Posttraumatic sleep disturbance

Mari Viola-Saltzman DO (Dr. Viola-Saltzman of NorthShore University HealthSystem has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released April 22, 1994; last updated May 5, 2015; expires May 5, 2018

This article includes discussion of posttraumatic sleep disturbance, TBI for traumatic brain injury, insomnia, narcolepsy, obstructive sleep apnea, and periodic limb movement disorder. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Sleep disturbances are common after traumatic brain injury, affecting 30% to 70% of individuals, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent complaints after head injury. Narcolepsy (with or without cataplexy), sleep apnea (obstructive and/or central), periodic limb movement disorder, and parasomnias are less commonly reported after traumatic brain injury. In addition, depression, anxiety, and pain are common traumatic brain injury comorbidities with substantial influence on sleep quality. Two types of traumatic brain injury that negatively impact sleep are contact injuries causing focal brain damage and acceleration/deceleration injuries resulting in more generalized brain damage. Diagnosis of sleep disorders after traumatic brain injury may involve polysomnography, multiple sleep latency testing, and/or actigraphy. Treatment is disorder specific and may include the use of medications, continuous positive airway pressure (or similar device), and/or behavioral modifications. Unfortunately, treatment of sleep disorders associated with traumatic brain injury often does not improve sleepiness or neuropsychological function.

Key points

 

• Sleep disturbance after traumatic brain injury occurs in 30% to 70% of individuals.

 

• Insomnia, fatigue, and sleepiness are the most frequent complaints after head injury.

 

• The 2 main types of traumatic brain injury negatively impacting sleep involve contact injury and acceleration or deceleration injury.

 

• Diagnosis of sleep disorder after traumatic brain injury may include polysomnography, multiple sleep latency test, or actigraphy.

 

• Treatment is disorder specific and may include the use of medications, continuous positive airway pressure (or similar device), or behavioral modifications.

Historical note and terminology

Traumatic brain injury is a significant cause of disability and death in the United States and worldwide. Traumatic brain injury is most frequently classified as mild, moderate, or severe using the Glasgow Coma Scale (mild = 13 to 15; moderate = 9 to 12; severe = less than or equal to 8 out of 15) (Winston 1979). The relationships between head trauma and impaired consciousness and cognitive disturbance have been well described (Bricolo et al 1968), but the association between head injury and sleep disturbance has not been extensively studied. Sleep disturbances after traumatic brain injury are thought to occur in 30% to 70% of patients and often impairs the resumption of the individual's normal activities (Ouellet et al 2004).

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