Sleeping disorders after a brain injury (stroke) can be another problem you don’t need during your rehabilitation.
Lack of sleep has a negative effect on our cognition, mood, energy levels and appetite. The average person needs eight hours of sleep a night or will suffer from decreased concentration, energy and many other problems. These effects are multiplied many times by a brain injury.
Unfortunately, a brain injury can often lead to a sleep disorder. This can be hard to detect as people with brain injuries can also experience fatigue. Although some people may have problems with getting too much sleep, the usual sleep disorder is trouble sleeping at night followed by feeling drowsy during the day.
Causes of sleeping problems
After a brain injury many find it not only difficult to sleep, but they are very easily awakened, sometimes dozens of times a night. On top of this, they may find themselves unable to sleep at all around 3am, despite being desperately tired. Sleep will usually be very light, so the smallest noise brings the person instantly awake. Research suggests a major cause of disruptions or “sleep fragmentation” is a change in release of neurotransmitters in the brain during sleep.
There can be a variety of other causes for disrupting sleep. Discomfort from headache, neck pain or back pain will always make it hard to get to sleep. Depression is a common feature after a brain injury and people may find they fall asleep easily but wake up several hours before dawn, unable to sleep again. Anxiety and inability to handle stress are other common problems. Negative thoughts whirring through the mind will usually make it very hard to fall asleep also.
Sleep your way to recovery
Sleep plays its part in not only helping the brain to recover from injury, but in physical healing as well. In a Traumatic Brain Injury, there are often muscles damaged. During active sleep, the brain stem secretes hormones that in effect paralyse our muscles to prevent twitching. This can play a role in helping muscles to heal, but poor sleep will hinder this process.
Medication and sleep
There are medications that can assist with sleep problems. Some medications are designed to promote sleep but they are typically avoided by physicians who treat brain injury. Typically, the medication is taken a half hour before bedtime and assists with sleeping through the night. Sometimes this medication works too well and people sleep for 12 to 15 hours for the first two or three days.
Some people report side effects such as difficulty waking up in the mornings. Lowered sensitivity to some medications can also occur after extended use - reducing medication effectiveness. It is important to always seek information from your doctor before starting, stopping or changing any medication. Only use medications as your doctor prescribes, and always inform them of any preexisting conditions (e.g. Brain Injury or stroke).
Practical steps to good snoozing
Routine is vital for sound sleep. Go to bed at exactly the same time every night — even on the weekend. Do not vary this by more than 15 minutes. That may sound extreme, but if you go to bed at the same time and get up at the same time each day, your body will adjust to that pattern. Avoid caffeine and nicotine. These stimulants have a negative effect on the brain, and for some people may increase the likelihood of seizures.
Don’t get the body stimulated with exercise late in the evening. Make sure your bedroom is at the right temperature and that the room is very dark. This can be very important because light plays a critical role in your sleep pattern. Make sure it’s quiet as well. Talk with family members about respecting your need for a quiet environment.
So what about naps during the day?
Some find that afternoon naps are essential due to the cognitive fatigue from a brain injury. Afternoon naps, however, can disrupt your night time sleeping so it is important to experiment. It might be better to lie down and rest without allowing yourself to sleep.
When stress, anxiety and negative thoughts are involved, cognitive behavioural therapy can also help. Speak with your GP about seeing a Psychologist or Neuropsychologist who can help you out with this.
This story was first seen in the Synapse bridge magazine www.synapse.org.au