Mild traumatic brain injuries (mTBI) can have lasting consequences on thinking, ability to function and work, and quality of life. Fifty percent of those with mTBI develop sleep apnea, insomnia, excessive daytime sleepiness, and other sleep problems. Difficulty sleeping can interfere with recovery, making rehabilitation and healing more difficult. When people with mTBI get poor sleep, it dramatically worsens their thinking, memory, and attention, and increases their risk of dementia. The two most common sleep problems in mTBI are sleep apnea and insomnia.
People with sleep apnea stop breathing during the night. This deprives the brain and heart of oxygen, slowing down recovery and putting patients at risk for heart disease and stroke. Struggling to breathe every night leaves them exhausted during the daytime. People with insomnia have trouble falling asleep and staying asleep.
mTBI may also cause irregular sleep patterns, staying awake at night and sleeping during the daytime. Treatment of sleep disorders in those with mTBI can greatly improve memory, decision-making, and attention. Because of the seriousness of mTBI, most patients should be evaluated in a hospital-based sleep lab, where advanced testing can be performed. It is a good idea to keep a nightly sleep diary, which helps doctors pinpoint the specifics of their sleep disorders. Once the sleep disorder is diagnosed, continuous positive airway pressure (CPAP) therapy is the first-line treatment for those with sleep apnea. If CPAP does not completely resolve all of the sleep problems, further investigation is warranted to rule out other types of sleep disorders.
Melatonin, cognitive behavioral therapy, certain medications, and other therapeutic techniques are more effective than common sleep aids and sedatives. Sleep disorders in patients with mTBI are underdiagnosed and undertreated. In light of the seriousness of brain injuries, all mTBI patients with sleep problems should undergo advanced testing that identifies specific mTBI-related sleep disorders.