Concussion

Traumatic brain injuries, also known as concussions, are caused by falls, violence, and sports injuries. Sleep problems commonly follow concussions. Poor sleep can negatively impact neurocognitive rehabilitation and and slow recovery by worsening headaches, mood disturbances, and cognitive dysfunction.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is impacting your concussion recovery. We prudently assess for sleep disorders as exampled below:

• Sleep-Disordered Breathing

  • Sleep-disordered breathing can follow a traumatic brain injury due to an impairment of the brain's ability to control breathing during sleep. Obstructive sleep apnea is a physical collapse of the upper airway that interrupts breathing during sleep. Central sleep apnea occurs when your brain doesn't send proper signals to the muscles that control your breathing. Apnea reduces blood and oxygen flow to the brain, making it difficult to recover for those with a concussion.

• Excessive Daytime Sleepiness

  • Concussions can lead to post-traumatic hypersomnia or excessive daytime sleepiness, which in turn impairs neuropsychological and cognitive rehabilitation.

• Insomnia

  • The injury can damage the neurotransmitters that regulate sleep or the neural networks that regulate sleep. Insomnia, defined as difficulty falling asleep, staying asleep, awakening too early, or non-restorative sleep, can be caused directly by brain trauma or indirectly by medication, anxiety, and depression.

• Circadian Dysrhythmias

  • Concussion-related inflammation can disrupt the chemical signaling that regulates sleep circadian and homeostatic processes.

Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and concussion. Treating sleep problems may improve concussion because, as mentioned, disordered sleep and daytime sleepiness can impair the rehabilitative process. We direct treatment toward the sleep disorder as exampled below:

• Removing the tonsils, expanding the palate, and starting CPAP can help concussion and disordered sleep symptoms.

• Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.

• Identifying and eliminating the cause of awakenings from sleep

• Utilizing light therapy to advance or delay your sleep cycle

In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:

• Ensuring your bedroom environment is conducive to sleep

• Eliminating sources of sleep interruption like light and noise

• Optimizing your diet as food can promote and hinder sleep

• Assessing your nighttime habits and rituals

A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and anxiety.

Several medication classes treat concussion, including anti-anxiety drugs, antidepressants, and headache and sleep medications. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications to treat an identified underlying cause.

Treating hypocapnia may help improve concussion symptoms by restoring proper blood flow and oxygen to the brain. Hypocapnia reduces cerebral blood flow, worsening symptoms like headaches and dizziness. Correcting it can enhance brain oxygenation and potentially aid in recovery.