Understanding Sleep and Concussions

Woman after a good night sleep

Sleep Issues and Concussion/mTBI

Contrary to popular health advice, in 2017 I made it my New Year’s Resolution to get less sleep. Ever since my concussion I had been sleeping more than normal. By the end of 2016 I still needed almost 10 hours of sleep at night. It was getting old.

I tried everything I could think of. A light therapy alarm clock to signal that it was time to wake up. Essential oils to make me feel more energetic. A “better” diet and exercise program. Some of these things helped a little, but there was no quick fix. 

These weren’t the only sleep issues I experienced. Early in recovery, it would take hours to fall asleep. Every night it felt like fireworks were going off in my brain and my limbs were restless. My hyperactivity got better over time, but sleep issues plagued me longer than most other symptoms.

If any of this sounds familiar you are not alone. Sleep disturbance is the second most common concussion/mTBI symptom. People report difficulty falling asleep, difficulty staying asleep, general fatigue, and daytime sleepiness. Sleep apnea, narcolepsy, and periodic limb movement disorder are possible but less common. 


In this post we’ll cover:

  • How Sleep Works

  • Why Brain Injury Causes Sleep Issues

  • Finding Relief for Sleep Issues after Concussion

  • Sleep Hygiene

How Sleep Works

Circadian Rhythm 

  • Normal sleep is controlled by several factors. Circadian clocks are located throughout the body. These clocks work together to create a 24-hour sleep/wake cycle called the circadian rhythm. The main clock is located in your brain and tells your body when it’s time to sleep. 



Sleep Stages

  • There are also different stages while you’re asleep. The two main stages are slow sleep and paradoxical sleep. Normally, 20% of your sleep cycle is slow sleep and 80% is paradoxical sleep. Each stage has its own important restorative function. 



Environmental Signals

  • Environmental signals play a major role in your sleep/wake cycle. Light is one of the most important. Light signals pass through your eyes and are sent to your brain. Then, they’re transmitted to the rest of the body through your sympathetic and parasympathetic nervous systems. This helps your central body clock know when it’s daytime and nighttime. 



Hormones

The sleep system is influenced by hormones and other compounds. A few examples are: 

  • Adenosine: This rises throughout the day and signals the urge to sleep around bedtime. 

  • Melatonin: This rises in the evening. It’s thought to promote sleep. 

  • Cortisol: This rises as you are exposed to light and signals your body to wake up. 


Why Brain Injury Causes Sleep Issues

Understanding normal sleep helps you see how easily this system can get disrupted. Brain injury can cause damage to different areas of the brain that control sleep. Or, the brain can have a hard time communicating between different areas. Some other problems include: 



Hormone Imbalance

Brain injury can change the brain’s production of hormones like melatonin and serotonin. When hormone production changes, the body’s sleep/wake cycles get disrupted. 

Altered Sleep Stages

People may experience sleep fragmentation after a concussion. This means that they spend more time in slow sleep stages, but they also get less sleep overall.


Autonomic Dysregulation

  • Some people experience Autonomic Dysregulation after a concussion. The autonomic nervous system includes the sympathetic and parasympathetic nervous systems. These systems control many vital functions including blood pressure regulation, thermoregulation, gastrointestinal responses, the body’s fight-or-flight response, and more. 

  • The autonomic nervous system plays a major role in sleep. Autonomic dysregulation negatively affects sleep, and poor sleep can also exacerbate dysregulation. There are tests your doctor and/or therapist can perform to detect dysautonomia. It’s important to know if you have an autonomic nervous system problem since it impacts so many functions. 


Mental Health Problems

  • Mental health issues like stress, anxiety, and depression are common after brain injury. It’s hard to go to sleep, stay asleep, and/or get the right amount of sleep with these issues affecting you.

Finding Relief for Sleep Issues after a Concussion

Sleep issues may resolve in a few weeks as the brain heals. For some people with post-concussion syndrome (PCS), sleep issues can last for several weeks or more after an injury. At that point, talk to your doctor. Since sleep impacts every aspect of recovery it’s important to address problems early on. 

There may not be a quick fix for prolonged sleep issues. But, there are some next steps you can try to decrease the severity of these issues. 

Treatment

  • There are treatment options for some underlying conditions that cause sleep issues. An endocrinologist can help with hormone imbalance. Physical therapy can help with dysautonomia. Cognitive therapy can help your brain communicate better with itself. Treating these systems may improve your sleep. Talk to your doctor about a referral for specific types of treatments. 

Medication

  • Your doctor may prescribe medication. If you get medication, it’s helpful to take it consistently. Take the recommended dosage at the same time each day since natural sleep happens in a 24-hour cycle.

Relaxation Exercises 

Relaxation exercises help some people soothe a restless mind or body and fall asleep faster. You can try these relaxation exercises: 

Counseling 

  • A counselor can help address mental health conditions like anxiety, depression, and stress. Cognitive behavioral therapy has been shown to help with sleep disorders including insomnia. 

Sleep Hygiene 

Sleep hygiene is the set of habits you do before bed to promote a restful sleep. They may not cure your sleep issues, but they can significantly improve the quality of your sleep. Some basic sleep hygiene tips include: 

  • Routine: Go to bed and wake up at a consistent time. For most people, the best time for sleeping is between 10pm and 6am. 

  • Stress: Even “good” stress, like exercise, can disrupt your sleep cycle. Avoid strenuous activities and keep cognitive and emotional demands low in the 1-2 hours before bed. 

  • Relaxation: Gentle yoga, meditation, progressive relaxation, a warm bath, slow-paced reading, listening to soothing music, and listening to a slow-paced podcast can promote relaxation before bed. 

  • Environment: Make your room feel restful. Clear clutter, turn on a lamp, make sure your sheets are clean, and try aromatherapy for a restful sleep. 

  • Prepare for tomorrow: Check your calendar, organize the clothes and items you need, and set up reminders to help you remember important things. That way you can go to bed confident that you are ready for tomorrow. 


Sources and additional Resources:

How Sleep Works

Update on Insomnia after Mild Traumatic Brain Injury

Sleep and Concussion

Sleep Disturbance and Melatonin Levels Following Traumatic Brain Injury

Concussion and the Autonomic Nervous System

Autonomic Dysfunction in Primary Sleep Disorders 

Autonomic Dysfunction after Mild Traumatic Brain Injury

The Link Between Concussion and Sleep Problems

Post Concussion Syndrome and Sleep



Disclaimer: This content is for informational purposes only and does not substitute personalized medical advice, diagnosis, or treatment. Always consult your doctor or other qualified healthcare provider with questions, and before starting any nutrition, diet, exercise, fitness, medical, or wellness program. 

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