A brain injury which includes mild injuries such as concussion can have lasting symptoms even after the brain has mostly recovered. Fatigue and sleep disorders are some of the most common complaints post-traumatic brain injury (TBI) and may impair recovery and quality of life and exacerbate other co-morbidities.
A meta-analysis conducted by Mathias and Alvaro (2012) found that 50% of people with traumatic brain injury (TBI) experience disturbed sleep. Complaints include delayed onset of sleep, increased frequency of nocturnal wakings, poor quality of sleep and insomnia. Anyone who has experienced more than an occasional poor night’s sleep can attest to how disruptive this can be to your day to day life.
Fatigue may be linked to these sleep disorders but also may occur independent of poor sleep. It is important to work with your care team to investigate all possible contributors to fatigue including neuroanatomical causes, psychological causes, endocrine causes, pain, depression, etc.
Significant fatigue and sleep disorders can impact one’s ability to participate in rehabilitation and cognitive activities but also in the ability to participate in daily and other social activities.
Management Strategies
-Exercise, such as a progressive walking program may improve these symptoms. Talk with your physical therapist or doctor about what kind of exercise program might be best for you and how to safely initiate and progress the program.
-Relaxation practices such as diaphragmatic breathing, meditation, or taking a warm bath may help to reduce stress and prepare the body and brain for sleep.
-Pacing: When energy stores are limited it is important to prioritize your daily activities in order to perform the most important ones when you feel you are at your best. Schedule time to rest and relax whenever possible in order to conserve your energy.
-Cognitive Behavioral Therapy: There is some evidence that cognitive behavioral therapy may reduce sleepiness and insomnia in individuals post-TBI. Work with your care provider to find a practitioner who is experienced in this area.
-Lifestyle management: good sleep habits are important for everyone including individuals post-TBI. Managing environmental factors such as minimizing light in the bedroom, minimizing noise or distractions can aid in sleep quality. Creating sound pre-bedtime habits such as stopping use of electronics a couple hours before bed, minimizing afternoon or evening caffeine and utilizing relaxation practices can aid in falling asleep.
Pharmacological Strategies
Though fatigue and sleep disorders have been known to impair neurocognitive recovery after a brain injury there has not been extensive research on pharmaceutical treatments for these symptoms. There may be, however, pharmacological options that can benefit you. Speak with your neurologist or other medical provider to discuss if these options may be beneficial to you.
In the end, recovery from a traumatic brain injury can be long and at times, overwhelming. Don’t be afraid to reach out to all of the professionals on your care team, including your therapy and rehabilitation providers for ways to maximize and support your recovery.
Resource: https://erabi.ca/modules/module-7-2/