Disorders of sleep are some of the most common problems experienced by patients after TBI. It is important to recognize and treat these problems early to allow for optimal cognitive recovery, but because they are so common, the importance of treating them is often underestimated. In NeuroRehabilitation scientists address the interplay of sleep and TBI with the aim of improving both diagnosis and treatment of these problems. Insomnia, fatigue, and sleepiness are the most frequent patient complaints following TBI, and patients with sleep disturbances have been found to have longer inpatient hospital stays, higher cost of rehabilitation, and higher rates of functional disability.
Studies have shown that minimizing sleep-wake cycle disturbance is associated with improvement in fatigue levels, mood, and cognitive functioning and decreased levels of anxiety, although the cause and effect relationship is uncertain. The authors explain that management of TBI-related sleep-wake disturbances requires a multifactorial approach, and key treatment principles include utilizing first-line non-pharmacological interventions such as establishing a regular bedtime routine, creating a restful bedroom environment with minimal light and ideal ambient temperature, minimizing daytime napping, limiting evening caffeine and alcohol intake, and avoiding late-night screen-time. They advocate minimizing the use of medications that may adversely affect cognition and selecting appropriate pharmacologic agents when indicated.