|Scooped by Dr. Maud Nerman, DO., CSPOMM, CA|
Sleep disturbances are often overlooked after a concussion or TBI, taking a backseat to more dramatic problems such as cognitive and memory impairments and mood disorders like anxiety and depression. Yet without sleep, cognitive function can worsen, and mood disorders can spiral out of control. Determining who is most at risk for developing a sleep disorder after TBI can help put this critical issue on the radar of treating physicians, who are often overwhelmed by the multitude of serious symptoms appearing after brain injury.
In this study, Chinese researchers investigated possible risk factors related to sleep disturbances following brain injury. While their patient numbers were strongly weighted towards mild traumatic brain injuries (70% of those studied), they still found some interesting patterns:
•overall, 38% of victims of brain injury suffer from some kind of sleep disturbance.
•Drilling down further, sleep problems increase as the severity of brain injury increases. 30% of mild TBI patients, 53% of moderate, and 57% of severe TBI patients experience sleep disturbances.
•The strongest risk factor for hypersomnia - excessive sleepiness - is severe brain injury,
•The predominant risk factors for sleep disturbance - seen in the graph above-- were headache, dizziness, and anxiety and depression. In fact, more than half of the patients with headache had sleep disturbances.
•Sleep disturbance did not seem associated with injury to any particular area or region of the brain.
Without more information, it's hard to know what common physiological basis links these risk factors and sleep problems. Headache and dizziness can have numerous causes after brain injury. However, one common thread to all three - headache, dizziness, and sleep disturbance - could be distortion of the brain's membranes, as described in an earlier article here. Distortion of the "tentorium cerebellum" or "tent", as described by other researchers, can press down on the brainstem and also cause autonomic nervous system disruption (both linked to dizziness) and can pull on any number of structures in the head that are linked to headaches. The research doesn't address that possibility. The researchers also did not discuss whether sleep improved after dizziness and headache were treated.
Still, any information about the prevalence and risk factors for sleep disturbance is important. Sleep is the greatest healer of all, and it's crucial to keep that fact front and center when we treat our patients with traumatic brain injury.