Sleep and Brain Injury

The University of Washington TBI Model System and the University of Washington Medical Center
Sleep and Brain Injury
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Why is sleep important?

During sleep, your brain and body recharge. Proper sleep follows regular and predictable rhythm cycles. When you sleep, your brain sets down memories and refreshes various connections that allow your brain to work. Quality sleep helps you think more clearly, be more alert, and function at your best in all areas: mental, physical, and emotional.

What is a sleep problem?

Sleep problems are related to the amount and quality of sleep you get each day. You may have a sleep problem if you:

  • Are sleeping a lot more or less than 8 hours each day.
  • Feel drowsy no matter how much you sleep.
  • Are not able to fall asleep at night.
  • Wake up often during the night.
  • Wake up extra early and can’t get back to sleep.
  • Have nightmares.
  • Have problems with breathing or snoring.
  • Have unusual body movements during sleep.

Why does a brain injury affect sleep?

You may need extra sleep while your brain is trying to heal from the brain injury. Even if you had a mild brain injury, you might have sleep problems. Your brain might also be having a hard time making or using the natural chemicals that help you fall and stay asleep. It is also possible, especially after a serious injury, that the brain’s electrical rhythms have been disrupted.

A brain injury may also affect control of breathing, dreaming or leg movements. Or, if you have other physical injuries that are causing pain, this pain may affect your ability to sleep.

As your brain and body heal from your injuries, your sleep patterns may become more normal. You may need to take medicines to help you sleep normally, but there are ways to treat some sleep problems without medicines.

Other things may cause sleep problems. Some people have sleep apnea and are not aware of it. Signs of sleep apnea are heavy snoring or gasping for breath during periods of sleep. It can make a person feel tired all the time.

Sleep problems can also be a side effect of some medicines. Ask your doctor if your sleep problems could be related to medicines you are taking.

What are some effects of sleep problems?

If you are having sleep problems, you may:

  • Feel tired even if you think you are getting a lot of sleep.
  • Feel irritable and cranky because you are so tired.
  • Have frequent headaches.
  • Feel depressed or anxious.
  • Develop body aches and pains.
  • Have problems remembering things or thinking clearly.
  • Not do things you would normally do because you are too tired or because you sleep through them.

What can make sleep problems worse?

  • Drinking caffeine, alcohol, or exercising too much late in the evening.
  • Sleeping in a room that is too hot, too cold, or not dark enough.
  • Watching TV while in bed.
  • Irregular sleep patterns.
  • Taking naps during the day, or sleeping longer than 20 minutes when
  • you nap.
  • Physical problems that interfere with sleep such as pain or sleep apnea.

When should I ask for help with sleep?

Talk with your health care provider if:

  • Your sleep problems are getting worse or do not seem to be getting better.
  • Practicing good sleep habits is not working.
  • Pain interferes with your sleep.
  • You think your sleep problems are related to a medicine side effect.

What can I do about sleep problems?

Follow recommendations from medical professionals:

If your doctor has prescribed a sleep medicine, take it as prescribed. When taking sleep medicine, talk with your doctor if:

  • The medicine doesn’t seem to be working.
  • You feel you are sleeping too much.
  • You think you may be having side effects from the medicine.

You may need to have a sleep evaluation so doctors can check you brain’s sleep rhythms. This can help identify why you are having sleep problems.

Evaluate your sleep problems:

Keep a journal of your sleep habits that includes:

  • What time you go to bed at night.
  • What you usually do right before bedtime.
  • What you eat during the day, and when.
  • What you drink during the day, and when.
  • What wakes you up during the night, such as the need to go to the bathroom.
  • What your sleep problems are like, and if you wake up at the same times during the night.
  • If you feel anxious at night.
  • If you have nightmares or bad dreams.

If you have a sleep partner, ask if they notice any unusual behavior during the night. Add this information to your sleep journal.

Practice good sleep habits:

  • Make your bedroom a comfortable place to rest.
  • Make your sleep environment as quiet as possible. Play soothing music or turn on a fan at night if these help you to sleep.
  • Sleep in a dark room that is not too hot or too cold.
  • Do not drink caffeinated beverages in the afternoon or evening.
  • This includes soda, coffee, or tea with caffeine.
  • Do not eat, drink any beverages, or smoke for at least 2 hours before bed.
  • Do not exercise strenuously in the evening.
  • Go to the bathroom before you go to bed.
  • Follow a relaxing, calming bedtime routine.
  • Go to bed at the same time every night, even on weekends.
  • Wake up and get up at the same time every morning.
  • Spend non-sleep time out of bed and out of your bedroom.
  • If you are tired during the day, try going for a walk or doing some gentle exercising instead of taking a nap.
  • Do not sleep or nap for more than 20 minutes during the day.

Where can I learn more about sleep problems?

Ask a professional:

  • Talk with your doctor or psychologist about your sleep problems.
  • Talk with any of your therapists about sleep concerns, so they can help direct you to good resources for help.
  • You may benefit from a sleep study in a sleep laboratory. Discuss this with your doctor.

Check out these resources:

Brain Injury Association of America
www.biausa.org/
8201 Greensboro Drive, Suite 611, McLean, VA 22102
703-761-0750
Brain Injury Information Hotline: 800-444-6443

Brain Injury Association of Washington
www.biawa.org/
3516 S. 47th Street, Suite 100, Tacoma, WA 98409
253-238-6085
Helpline: 800-523-5438
E-mail: info@biawa.org

Multiple Sclerosis Association of America
www.msaa.com
706 Haddonfield Road, Cherry Hill, NJ 08002
856-488-4500

National Brain Tumor Foundation
www.braintumor.org
22 Battery Street, Suite 612, San Francisco, CA 94111
Patient Line: 800-934-2873
E-mail: nbtf@braintumor.org

National Multiple Sclerosis Society
http://was.nationalmssociety.org
Greater Washington Chapter
192 Nickerson St., Suite 100
Seattle, WA 98109
800-344-4867
E-mail: greaterWAinfo@nmsswas.org

National Stroke Association
www.stroke.org
9707 E. Easter Lane, Englewood, CO 80112
800-STROKES (800-787-6537)

Alzheimer’s Association
www.alz.org
225 N. Michigan Ave., Fl. 17, Chicago, IL 60601
Helpline: 800-272-3900

National Parkinson Foundation
www.parkinson.org
1501 N.W. 9th Avenue, Miami, FL 33136-1494
800-327-4545

Posted on BrainLine June 19, 2009.

From the University of Washington TBI Model System and the University of Washington Medical Center. Used with permission. 

Comments (19)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Anonymous replied on

In auto accident 34 years ago. After months of hospitalization, and rehab, I came home. NO PROBLEMS WITH SLEEP. 21 years later I move to housing. Shortly there after I find myself with sleep problems. I’ve had five different prescriptions for sleep meds, and nothing works. I’ve actually gone days on a few hours sleep, I just cannot sleep. HELP!

Justin replied on

I suffered a TBI back in July 2018 and was in a coma for nearly 3 weeks and then eventually woke up, Memory and other simple tasks are still a little difficult; however, it has improved as I've retaught myself how to redo everything and am back working full-time. However, I still suffer the sleep problems and still working on my short-term memory. Once I fall asleep, I'm usually able to get maybe 6-8 hours of rest, but it still takes me about 40-50 minutes to fall asleep, pre-injury it was super easy, taking maybe 5 minutes or less to fall asleep. Hoping with the doctor's estimating I'll eventually make a 100% recovery due to my age (25), that in time sleep returns to normal.

Ryan replied on

If you want to fall asleep pretty quickly then try what I am using. I was in a horrible car accident that almost killed me. In turn it caused a traumatic brain injury. I am the age of 34. Right before you go to bed take a tea spoon of buckwheat honey. It can be purchased off of eBay. I know it sounds weird, but it really works. Before my accident I was not big on "home remedies", but there Is use for everything all natural. The best part about it is that there is no pills involved.

Danielle replied on

I was in a horrible car crash in July of 2018. It caused a stroke and concussion. Had issues sleeping for several months. Now I sleep 12 plus hours. I take CBD oil and Lion Mane Mushroom tables. Helps with anxiety. Anyone else sleep 12 plus hours?

Joshua Dolezal replied on

I have found that the only thing that works for me is Alprazolam 2MG. I have been on EVERY sleep medication available.

David replied on

I've been through all the tca antidepressants they all keep me awake. Only phenergan (promethazine) seems to work for sleep plus sitting and looking at a tree out the window and acting sleepy and heavy eyed before bed. I also look at the tree when I wake for to long.

Abby replied on

I was in a coma for six weeks after falling 70 feet off a cliff. This happened a year ago, July 2016, and I still wake up pretty early. Like 5:30. But 5:30 is so much better than what it was before, it was 4:30 for several months. Now it feels like my life can continue to progress as I relearn "simple" tasks, like walking, driving, or playing the piano. I'm not completely experienced in the world of brain injury recovery yet, it's only been a year, but it feels like I'm relearning every task that was taken from me.
Stay strong, everyone!

Anonymous replied on

I was in a vehicle crash in 2015 (not my fault at all) and was diagnosed with whiplash, concussion, TBI, fractured c5, fractured t4, herniated/bulging discs, torn ACL in knee, bakers cyst.... list goes on and on. I never had ANY trouble sleeping until the wreck. I used to be able to fall asleep within 10 minutes and bragged about how well I slept. Now I lay there trying to fall asleep and it takes at least an hour if not more. I wake up every two hours and fight to go back to sleep. Those two or so hours of sleep feels like 10 minutes. I have to take 10 MG of melatonin every night to be able to sleep.... I fall asleep within an hour and wake up feeling semi-rested. I'm still tired throughout the day and lay down for a nap every afternoon (whether I can sleep or not is another story). Still have headaches, memory issues, trouble getting the right word out, forgetfulness, confusion. They say it gets better - I sure hope so! It's been over 18 months now and still not any better than the day of the wreck.

Anonymous replied on

I'm prescribed trazadone. I flipped my car and was in coma for 3 months. No matter how much sleep I get I still feel tired. Went to bed at 7:00 woke up at 6:00 still tired and can't fall back to sleep. So took my morning medicine :-\ and up for the day. Might take a valium later but it won't matter if I sleep more I'll still be tired. So sad.

Anonymous replied on

I suffered a TBI in a car accident in early 2015. I still have some problems sleeping, but here's what's worked the best for me. For the couple of months after the accident, I took kava supplements, which helped a lot. It's only for short-term use, though. I've been taking 10mg melatonin every night for the past 2 years. When using melatonin, though, you have to start at small doses and work your way up. I was disabled for 8 months and then only went back to work p/t, so I don't have to use an alarm clock. I can also lay down and take a cat-nap while working, if needed. I wear a sleep mask to block out ALL light, because any light at all will awaken me. I also avoid anything physically or cognitively stimulating in the evening before bedtime. Practicing gentle yoga in very dim light for the half hour before bedtime seems to help me a lot, too.

Anonymous replied on

I had an accident on 1st sep 2014 it has been 1 year and 10 months i had accident on my bike i was in coma for four days and when i came conscious i was unable to speak that whole day and to make things worse my left part was paralysed temporary and i am a lefty also since then i am : 1) unable to speak properly 2) have problem in writing 3) sleeping problem and i also smoke a lot i am 24 years old

Anonymous replied on

I've tried everything the article said above that was suppose to help, but nothing worked. My accident happened August 2012. It is June 2016 now. I am missing out on life because of my sleep issue--it is very depressing, and disturbing not only to me but others who are affected by the problems that come with my sleep issues.  I no longer have a normal healthy and active life.

Anonymous replied on

i suffered a brain injury august 24 the summer of 2014 it is now at least year and a half later and i cannot take full days of school because i need sleep. i sometimes can sleep for 5 hours and still be tired. as much as i sleep during the day,i sleep fine at night. i am now 15 years old. that same summer i got mono and right when it went away i got the TBI. I am not sure why i am still sleeping if it is the injury or mono that hasn't gone away but i am on Vyvanse stimulant which helps me a lot with focus but we keep increasing the dose and i am still sleeping. the psychologist said that i wouldnt sleep on this stimulant but we are now at a point where if we increase the dose anymore, it is past the FDA law not sure what to do.

Anonymous replied on

I had a major TBI in August 1997. I have not had one normal night sleep since. I just recently found out I had issues with my C1, and am going through a treatment plan to fix these problems. There is some hope that once treatment is finished, I will be able to sleep, but who knows

Anonymous replied on

i feel exactly the same i try to go to sleep a little later so that ill sleep all night but nope im up all night and really anxious during the day :(

Anonymous replied on

So sorry no one ever responded to you. I have a terrible time staying asleep, wake up every 2 hours. My mind never stops. Random words flood out and echo in my mind in a nonsensical pattern..it's exhausting. My injury in the left parietal. The headaches are terrible, but not constant anymore. It's been 6 years...I'm so much better, please don't lose hope out there. I still have a ways to go...almost my old self again. :)

Anonymous replied on

I was in a car accident and received a brain injury and cannot sleep i have been to a doctor and been to the hospital and nothing is working im now on my phone looking for help i like there it said your sleep can fet better after hesling time thats 3 years now and still the same im going to post this but i have just noticed no reply haha i hope if anyone else sees this and has the same problem you are not alone cos i feel i am

Wade replied on

You are not alone. Multiple concussion with a trigger for PCS 5 years ago hitting a deer at 65mph. Nightmares, insomnia, supersomnia, thrashing shouting. My pre injury sleeping was amazing. Now it's awful. Best solution so far has been tart cherry juice every night before bed. Good luck.

Anonymous replied on

great article