Rachel Newcombe
Manager, Education & Engagement,
Brain Injury Canada
Everyone needs quality rest in order to feel their best. But for individuals with brain injury, it’s common to experience lack of sleep and sleep disturbances that impact quality of life.
It’s “one of the most persistent and debilitating consequences of TBI [traumatic brain injury]” [1], and can have a huge impact on a person’s ability to navigate day-to-day life and their recovery.
Think about how you feel when you don’t get enough sleep: you may feel fatigued, unable to engage with what’s going on around you, more moody (such as feeling anger or sadness), and just overall feel pretty bad. Someone with a brain injury may be coping with ongoing effects like headaches, memory loss and fatigue (and more) that are made worse by lack of sleep. Sleep is an important part of brain injury recovery and overall wellness because it directly contributes to how much energy we have each day. If you don’t have as much fuel in the tank, you won’t be able to do as much–or you may try to do too much and hit a metaphorical wall. This can be incredibly discouraging and frustrating, particularly for those adjusting to new things post-injury.
Have you heard of spoon theory? While not directly related to sleep, it is related to understanding how much energy someone has, how much they can give, and what happens when too much is spent. It was introduced to help people with chronic conditions illustrate their capacities day-to-day. Watch this video on spoon theory from Paul.
Sleep helps replenish spoons and supports emotional, physical and mental wellbeing. That’s why it’s so important for brain health and brain injury recovery.
Let’s dive into what can impact sleep and some tips for creating the best possible chance to get a good night’s rest.
How can brain injury affect someone’s sleep?
There could be lots of different reasons someone may struggle to get a good night’s sleep after a brain injury.
Changes in breathing
The brain helps regulate breathing, and damage to the part that controls the breath can lead to challenges. In some cases, a person with affected breathing control may actually stop breathing for short periods of time. This is commonly called sleep apnea and can also cause snoring problems.
A common challenge faced by people with sleep apnea is that they don’t know they have it. There are some signs you may notice yourself: you wake up choking, gasping, or with shortness of breath. Other signs such as snoring or stopping breathing are only noticed by others. Sleep apnea may also cause insomnia. If you or someone you share a sleeping space with have noticed these symptoms, you can speak with a doctor about being referred to a sleep specialist who can run more tests.
Chemical changes
Parts of the brain control chemical levels that contribute to sleep. For example, the pineal gland in the brain regulates melatonin, which plays a role in falling asleep [2]. When there is damage to these brain functions, a person may have trouble falling asleep or experiencing disrupted sleep patterns because the chemicals are no longer affecting the brain and body in the same way.
Depression or anxiety
When a person is experiencing mental health struggles such as depression or anxiety, it can make it harder to fall and/or stay asleep. Unfortunately a lack of sleep can then contribute to depression and anxiety. For questions about mental health, you should speak directly to a doctor or medical professional.
Medications
Some medications have side effects that could include trouble falling asleep, staying awake, or drowsiness. Any side effects that may be stemming from medication should be shared with the medical team in charge of prescribing them. While they may not be able to eliminate the side effects, they will be able to explain what’s happening and how to manage them.
Pain and discomfort
Physical pain and uncomfortable positions may contribute to lack of sleep. If you can’t get comfortable, you just won’t be able to get to sleep as easily. While you may not be able to fully eliminate pain, you can try strategies like prescribed medication, special supportive mattresses and pillows, and other sleep aids depending on the type of pain.
Sleep disorders and syndromes
Studies have shown that brain injury and sleep disorders go hand in hand. When looking at a successful sleep-wake cycle, a person gets uninterrupted rest at night and is awake during the day. Sleep disorders make it difficult to rest, and brain injury recovery can suffer as a result. It’s difficult to recognize a sleep disorder or a related sleep problem because it can include resting too much as well as not resting enough.
Any sleep challenges should be shared with the medical team, who may be able to offer additional recommendations for treatment.
Too much napping
A person coping with physical and cognitive changes after a brain injury may need to take more rest periods or naps. Part of a good sleep hygiene routine is listening to your body, and sometimes the body and brain do need a nap. But too much napping can make it difficult for a person to fall asleep at night, when they are supposed to be doing the bulk of their recharging for the next day. This leads to mixed up sleep patterns or poor sleep.
Naps should be limited during the day and should be kept short. An alternative to napping is practicing meditation. It allows you to take some time to rest, but keeps you awake [3].
Sleeping problems can become a cycle that can be difficult to break. But as sleep improves, so does brain injury recovery, and vice versa. The key is finding ways to understand your relationship with sleep and developing methods to support healthy sleeping patterns.
First: figure out what your sleep is like and what could be impacting it
In order to prioritize better, more restful sleep, it’s helpful to understand what could be affecting sleep in the first place. A great way to do this is to keep a sleep journal. This can not only help identify potential sleep problems, but it can be shared with the medical team.
You can also keep track of sleep through technology specifically designed to help monitor sleep. For example, some fitness trackers have sleep functions. They are designed to be as easy on your eyes and brain as possible (little-to-no blue light) and can tell you important information about periods of sleep, if you were restless, and if you woke up. Some even monitor heart rate!
Tips to help get a good night’s sleep
There’s no tried and true method to get a perfect night’s sleep every time. But there are lots of things people with brain injury (and anyone else struggling to sleep) can try.
Avoid stimulants such as caffeine and nicotine
Stimulants like caffeine and nicotine can keep you awake and alert, and when taken before bed, they make the natural chemicals your brain releases much less effective.
Create a bedtime routine and good sleep environment
Creating a consistent and relaxing bedtime routine is an important part of proper sleep hygiene. It’s also good for your mental health to engage in relaxing, self-care focused activities. This includes:
- Bathing 2-3 hours before bed, or at least thoroughly washing your face
- Engaging in proper dental hygiene
- Keep a paper and pencil by your bed so you can write down everything that is on your mind. By writing it down, you have the freedom to let it go from your mind and don’t have to worry about forgetting it
- Meditation
- Only getting into bed at bedtime
- Using earplugs if your home is noisy
- Using a supportive mattress or pillow
- Making sure your bed is big enough and you have plenty of space if you are sleeping with a partner
- Using an eye mask if you need a little extra help blocking out light
You can set reminders on your phone or computer to put technology away, start getting ready for bed, or anything else you have scheduled into your bedtime routine. It may be hard to stick to a routine if you’re not used to it, but over time it can help signal your brain and body that it’s time to sleep.
Don’t exercise right before bed
While exercise is a good and important part of overall wellness, doing it right before bed might impact quality of sleep. This is because adrenaline, heart rate and temperature are elevated. Try wrapping up any exercising earlier in the day. Every person is different so it will take some time to figure out your best time.
Get outdoors when you can
Outdoor activities, fresh air and natural light are commonly known to support health and wellbeing, including sleep.
Keep your room cool and dark
It is recommended that bedrooms be kept cool and dark during sleep because temperature and light play a role in sleep. Ways to help create the right sleeping atmosphere include investing in blackout blinds, removing unnecessary technology from the room, and opening a window, using a fan or using a portable air conditioner if the room is too warm.
Medication
There is medication available to help with sleep, but this should only be taken at the recommendation of a physician. First speak with your doctor about whether a sleep-aid medication is a safe, appropriate choice.
Set a regular bedtime and wake up time
Going to bed and waking up at the same time as consistently as possible helps the body and brain realize it’s time for bed.
Stop screen time a couple hours before bed
Technology has become an important part of daily life, and while you don’t have to give up screens, they shouldn’t be used before bedtime. Your body responds to screens and the artificial blue light they create by suppressing natural functions designed to help you sleep. You should stop using screens and technology at least a couple of hours before bed. The earlier you stop, the easier it will be for your body’s natural sleep functions to kick in.
Use the bedroom only for sleep
Over time, bedrooms can become multi-purpose rooms where people read, watch television, go on their phones, or work. But when a person is experiencing sleep problems, a big part of practicing proper sleep hygiene is to use the bedroom only for sleep and intimacy. Remove all distractions from your bedroom, such as phones, laptops and televisions.
Sleep is an important part of brain injury recovery and overall brain health. Wherever you are in your journey, make sure to prioritize a good night’s rest whenever you can.
To learn more, visit braininjurycanada.ca/en.
