Michael S. Jaffee
by Michael S. Jaffee, MD, FAAN, FANA
You might not think about sleep as being related to concussions, but there are a number of ways that a good night’s rest affects (or is affected) by traumatic brain injury.
Sleep problems are a common symptom
Sleep dysfunction, ranging from insomnia to hypersomnia, is very common after traumatic brain injury (TBI). In moderate to severe TBI, where there may be a focal injury to one specific area of the brain, we often see circadian rhythm disturbances and hypersomnia related to hypothalamic injury, while damage to the brain stem’s locus coeruleus has been associated with worsening sleep apnea.
But sleep dysfunction is also commonly associated with mild TBI, or concussion, from which it is more likely to be due to transient impairment of the brain’s neural networks. Sleep dysfunction usually resolves as the concussion resolves, but in some cases, intervention may be needed.
Sleep can affect everything else
It is important to recognize that symptoms don’t occur in silos. If a patient is having trouble sleeping, it can make it more difficult for them to overcome headaches or respond well to therapy for vestibular-ocular dysfunction. Yet sleep problems often fall through the cracks of concussion management.
Optometrists can help by asking something as simple as, “Has your sleep been different since the injury?” If the answer is yes, get more detail on what has changed, and make sure that sleep is on the radar of the team managing the concussion.
Think twice before taking a sleeping pill
Concussion patients should avoid some common sleep aids that can actually worsen recovery due to their effects on brain plasticity and cognition.
For example, I would advocate avoiding benzodiazepines, as well as any drug with anti-cholinergic effects that can contribute to cognitive symptoms. Patients with chronic insomnia often benefit from cognitive behavioral therapy for insomnia, and there is some research suggesting that acupuncture and other behavioral modalities may be beneficial.
Extra sleep may help
We know that one of the physiological functions of sleep in general is to make synaptic function more efficient by recalibrating neurotransmitters and their receptors to reduce “noise” in these neuronal signals.
In addition, we have recently discovered that sleep helps the glymphatic system remove abnormal protein waste products, including the protein amyloid that is associated with Alzheimer’s disease and other cognitive problems. This suggests that adequate sleep after a TBI may be an essential component in brain healing and recovery, especially for older patients.