Mar 26, 2025 / Physical Wellness
Traumatic Brain Injury (TBI) can disrupt arousal/sleep regulation and hormonal systems with sleep disturbances affecting up to 70% of people who have experienced a TBI. The most common complaints include insomnia, fatigue and sleepiness. Poor sleep can worsen depression, anxiety, irritability and overall well-being which leads to poor performance and accidents. Managing sleep disorders is a critical element for recovery from TBI.
Dr. Duc Tran, Medical Director of Collage Home & Community’s Southern California program provides us with some answers related to TBI and sleep.
What is the relationship between TBI and sleep disorders?
Unfortunately, sleep disorders often go undiagnosed in people with TBI. An estimated 60% of survivors of TBI do not receive treatment for sleep disorders when, in fact, these issues are integrated. TBI causes sleep disorders and sleep disorders worsen TBI symptoms.
What types of sleep disorders can you experience after a TBI and how are they diagnosed?
There are a variety of sleep disorders that survivors of TBI experience including:
A physician that specializes in sleep disorders can help diagnose and treat these issues. A sleep study or polysomnography is often recommended. This diagnostic procedure monitors physiological parameters during sleep. This test involved placing sensors on the individual, while they sleep to record things like brain waves, eye movements, heart rate, breathing problems and muscle activity.
How do sleep disorders impact a TBI patient?
Even in people without TBI, sleep disorders lead to weakened will power, attention deficit, loss of word finding, memory impairment, irritability, impulsivity, emotional dysregulation, lack of motivation, depression, anxiety, sexual dysfunction and unsafe driving. Sleep disorders make it harder to heal from and to live with TBI which could have caused the sleep disorder in the first place, leading to a vicious-cycle predicament. Individuals with TBI that suffer from sleep disorders experience highly exacerbated symptoms.
Sleep is needed to consolidate memories, encode learning, and clean out neuronal waste accumulated from the day before. Since the healing stages of sleep are shortened by TBI, the brain is not given a chance to heal. Additionally, adding substance abuse to the equation, can shorten regenerative sleep stages as well.
How do you work with patients and collaborate with their treatment teams and families to improve sleep disorders?
These behaviors are difficult to change if someone isn’t motivated to make these changes. Developing a trusting and reciprocal relationship by listening to the patient’s complaint and avoid nagging or offering unwanted advice is an important step toward finding what will work for the individual. Assessing their motivation and desire to change their sleep habits is also a critical element for success. Key indicators for collaboration with the patient include asking how their sleep is and how they feel during their waking hours. This information allows us to offer that their issues could be directly related to sleep quality and motivate them to consult with a sleep specialist. Avoid nagging or offering unwanted advice.
What are some lifestyle factors and treatment options that you might recommend?
Treatments can range from behavioral, environmental and, as a last resort, pharmacologic interventions. It’s a good idea to ask patients what they already know about sleep hygiene, and fill in the gaps from there.
Sleep hygiene highlights can include daily exercise, avoiding screens and technology in the bedroom, avoiding caffeine after a certain time of day, sticking to a routine schedule of going to bed and waking up at the same time every day, maintaining a healthy heart rate and blood pressure, and avoiding alcohol. Self-medicating with over the counter medications (like Benedryl and Doxalymine which is Nyquil) should be avoided. These can impair learning and block the natural brain chemistry needed for memory, and have been linked to dementia after many years of use. Pharmacologic options for sleep disorders in TBI should eb carefully discussed and monitored with a brain injury specialist or a sleep specialist and should be discussed routinely with the individual’s treatment team.
Duc Tran, MD, PhD is the Medical Director for Collage Home & Community Partners Southern California program. He is on the faculty of Loma Linda University School of Medicine (LLUSM) and an integral part of their Department of Physical Medicine and Rehabilitation.