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Are sleep issues a part of my TBI recovery?

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Division Director PM&R

Answer transcribed from Brightway's interview with Dr. Thomas Franz:

Yes, they definitely are and depending on the stage of recovery a person can have a variety of different problems with sleep. In the early phases after a brain injury, where there's been a large amount of damage the the cell membranes in the brain are very leaky, to put it in a simple term, and the chemicals that normally stimulate the brain to work are are out and floating free and they're not being released in a controlled manner.

So a person may be very restless, they may want to pace all the time, they may not sleep at all. They may almost look like they're manic, and then as those cells begin to die back and those chemicals are no longer present, the person can become very fatigued and lethargic, and then over the longer term I see patients who have sleep disorders because they have what often patients will call "racing thoughts" or can't shut their mind down. They try to go to bed and whether it's things that they're worried about or things they're trying to remember or just things that have occurred throughout the day that are coming back. They can't settle down.

There is also often damage to the pituitary which sits right at the base of the brain. This very common after head injury and so there can be hormonal problems that can cause primarily lethargy. For example, somebody has injury to the pituitary and is very hypothyroid, they may be very easily fatigued.

And finally the other thing that we see, particularly someone farther out in their recovery, is we know that a person who's had a brain injury may be able to complete a mental task but if we look at studies of the brain, at specialized scans that look at function, we call on a lot more areas of the brain to get the same task done after brain injury as compared to prior to brain injury. These patients experience then that when they're doing a cognitive task, a mental task, it might be reading, it might be taking a test but they're profoundly fatigued and most likely this is because they're activating so many different areas of the brain to get the same amount of work done. It just wears them out.

So there's a lot of reasons to have disrupted sleep after brain injury.