sleep apnea and can also cause snoring problems. There are sleep apnea machines (such as continuous positive airway pressure (CPAP) machine) that a person can wear to bed to help control breathing.

A common challenge faced by people with sleep apnea is that they don’t know they have it. Some common signs that are noticeable by everyone (including the person who has it)) includes wake up choking, gasping, or with shortness of breath. Other signs such as snoring or stopping breathing are typically only noticed by others. For example, if your partner has sleep apnea, you may notice their snoring.

Sleep apnea may also cause insomnia. If you or a partner have noticed these symptoms of sleep apnea, you can speak with your doctor about being referred to a sleep specialist who can run more tests. Successful treatment for sleep apnea can be a game-changer.

Chemical changes
Parts of the brain control chemical levels in the body that help a person fall asleep. For example, the pineal gland in the brain regulates melatonin, which plays a role in falling asleep [1]. When there is damage to these brain functions, a person may have trouble falling asleep or experiencing disrupted sleep patterns because the chemicals no longer affect the body in the same way.
Depression or anxiety
When a person is experiencing mental health struggles such as depression or anxiety, it can affect their sleep. This can in turn lead to feelings of fatigue and tiredness that can impact depression and anxiety. Taking care of mental health and practicing proper sleep hygiene will help with the related challenges.

Medications
Some medications have the side effect of interfering with sleep. They may also cause drowsiness during the periods of time the person is awake. Any side effects that may be stemming from medication should be shared with the medical team in charge of prescribing them. While they may not be able to eliminate the side effects, they will be able to explain what’s happening and how to manage them.
Pain and discomfort
Physical pain and uncomfortable positions may contribute to a person not being able to fall asleep or stay asleep. Before the person with a brain injury goes to bed, they should take their prescribed pain medication, lay in a position that is comfortable position, and use a supportive mattress, pillows and bedding.

  • More information on assistive devices for sleep

Managing pain can help manage sleep. Common pain management strategies include physiotherapy, medication, meditation, or even special pillows or mattresses to provide more support to affected areas.

Sleep disorders and syndromes
Studies have shown that brain injury and sleep disorders go hand in hand. When looking at a successful sleep-wake cycle, a person gets uninterrupted rest at night and is awake during the day. Sleep disorders make it difficult to rest, and brain injury recovery can suffer as a result. It’s difficult to recognize a sleep disorder or a related sleep problem because it can include resting too much as well as not resting enough. Types of sleep disorders include:

Circadian rhythm sleep disorders. These disorders make it difficult for a person to follow a normal sleep pattern Hypersomnias. These are disorders that make the person extremely sleepy

Sleep disorders/syndromes are challenging to cope with but can improve over time when the person with a brain injury commits to good sleep hygiene/routines. Any sleep challenges should be shared with the medical team, who may be able to offer additional recommendations for treatment.

  • Insomnias. These are disorders that make it difficult to fall asleep or stay asleep
  • Parasomnias. These are disorders that include unwanted events during sleep. This can include sleep walking, talking, and bedwetting
  • Sleep related breathing disorders. These are disorders that cause difficulty breathing while asleep
  • Sleep movement disorders. These are disorders that cause unwanted movement, which can make it difficult to fall or stay asleep
Too much napping
A person coping with physical and cognitive changes after a brain injury may need to take more rest periods or naps. This is normal, as they’re using a lot of energy to complete tasks and may need to take more breaks than they did before their injury. But too much napping can make it difficult for a person to fall asleep at night, when they are supposed to be doing the bulk of their recharging for the next day. This leads to mixed up sleep patterns or poor sleep.

Sometimes the body and brain do need a nap. But naps should be limited during the day and should be kept short. An alternative to napping is practicing meditation. It allows the person with a brain injury to take some time to rest but keeps them awake. You may need to help your friend or family member time their naps and wake them up [2].

Effects of poor sleep

If the person with a brain injury isn’t getting a lot of sleep, they may experience:

  • Bad moods or emotional lability (mood swings)
  • Depression/anxiety
  • Fatigue
  • Headaches
  • Increased difficulty thinking or remembering. Any cognitive challenges they are coping with may be worse on days when they aren’t getting enough sleep
  • Physical discomfort, including aches

A lack of sleep leading to effects like these can impact an entire day and make it difficult (or in some cases impossible) for the person to complete activities of daily living (ADLs).

These effects can also happen to you if you aren’t sleeping well. This can make caregiving more difficult.

Treatment for sleep problems after brain injury

It can take time for sleep to get back on track. But if the person with a brain injury is still experiencing poor sleep after several weeks of doing everything they can at home – including following tips for better sleep hygiene – you should consult with their family doctor. They may recommend the person work with a cognitive behavioural therapist with specialties in sleep problems, prescribe medication, or recommend other therapies.

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