Sleep Disruption with TBI's

Many people who have brain injuries suffer from sleep disturbances.  Sleep is a complex process that involves many parts of the brain.  The brain directs sleep by putting your body to rest.  When you injure your brain, it can lead to many changes in sleep.  For this reason, and depending on the location and the extent of the injury, many different kinds of sleep disturbances can occur after a brain injury.  Not sleeping well can increase or worsen depression, anxiety, fatigue, irritability, and one’s sense of well-being.  It can also lead to poor work performance and traffic or workplace accidents.  A review of sleep disorders studies and surveys revealed that a sleep disorder is three times more coming in TBI patients than in the general population.  Women are more likely to be affected, as are the elderly. 

Some common sleep disorders include:

Insomnia-difficulty with falling asleep or staying asleep or sleep that does not make you feel rested.  Insomnia can worsen other problems resulting from brain injuries, including behavioral and cognitive difficulties.  Insomnia makes it harder to learn new things, and is typically worse directly after injury, and often improves as time passes.   

Excessive Daytime Sleepiness.

Delayed Sleep Phase Syndrome-Mixed up sleeping patterns.

Narcolepsy- Falling asleep suddenly and uncontrollably during the day.

Common sleep syndromes include:

Restless Leg Syndrome (RLS): Urge to move the legs because they feel comfortable, especially at night or when lying down. 

Bruxism: Grinding or clenching teeth.

Sleep Apnea: Brief pauses in breathing during sleep, resulting in reduced oxygen flow to the brain and causing loud snoring and frequent awakening.

Periodic limb movement disorder (PLMD): Involuntary movement of legs and arms during sleep. 

Sleepwalking: Walking or performing other activities while sleeping and not being aware of it.

Things You Can Do to Improve Sleep:

Set an alarm to try to wake up at the same time every day.

Include meaningful activities in your daily schedule.

Get off the couch and limit TV watching

Exercise every day.

Try to get outdoor for some sunlight during daytime. 

Don’t nap for more than 20 minutes a day.

Go to bed at the same time every night.

Follow a bedtime routing.

Avoid caffeine, nicotine, alcohol, and sugar for five hours before bedtime.

Avoid eating prior to sleep to allow time to digest, but also do not go to bed hungry.

Do not eat, read, or watch TV while in bed.

Keep stress out of the bedroom.  Do not work or pay bills there.

Create a restful atmosphere in the bedroom.

If you don’t fall asleep in 30 minutes, get out of bed and do something relaxing or boring until you feel sleepy.  

Understanding an Individual with a TBI

A brain injury occurs every 23 seconds.  3.1 Million Americans live with a Brain Injury.  Obtaining knowledge of Traumatic Brain Injuries will help you understand a client or family member who has one and it will improve the quality of services that you provide to individuals with brain injuries. 

The brain controls everything that we do.  Breathing, walking, talking, thinking, behaving, and feeling are all connected to the brain. Damage to the brain may vary in extent, area, and type of damage, depending on a variety of factors relating to the nature of the injury, the severity of the injury, how the injury occurred, and the quickness of medical response.  Brain Damage occurs in a TBI in 3 different areas.  The Focal Damage would pertain to damages such as skull fractures, contusions or bruises under the location of a particular area of impact.  The Fronto-Temporal Contusions/Lacerations refers to the bruising of the brain, or tearing of blood vessels in the frontal and temporal lobes of the brain caused by the brain hitting or rotating across the ridges inside the skull.  The Diffuse Anoxal Injury refers to when the shifting and rotation of the brain inside the skull will result in tearing and shearing injuries to the brain’s long connecting nerve fibers or axons.  If the brain damage is from a medical incident that results in an infection, swelling of the brain or anoxia, the damage tends to be more diffused.  If the brain damage is related to a medical incident like a stroke or aneurysm, the damage tends to be more focal.

Every person with a brain injury is vastly different because every individual is different prior to an injury, and all brain injuries are different within themselves.  Damage to the brain may vary in extent, area, and type of damage depending on a variety of factors relating to the nature of the injury, the severity of the injury, how the injury occurred, and the quickness of medical responses, among other factors.  Every person adjusts differently to the changes that result from brain injury. Therefore, every person with a brain injury needs differing types and levels of support.  The results of brain injuries can be categorized into the following areas:   Physical, Cognitive, Executive Functioning, Affective Behavioral, and Psychosocial.    

Since every person is different, it is very important to get to know your family member’s or client’s abilities.  A good acronym to remember for this is ROAD.  This stands for Read/Review, Observe, Ask questions, Don’t assume.  ROAD will help to support an individual with a brain injury. 

There are some things to keep in mind and remember while you are with an individual with a Traumatic Brain Injury.  Remember to stress the individual’s strength’s.  Be honest, but gentle and tactful when helping them.  Don’t take things personally; people with brain injuries tend to not have a filter.  Treat everyone with dignity and respect, and never talk down to this person.  Avoid arguments and blame.  Respect differences, and understand you’re own and the person’s cultural and personal values.  Remember that progress may be slow, but keep at it-it works!!  Lastly, make sure you give yourself a pat on the back for a job well done! 

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