Insomnia After Head Trauma

Insomnia after head trauma and brain injury is a common long-term complaint.

Insomnia can interfere with recovery in a variety of ways. Not sleeping well at night results in fatigue throughout the day. This, in turn, makes concentrating more difficult and increases the strain required to remain alerted and engaged. Fatigue can also affect memory, which is already a problem for many head trauma sufferers.

Fatigue secondary to insomnia reduces the amount of energy available to engage in social activities. Research demonstrates that getting back into the community via enjoyable activities aids recuperation after head trauma. Not being able to engage with others and have fun due to insomnia and fatigue may slow progress.

Sleep is known to start cellular processes that help the brain heal itself, clear waste and repair cells. Not getting adequate sleep slows this process, and according to animal studies may even contribute to cellular damage.

All of these secondary consequences of insomnia add up, making understanding and treating insomnia an important part of head trauma management.

Why Insomnia Happens After Head Trauma

Researchers have identified a few processes that lead to insomnia after head trauma.

Injury to the areas of the brain that control sleep-wake cycles may be directly linked to sleep disturbance. Circadian rhythms send signals to the body when it is time to wake up, and when it is time to fall asleep.

Wakefulness and sleepiness are regulated by a variety of neurotransmitters including histamine, orexin, and gamma-aminobutyric acid (GABA). These and other neurotransmitters stimulate wakefulness in the brain or inhibit wakefulness which leads to sleep.

One theory is that after a brain injury, the brain does not produce the correct neurotransmitters at the optimal sleep time. There may also be communication problems, meaning if nerve cells are injured they can’t correctly respond to sleep and wakefulness neurotransmitters.

This means that the brain either doesn’t transition into sleep mode or doesn’t maintain sleep. Sleep cycles are also affected, with changing patterns of rapid eye movement (REM) sleep which is associated with dreaming.

Contributing Conditions

Depression after head trauma is very common. When depression is present, insomnia rates go up. This is especially true for individuals who have suffered milder head trauma resulting in just a concussion. Any time there is associated depression it is important to seek medical and psychological care.

Medications used to treat head trauma symptoms can interfere with normal sleep patterns. Sleep is also disturbed if there is pain.

When insomnia is present a thorough medical evaluation is needed to determine if there are any specific behaviors or treatments contributing to the problem. Seeing a specialist who is trained in understanding and managing all types of brain injury is a good idea.

Treatments

Cognitive behavioral therapy (CBT) has been helpful for some with brain injury associated with insomnia. Some elements of CBT include strict sleep hygiene patterns. Sleep hygiene is a term used to describe good sleep habits, such as:

• Getting plenty of exercise during the day, but not right before bed
• Going to bed at the same time every night, even on the weekends
• Getting up at the same time every day
• Keeping your bedroom dark and quiet
• Making sure your bedroom isn't too warm or too cold
• Avoiding large meals, caffeine, and alcohol right before bed

In addition, stimulating activities need to be controlled and reduced prior to bedtime. When the brain is already confused about when it needs to be alert versus restful, activities like watching an exciting movie right before bedtime can interfere with sleep signals.

The primary care provider and specialist involved in treating the initial head injury should be actively involved so they can complete a comprehensive review of medications that contribute to sleeplessness, diagnose any other contributing conditions and develop a plan to help the brain re-learn normal sleep and wake cycles. Each head injury is unique, so seeing the doctor and a licensed professional therapist trained in treating insomnia after brain injury is recommended.