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. The brain moderates 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

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. Addressing sleep problems 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.

Topics in this section include:

The importance of sleep in brain injury recovery

Sleep problems can make recovery more difficult. If a person isn’t able to focus, gets tired at a faster rate or is unable to complete rehabilitation exercises, progress in recovery can be slower.

A great way to monitor sleep and understand how it is affecting the individual is to ask them to keep a sleep journal. 

The individual can also keep track of sleep through 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 important information about periods of sleep, if they 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 relationship with sleep and developing methods to 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 the breath can lead to challenges. In some cases, a person with affected breathing control may actually 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. There are some signs they may notice: they wake up choking, gasping, or with shortness of breath. Other signs such as snoring or stopping breathing are only noticed by partners. Sleep apnea may also cause insomnia.
You may want to inquire if the person (or their partner if relevant) has noticed these symptoms of sleep apnea. They may need to be 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 actually impact depression and anxiety more. 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. If the patient/client shares side effects with you, you may be able to help recommend ways for managing them. 

Pain and discomfort

Physical pain and uncomfortable positions may contribute to a person not being able to fall asleep or stay asleep. Before going to bed, remind them to take any pain medications (following the instructions) prescribed, lay in a comfortable position, and use a supportive mattress, pillows, and bedding. Additional 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 [2]. 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
  • 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

Sleep disorders/syndromes are challenging to cope with but can improve over time by committing to good sleep hygiene/routines. 

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.

Part of a good sleep hygiene routine is listening to the body, and 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.

[3]

Effects of poor sleep

If a person 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

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