Clinicians and researchers are calling for a paradigm shift.
You will sleep for around one-third to one-fourth of your lifespan. Sleep helps babies grow and develop, protects against the worsening of various physical and mental health problems, and mitigates the functioning and recovery of the brain. For traumatic brain injury (TBI) patients, sleep is especially critical. Nearly 60% of people suffering from a TBI will experience long-term difficulties with sleep, according to the Model Systems Knowledge Translation Center (MSKTC), and sleeping disorders are three times more common in TBI patients than in the general population.
What’s more, recent research on TBI and sleep has highlighted the importance of rest for patients.
According to a 2021 study published in the Journal of Neurotrauma, researchers found that of data from 56 veterans at the Mental Illness Research, Education, and Clinical Center at VA Puget Sound between 2011 and 2019, those that slept poorly had more evidence of enlarged perivascular spaces and perivascular waste and more post-concussive symptoms than those that reported sleeping well.
“This study suggests sleep may play an important role in clearing the brain after traumatic brain injury,” Dr. Juan Piantino, a co-author of the study, told Neuroscience News. “And if you don’t sleep well, you might not clean your brain as efficiently.”
And waste buildup becomes even more problematic post-TBI.
“Imagine your brain is generating all this waste and everything is working fine,” Dr. Piantino continued. “Now you get a concussion. The brain generates much more waste that it has to remove, but the system becomes plugged.”
With these findings in mind, here are five tips from Mainline Health and the Air Force Center of Excellence for Medical Multimedia for how to improve sleep in TBI patients:
- Sleep should not begin too early in the evening.
Similarly, patients should try to restrict their nighttime sleeping to eight hours. Excessive sleepiness, known as post-traumatic hypersomnia, will disturb patients’ normal sleep-wake cycle, which can interfere with their ability to function normally and perform everyday tasks. Post-traumatic hypersomnia can also lead to irritability, anxiety and memory problems.
- Patients should avoid using their bed for anything other than sleep and intimacy.
According to the Guidelines for Concussion/mTBI and Persistent Symptoms: 3rd Edition, patients should restrict their time spent in bed to the time they spend sleeping, because spending too much time in bed may actually worsen sleeping problems. Encourage patients to not do stressful activities, such as working or paying bills, in their bedroom. This will also help build an association between the patient’s bed, bedroom and the need for sleep.
- Patients should adjust their bedroom environment for optimal sleep
This can include using room-darkening shades, turning their alarm clock away from their bed, and adjusting the temperature of the room – most people tend to sleep better in colder environments, but this varies based on the individual. Eliminate all possible sources of noise whenever possible.
- Cut out daytime naps altogether or limit them to 30 minutes a day.
After the first few days post-TBI, naps are thought to negatively affect the quantity and quality of sleep the following night. Naps longer than 30 minutes can cause a period of sleepiness and difficulty concentrating afterward that is thought to last up to one hour after waking. However, if patients are struggling with sleepiness during the day, they can be advised to take short naps, preferably before 3:00 in the afternoon.
- Patients should avoid going to bed until they feel tired.
If patients attempt to sleep while they are still wide awake, this can lead to bouts of insomnia throughout the night and can lead them to associate their bedroom with insomnia rather than sleep. If it is late and patients are not yet tired, suggest having them watch TV or read in a different room until they feel tired. Additionally, taking a warm shower or bath before bed can help promote relaxation and encourage sleepiness.