Getting needed rest after brain injury
Challenges with sleep
One in two people who have sustained brain injuries report experience with disturbed sleep patterns or arousal challenges. Sleep disturbances leading to less restorative sleep include:
- Increased awakenings
- Decreased sleep efficiency
- Changes in the amount of time spent in different stages of sleep
- Difficulty with sleep inertia, when it takes longer to wake up. The brainwaves normally seen during sleep continue even after waking and take a longer time to go away.
Tips for improving sleep
Sleep is essential for thinking, mood regulation, and physical functioning. Adults require an average of 7 to 8 hours of sleep each night for optimal function. Here are some tips for healthy sleep:
- Maintain a consistent bedtime and wake routine.
- Get regular exercise.
- Keep your room quiet, cool, and comfortable.
- Have physical and medical concerns addressed by your healthcare team.
- Use the bed only for sleep and sex.
- Avoid these behaviors:
- Staying in bed when not tired.
- Taking naps, especially in the afternoon.
- Having caffeine in the afternoon or evening.
- Drinking alcohol, as it prevents the body from reaching the deeper restoring stages of sleep.
Getting help
Your physician or healthcare provider may wish to consider a trial of sleep aids, such as Trazodone, balancing side effects, medical issues, and effectiveness of the potential medications.
They may also order a sleep study or overnight oxygen monitoring to determine if there are any other abnormalities, such as when the airway becomes blocked and there are periods of poor breathing at night.
Caregivers can help by recording sleep logs to look at changes that occur with different strategies used to improve sleep.
Challenges with fatigue
Brain injury survivors can also experience difficulty with fatigue following their injury. Fatigue symptoms include feelings of exhaustion, tiredness, weariness, or lack of energy, and difficulty with initiating and/or sustaining attention to tasks and physical activities
Types of fatigue
- Physical: Feeling physically tired, having low energy, or dragging. Physical fatigue is associated with muscle weakness, damage to parts of the brain including basal ganglia and the reticular activation system, or medical conditions such as insomnia or sleep apnea.
- Mental: Difficulty staying focused for long periods of time, brain seems to go blank. Mental fatigue is associated with the extra effort the brain uses after a traumatic brain injury (TBI) to complete the same tasks.
- Psychological: Low motivation, weariness, or feeling worn out. Psychological fatigue is associated with depression, anxiety, and other types of stress.
Tips for managing fatigue
- Physical
- Get adequate rest.
- Avoid alcohol, tobacco, illicit drugs, and caffeine.
- Resume physical activity gradually while also getting adequate exercise.
- Mental
- Take frequent breaks when working on activities.
- Develop strategies for managing time, such as checklists and calendars.
- Resume mental activities gradually, beginning with most familiar tasks.
- Do not over-schedule activities, tasks, or visitors.
- Psychological
- Work on developing a routine to combat low motivation.
- Enlist family members to provide encouragement.
- Engage in enjoyable activities.
- Discuss your mood and motivation with your doctor.
Getting help
It is important to determine whether the fatigue is primary to the brain injury or secondary to another condition, such as depression, pain, sleep disorders, or neuroendocrine abnormality, which have all been associated with fatigue after brain injury.
Your physician/healthcare provider may want to review your current medications to determine if there is a side effect that can be reversed, or may run a series of laboratory tests to rule out additional health conditions.
Families and loved ones can assist by appreciating the impact of fatigue on a person’s activity tolerance and scheduling breaks as needed in the daily routine to help recover.