Sleep disruption in TBI patients

Sleeping difficulties occur either as a direct result of injury, or as a secondary consequence of

changes in lifestyle and symptoms that occur following injury, such as increased need for rest
and reduced physical activity (Theodom, Starkly and Jones, 2016).
There are many factors that can contribute to the sleep disruption a patient may be
experiencing. This may include depression and anxiety, which causes the patient to focus more
on their symptoms and expect the worst. It is almost as if they are tricking their mind into
believing they will not recover. Because of the concussion, the patient may be experiencing
hypersensitivity to light or sound (Smith, Turner, 2015). The reticular formation and cerebral
cortex come together and this is called the reticular activating system. When external stimuli
such as light or sound are strong enough, the cerebral cortex is stimulated, affecting the reticular
activating system, thus waking the patient. Along with the concussion symptoms comes pain and
tension which can make it hard for the patient to get comfortable during sleep as well (Wilson,
2011). Any factors from as big as the pain they are feeling to as small as the temperature of the
room can effect the patients quality of sleep drastically.
50% of those suffering from post concussion syndrome have problems sleeping. Of those
50% , 64% complain of early morning awakenings, and 45% have problems initiating sleep
(Singh, Morse, Kothare, 2016) . Because of all these factors contributing bad sleep, there are
many different types of sleep disorders and disturbances that can occur. A few of these disorders
include:
Sleep apnea- pauses in breathing during sleep (23% report)
Post-Traumatic Hypersomnia- sleeping way too much (11% report)
Narcolepsy- excessive daytime sleepiness (6% report)
Periodic limb movements of sleep (7% report)
In order to test the severity and type of sleeping disorder a patient has, professionals will
conduct sleep studies, use sleep logs. To manage the symptoms of disorders the doctor will
prescribe medication, or recommend psychological counseling (Singh, Morse, Kothare, 2016).
There is a wide range of effects sleep disturbances have on the post-TBI patients. It impairs
your cognition, mood, learning ability, and memory. It increases susceptibility to obesity and
metabolic syndrome, causes hypertension in some cases, increases your resting blood pressure,
disrupts your blood-brain-barrier, decreases hippocampal volume, causes uneven
expansion/contraction of blood vessels which limits blood to neural cells, and increases your
possibility of getting headaches. If you are not getting enough sleep, you are three times more
likely to develop headaches (Smith, Turner, 2015).
Children with poor sleep were found to have significantly increased symptoms and
externalizing behaviors. Improving sleep for children post-TBI may help to facilitate recovery
from injury (Theodom, Starkly and Jones, 2016). Facilities could help the recovery of
concussions by simply making sure patients are pain free. It would also help to initiate periods of
rest with the appropriate use of light, and add in the use of earplugs if the patient is

hypersensitive to noise or light (Wilson, 2011). With this info, we need to make sure nurses make
sleep a much higher priority in their care of a concussion patient.