Sleep And Concussion: TBI Sleep Disruptions, Recovery Impacts, & Treatment
Quick Summary
Sleep disorders are a very common consequence of a traumatic brain injury (TBI), affecting approximately 50% of survivors, regardless of the injury's severity.
The most frequent problems include excessive daytime sleepiness (EDS), an increased need for sleep (post-traumatic hypersomnia), persistent fatigue, and insomnia.
Survivors of TBI often have difficulty accurately perceiving their own sleep problems; they may significantly underestimate their sleepiness or overestimate their insomnia, making professional diagnosis crucial.
Untreated sleep disorders can seriously interfere with rehabilitation, worsen cognitive and emotional symptoms, and negatively impact a person's quality of life and ability to return to work.
An Overview of Sleep Disorders after Traumatic Brain Injury
A traumatic brain injury, or TBI, whether a concussion or a major brain injury, is a significant health issue and a leading cause of long-term disability, especially in young adults worldwide (Singh et al., 2016).
While the immediate physical and cognitive effects of a TBI are often the primary focus of treatment, sleep-wake disturbances are an extremely common, persistent, and frequently overlooked consequence. These problems can appear shortly after the injury or develop over time, lasting for months or even years.
Effectively managing sleep is a critical part of TBI recovery. Disrupted sleep can hinder the brain's natural repair processes and worsen other common TBI symptoms like headaches, irritability, and difficulty with concentration. Understanding the types of sleep disorders that can occur, their causes, and the available treatments is a vital step for patients, families, and caregivers on the path to recovery.
But what exactly are these disorders, and how do they develop after an injury to the brain?
What Are Common Sleep Disorders after Traumatic Brain Injury (TBI)?
Sleep disorders after a traumatic brain injury are a wide range of problems with sleep patterns, sleep quality, and daytime alertness that begin or worsen following an injury to the head. A TBI is formally defined as "an alteration in brain function, or other evidence of brain pathology, caused by an external force" (Menon et al., 2010). This external force can damage brain regions and disrupt the complex neurochemical systems that regulate our sleep-wake cycle.
These are not a single condition but a category of different disorders, which can occur alone or in combination. The most common types include:
Insomnia: Insomnia is a persistent difficulty with falling asleep, staying asleep, or experiencing non-restorative sleep.
Excessive Daytime Sleepiness (EDS): An overwhelming feeling of sleepiness during the day, often leading to unintentional naps.
Post-Traumatic Hypersomnia: A significantly increased need for sleep, often defined as needing two or more hours of extra sleep per 24-hour period compared to before the injury (Baumann et al., 2007). This is sometimes referred to as pleiosomnia.
Post-Traumatic Fatigue: A persistent and subjective feeling of physical and mental exhaustion and lack of energy that is distinct from sleepiness.
Circadian Rhythm Sleep-Wake Disorders: Circadian rhythm disorders are a mismatch between a person's internal body clock and the external 24-hour day, leading to conditions like delayed sleep-wake phase disorder (consistently falling asleep and waking up very late).
Sleep-Related Breathing Disorders: Conditions like obstructive sleep apnea (OSA), where breathing repeatedly stops and starts during sleep.
Parasomnias: Parasomnias are undesirable events or experiences that occur during sleep, such as nightmares, acting out dreams (REM sleep behavior disorder), or sleepwalking.
Sleep-Related Movement Disorders: Sleep-related movement disorders include conditions like restless legs syndrome, bruxism, which involves grinding or clenching the teeth during sleep.
Given how many people are affected, just how common are these conditions?
How Common Are Sleep Disorders after Traumatic Brain Injury?
Sleep disorders are remarkably common after a TBI. Research shows that these issues are far more prevalent in TBI survivors than in the general population.
A comprehensive meta-analysis, a type of study that combines the results of many previous studies, found that about 50% of all individuals with a TBI experienced post-traumatic sleep-wake disturbances (Mathias & Alvaro, 2012).
Another prospective study, which follows participants forward in time, found that six months after an injury, 72% of patients reported new sleep-wake disturbances that they did not have before the accident (Baumann et al., 2007).
These problems can persist for a long time; one study found that 67% of patients still had symptoms three years after their TBI (Kempf et al., 2010).
The prevalence of specific disorders is also high:
Insomnia is reported by 30% to 70% of TBI patients (Ouellet et al., 2004).
Subjective daytime sleepiness is reported in 50% to 85% of individuals after a TBI (Collen et al., 2012; Guilleminault et al., 2000; Verma et al., 2007).
Obstructive sleep apnea has been found in 23% to 36% of TBI survivors in various studies (Castriotta et al., 2007; Collen et al., 2012; Guilleminault et al., 2000).
Post-traumatic hypersomnia (increased sleep need) was diagnosed in 22% of patients six months after their injury (Baumann et al., 2007).
These statistics highlight that sleep problems are a majority, not minority, experience after TBI.
So, what is it about a brain injury that causes such widespread disruption to sleep?
What Causes Sleep Disorders after Traumatic Brain Injury? What Are the Risks That Make It More Likely?
The causes of sleep disorders after a TBI are complex, resulting from a combination of direct physical damage to the brain, neurochemical imbalances, and secondary factors like inflammation and pain. No single cause is responsible; rather, multiple overlapping factors contribute to the disruption of sleep.
Direct Neurological Damage:
Loss of Wake-Promoting Neurons: One of the most significant findings is damage to the hypocretin (also called orexin) system in the hypothalamus. Hypocretin is a key chemical for stabilizing wakefulness. Post-mortem studies of patients with severe TBI have shown a significant physical loss of the neurons that produce it (Baumann et al., 2009). This damage helps explain the profound sleepiness seen after an injury.
Circadian Clock Disruption: The brain's master clock, known as the suprachiasmatic nucleus (SCN), can be thrown off by a TBI. Animal studies show that an injury can alter the expression of "clock genes" that regulate the body's internal timing (Gosselin & Baumann, 2022). This is often combined with lower production of melatonin, the hormone that signals sleep time, leading to delayed sleep schedules and fragmented rest.
Neuroinflammation: A TBI triggers a major immune response in the brain, releasing inflammatory chemicals called cytokines. These are the same chemicals that make you feel sleepy when you have the flu. This neuroinflammation promotes "sickness behavior," which is characterized by a biologically driven need for increased sleep to aid healing.
Secondary and Pre-existing Factors:
Beyond the direct injury, a number of other factors can trigger or worsen sleep problems (Ouellet et al., 2015):
Pre-Injury Factors: These include genetic predisposition, prior sleep habits or disorders, age, and general health.
Acute Factors (During and Immediately After Injury): These include the hospital environment which can significantly disrupt sleep, pain, anxiety, and medications used for treatment.
Post-Acute Factors (During Long-Term Recovery): These factors cause sleep problems to continue over the long term. They include chronic pain, psychiatric conditions like depression and PTSD, and the side effects of long-term medications.
These various factors combine to create a complex clinical picture. So what are the specific signs and symptoms a person might experience?
What Are the Signs And Symptoms of Sleep Disorders after Concussion And TBI?
The signs and symptoms of sleep disorders after a TBI vary widely depending on the specific condition or conditions a person develops. It is common for an individual to experience symptoms from more than one type of sleep disorder.
The most common symptoms fall into several key categories:
Problems with Daytime Alertness:
Excessive Daytime Sleepiness (EDS): This is more than just feeling tired. It is an intense pressure to fall asleep during the day, especially during quiet or sedentary activities like reading or watching television. It can lead to involuntary and unrefreshing naps.
Post-Traumatic Hypersomnia (Pleiosomnia): The primary symptom is a biological need for much more sleep than before the injury. A person may find they need to sleep 10, 11, or more hours a night to function. It is important to distinguish this from depression; patients with pleiosomnia physically require the extra sleep to function, whereas individuals with depression may stay in bed due to a lack of motivation.
Fatigue: This is a constant feeling of mental and physical exhaustion, apathy, and a lack of energy that is separate from sleepiness, and not necessarily relieved by sleep. A person can feel fatigued even if they are not sleepy. Post-traumatic fatigue is one of the most persistent symptoms after a TBI (Ponsford et al., 2014).
Problems with Nighttime Sleep:
Insomnia: This includes a range of symptoms such as taking a long time to fall asleep, waking up frequently throughout the night, waking up too early and being unable to get back to sleep, and feeling that sleep was not refreshing.
Fragmented Sleep: Even if a person does not fully awaken, their sleep may be broken by many brief arousals, leading to poor sleep quality.
Problems with Sleep Timing:
Delayed Sleep-Wake Phase Disorder: A person's internal clock is shifted later. They may not feel sleepy until 2 or 3 a.m. and will then have great difficulty waking up for work or school in the morning.
Irregular Sleep-Wake Rhythm: There is no consistent pattern of sleep and wakefulness. A person may take multiple short naps scattered throughout the 24-hour day.
Other Sleep-Related Symptoms:
Sleep Apnea: Symptoms include loud snoring, gasping or choking sounds during sleep (often reported by a bed partner), and morning headaches.
Parasomnias: This can include having frequent, distressing nightmares or physically acting out dreams, which can be violent and potentially cause injury.
Bruxism: Jaw pain, facial soreness, or headaches upon waking due to clenching or grinding teeth during the night.
With such a wide array of potential symptoms, how do healthcare professionals arrive at an accurate diagnosis?
How is Sleep Disorders after Traumatic Brain Injury Diagnosed?
Diagnosing sleep disorders after a TBI requires a thorough approach that often involves a team of specialists, including experts in neurology, sleep medicine, and rehabilitation.
A key challenge in diagnosis is that TBI survivors often misperceive their own symptoms. This discrepancy between subjective feelings and objective reality, sometimes related to a condition called anosognosia (a lack of insight into one's own deficits), is one of the most consistent findings in TBI research.
Specifically, patients with moderate-to-severe TBI tend to significantly underestimate their daytime sleepiness and increased need for sleep (Baumann et al., 2007; Masel et al., 2001; Sommerauer et al., 2013).
Conversely, those with mild TBI may be more likely to overestimate the severity of their insomnia (Ouellet & Morin, 2006).
Because of this, doctors need to be highly alert to the possibility of these disorders, and relying solely on a patient's self-report is often insufficient.
The diagnostic process typically includes several components:
Structured Clinical Interview: A detailed discussion about sleep patterns both before and after the injury. Whenever possible, input from family members or caregivers is crucial.
Questionnaires and Sleep Logs: Standardized questionnaires, like the Epworth Sleepiness Scale, are used to measure subjective sleepiness. A sleep log can help identify patterns.
Actigraphy: This involves wearing a wrist-watch-like device that tracks movement to estimate sleep-wake patterns over several days or weeks in the person's home environment.
Polysomnography (PSG): This is a comprehensive, overnight sleep study conducted in a lab that records various body functions during sleep. It is essential for diagnosing conditions like sleep apnea.
Daytime Sleep Studies (MSLT and MWT): These tests objectively measure sleepiness (MSLT) or the ability to stay awake (MWT) through a series of scheduled nap opportunities in a controlled lab setting.
This thorough evaluation is critical because untreated sleep disorders are linked to a number of other health problems.
Health Problems Linked to Sleep Disorders after Traumatic Brain Injury
Sleep disorders that develop after a TBI are not just a matter of feeling tired; they can trigger, worsen, and complicate a range of other physical and psychological health issues, significantly impacting overall recovery.
One of the most direct consequences is the worsening of other TBI-related symptoms. Poor sleep can worsen:
Cognitive Deficits: Problems with attention, concentration, and memory.
Headaches and Pain: Creating a vicious cycle where pain disrupts sleep and lack of sleep lowers the pain threshold (Chaput et al., 2009).
Irritability and Emotional Dysregulation: Leading to difficulty managing emotions, increased irritability, and mood swings.
Furthermore, sleep problems are closely associated with mental health conditions. A large study of military service members found that sleep problems were an early marker for an increased risk of developing post-traumatic stress disorder (PTSD) and depression later on (Macera et al., 2013).
How Does Sleep Impact Recovery from TBI?
Untreated sleep disturbances can seriously compromise rehabilitation, worsen cognitive deficits, and impair long-term quality of life because sleep is not passive rest - it is when the brain actively repairs itself.
Recovery from a brain injury depends on neuroplasticity, the brain's ability to rewire itself, a process that is heavily dependent on sleep. Patients with sleep disturbances often require longer hospital stays to achieve the same functional gains as those with good sleep (Makley et al., 2008).
A critical part of this repair process is the glymphatic system, which acts as the brain's waste-clearance mechanism. This system is thought to be most active during deep sleep, when it flushes out toxic metabolic byproducts that accumulate during the day, including proteins like amyloid-beta and tau that are linked to neurodegenerative diseases.
A TBI can impair this nightly "cleaning cycle." If a TBI survivor also suffers from poor sleep, these toxic proteins may build up, potentially increasing the long-term risk of developing conditions like Alzheimer’s disease or Chronic Traumatic Encephalopathy (CTE) (Gosselin & Baumann, 2022).
How Sleep Disorders after Traumatic Brain Injury Affect Daily Life
The impact of post-TBI sleep disorders on daily life is profound and far-reaching. Untreated sleep problems can create significant barriers to a successful recovery and a return to a fulfilling life.
One of the most critical impacts is on the rehabilitation process itself. Patients with disrupted sleep patterns often have poorer daytime function and may require longer stays in both acute care and rehabilitation facilities (Makley et al., 2008).
Arousal and sleep disorders can compromise a patient's ability to participate fully in physical, occupational, and speech therapies (Worthington & Melia, 2006).
The consequences for long-term outcomes are also significant:
Reduced Quality of Life: The combination of fatigue, sleepiness, and other related symptoms can severely diminish a person's overall health-related quality of life.
Poorer Functional and Occupational Outcomes: TBI survivors with sleep disturbances may have a harder time returning to work or school (Frieboes et al., 1999).
Increased Safety Risks: Excessive daytime sleepiness poses a serious risk for accidents, particularly while driving.
Financial and Medicolegal Strain: The struggle to maintain employment can lead to financial hardship and disputes with insurance companies (Guilleminault et al., 2000).
Given these serious consequences, what treatment options are available?
How Are Sleep Disorders after Traumatic Brain Injury Treated?
Treating sleep disorders after a TBI is challenging, but effective strategies are available. The most successful approach is a comprehensive one that addresses not only the sleep problem itself but also contributing factors like pain and depression.
Non-Pharmacologic Therapies:
Cognitive-Behavioral Therapy for Insomnia (CBT-I): CBT-I is a highly effective structured program for treating insomnia by helping patients change behaviours and beliefs that interfere with obtaining quality sleep (Ouellet & Morin, 2007).
Light Therapy: Exposure to bright, blue-wavelength light in the morning can help reset the body's internal clock, reduce fatigue, and has even been associated with physical signs of brain repair (Killgore et al., 2020).
CPAP Therapy: For patients with obstructive sleep apnea, continuous positive airway pressure (CPAP) uses a machine and mask to keep the airway open during sleep.
Pharmacologic Therapies:
Modafinil: This wakefulness-promoting medication significantly improves excessive daytime sleepiness in TBI patients, though it does not improve fatigue (Kaiser et al., 2010).
Melatonin: Melatonin is a hormone that can help improve sleep quality and correct the timing of the internal body clock (Grima et al., 2018).
Avoidance of Benzodiazepines: Traditional sedative medications (like Valium or Xanax) are generally avoided. They can worsen cognitive problems, increase the risk of falls, and interfere with the deep stages of sleep that are critical for brain recovery.
Special Considerations for Children with TBI
Sleep disturbances are common and persistent in children after a TBI, but they often show up as behavioral issues rather than direct complaints about sleep. A child who has had a TBI may not say they are tired but instead exhibit:
Hyperactivity
Aggression
Poor school performance
These are classic signs of sleep deprivation in the developing brain. One study found that parents of children with mild TBI reported significantly more sleep disturbances six months after the injury, even when the children themselves did not report any problems (Milroy et al., 2008). This highlights the need for parents and doctors to be vigilant and consider sleep problems as a potential cause of post-injury behavioral changes.
When to Get Professional Help for Sleep Disorders after Traumatic Brain Injury
Any person who has had a traumatic brain injury - regardless of its severity - should be screened for sleep-wake disturbances. You should seek a professional evaluation from a doctor or sleep specialist if you or your family members notice any of the following:
Persistent difficulty falling asleep or staying asleep.
Loud snoring, gasping, or pauses in breathing during sleep.
An overwhelming need to sleep during the day that interferes with your daily activities.
A noticeable increase in the total amount of sleep you need compared to before your injury.
Pervasive fatigue and lack of energy that does not improve with rest.
Early and accurate diagnosis is the first step toward effective treatment that can improve your recovery and overall quality of life.
Key Takeaways About Sleep Disorders after Traumatic Brain Injury
Sleep disorders are a very frequent and persistent consequence of traumatic brain injury, affecting at least half of all survivors.
The most common issues are excessive daytime sleepiness, an increased need for sleep (hypersomnia), chronic fatigue, and insomnia.
A critical feature of these disorders is that patients often misperceive their symptoms, especially by underestimating their sleepiness, which makes professional diagnosis and testing essential.
The causes are complex, stemming from direct damage to the brain's sleep-regulating centers and secondary factors like chronic pain, medication side effects, and psychiatric conditions.
Untreated sleep disorders can significantly hinder rehabilitation, worsen cognitive and emotional symptoms, and negatively impact quality of life and safety.
Effective treatments are available and include behavioral therapies (like CBT-I), light therapy, medical devices (like CPAP), and targeted medications, but they require a comprehensive, multidisciplinary approach.
Concerned about your sleep? We always advocate talking to your primary care health provider in the first instance.
You can also talk to a NZ sleep clinic like The Better Sleep Clinic for sleep help. Whether it’s an Auckland sleep clinic, Wellington sleep clinic, Christchurch sleep clinic, Hamilton sleep clinic, New Plymouth sleep clinic or anywhere in NZ, we can help. We specialise in the recommended treatments for circadian rhythm disorders such as delayed sleep phase as well as treatments for other sleep disorders such as insomnia treatment - CBT for insomnia.
Book an assessment (no referral required) or, if you have a specific question, enquire about treatment and get started addressing your sleep problems today.
Frequently Asked Questions on Sleep and Concussion / Traumatic Brain Injury
Q1: What are the most common sleep problems after a TBI?
A1: The most common sleep problems after a traumatic brain injury (TBI) are arousal disturbances, which include excessive daytime sleepiness (EDS), post-traumatic fatigue, and an increased biological need for sleep, a condition known as post-traumatic hypersomnia or pleiosomnia. Insomnia, sleep apnea, and circadian rhythm disorders are also highly prevalent, affecting a large percentage of TBI survivors (Ouellet et al., 2004).
Q2: Why does a concussion or brain injury cause sleep disturbances?
A2: A brain injury causes sleep disturbances by physically damaging the brain's sleep-regulating systems. This damage can lead to several key biological changes:
Loss of Wake-Promoting Neurons: A TBI can destroy hypocretin-producing neurons, which are essential for maintaining stable wakefulness (Baumann et al., 2009).
Circadian Clock Disruption: The injury can alter the function of the brain's master clock (the SCN) and reduce the production of melatonin, the hormone that signals sleep time (Gosselin & Baumann, 2022).
Neuroinflammation: The brain's immune response to the injury releases inflammatory chemicals that create a strong biological drive for more sleep, similar to how you feel when you have the flu.
Q3: Can a mild concussion cause long-term sleep issues?
A3: Yes, even a mild TBI, or concussion, can cause significant and long-term sleep problems. While some symptoms like an increased need for sleep are common after severe injuries, individuals with mild TBI also report persistent sleep difficulties, including insomnia and circadian rhythm disorders, at rates much higher than the general population. The severity of the initial injury does not always predict the severity or duration of the sleep disturbance.
Q4: How does poor sleep affect my recovery from a TBI?
A4: Poor sleep can seriously compromise your recovery from a TBI by interfering with the brain's natural repair processes. Recovery depends on neuroplasticity—the brain's ability to rewire itself—which is heavily dependent on sleep. Furthermore, deep sleep is critical for activating the glymphatic system, the brain's waste-clearance mechanism that removes toxic proteins. Impaired sleep hinders this process, which may increase the long-term risk for neurodegenerative diseases (Gosselin & Baumann, 2022). As a result, patients with sleep disturbances may require longer hospital stays and have poorer cognitive outcomes (Makley et al., 2008).
Q5: What is the difference between fatigue and sleepiness after a head injury?
A5: Fatigue and sleepiness are two distinct symptoms. Excessive daytime sleepiness (EDS) is a physiological drive to fall asleep, often leading to unintentional naps. Post-traumatic fatigue, on the other hand, is a constant feeling of mental and physical exhaustion and a lack of energy that is not relieved by sleep. While a sleepy person struggles to stay awake, a fatigued person feels they lack the energy to perform activities. Treatments that work for sleepiness, like the medication modafinil, may not improve fatigue (Kaiser et al., 2010).
Q6: Why do I need so much more sleep now than I did before my brain injury?
A6: Needing significantly more sleep is a recognized condition called post-traumatic hypersomnia, or pleiosomnia. It is defined as a biological need for two or more additional hours of sleep per 24-hour period compared to before your injury (Baumann et al., 2007). This is not a sign of depression or laziness; it is a physiological response to the brain injury, likely driven by neuroinflammation and the brain's intense effort to heal and repair itself.
Q7: What are the best treatments for sleep problems after a TBI?
A7: The most effective treatments combine non-pharmacological therapies with carefully selected medications. First-line approaches include:
Cognitive-Behavioral Therapy for Insomnia (CBT-I): A structured therapy that is highly effective for insomnia (Ouellet & Morin, 2007).
Light Therapy: Using bright, blue-wavelength light in the morning can help reset the body's internal clock and has been shown to aid in brain repair (Killgore et al., 2020).
Targeted Medications: Wake-promoting agents like modafinil can treat excessive sleepiness, while melatonin can help with sleep timing. Traditional sedatives like benzodiazepines are generally avoided as they can worsen cognition and fall risk.
References
Baumann, C. R., Stocker, R., Imhof, H. G., et al. (2005). Hypocretin-1 (orexin A) deficiency in acute traumatic brain injury. Neurology, 65(1), 147–149.
Baumann, C. R., Werth, E., Stocker, R., Ludwig, S., & Bassetti, C. L. (2007). Sleep-wake disturbances 6 months after traumatic brain injury: a prospective study. Brain, 130(7), 1873–1883.
Baumann, C. R., Bassetti, C. L., Valko, P. O., et al. (2009). Loss of hypocretin (orexin) neurons with traumatic brain injury. Annals of Neurology, 66(4), 555–559.
Castriotta, R. J., & Lai, J. M. (2001). Sleep disorders associated with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 82(10), 1403–1406.
Castriotta, R. J., Wilde, M. C., Lai, J. M., et al. (2007). Prevalence and consequences of sleep disorders in traumatic brain injury. Journal of Clinical Sleep Medicine, 3(4), 349–356.
Chaput, G., Giguère, J. F., Chauny, J. M., Denis, R., & Lavigne, G. (2009). Relationship among subjective sleep complaints, headaches, and mood alterations following a mild traumatic brain injury. Sleep Medicine, 10(7), 713–716.
Collen, J., Orr, N., Lettieri, C. J., Carter, K., & Holley, A. B. (2012). Sleep disturbances among soldiers with combat-related traumatic brain injury. Chest, 142(3), 622–630.
Frieboes, R. M., Müller, U., Murck, H., et al. (1999). Nocturnal hormone secretion and the sleep EEG in patients several months after traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 11(3), 354–360.
Gosselin, N., & Baumann, C. R. (2022). Pathophysiology of sleep-wake disturbances after traumatic brain injury. In M. H. Kryger, T. Roth, C. A. Goldstein, & W. C. Dement (Eds.), Principles and practice of sleep medicine (7th ed., pp. 326-333). Elsevier.
Grima, N. A., Rajaratnam, S. M. W., Mansfield, D., Sletten, T. L., Spitz, G., & Ponsford, J. L. (2018). Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial. BMC Medicine, 16(1), 8.
Guilleminault, C., Yuen, K. M., Gulevich, M. G., et al. (2000). Hypersomnia after head-neck trauma: a medicolegal dilemma. Neurology, 54(3), 653–659.
Kaiser, P. R., Valko, P. O., Werth, E., et al. (2010). Modafinil ameliorates excessive daytime sleepiness after traumatic brain injury. Neurology, 75(20), 1780–1785.
Kempf, J., Werth, E., Kaiser, P. R., Bassetti, C. L., & Baumann, C. R. (2010). Sleep–wake disturbances 3 years after traumatic brain injury. Journal of Neurology, Neurosurgery & Psychiatry, 81(12), 1402–1405.
Killgore, W. D. S., Vanuk, J. R., Shane, B. R., Weber, M., & Bajaj, S. (2020). A randomized, double-blind, placebo-controlled trial of blue wavelength light exposure on sleep and recovery of brain structure, function, and cognition following mild traumatic brain injury. Neurobiology of Disease, 134, 104679.
Macera, C. A., Aralis, H. J., Rauh, M. J., & MacGregor, A. J. (2013). Do sleep problems mediate the relationship between traumatic brain injury and development of mental health symptoms after deployment? Sleep, 36(1), 83–90.
Makley, M. J., English, J. B., Drubach, D. A., Kreuz, A. J., Celnik, P. A., & Tarwater, P. M. (2008). Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit. Neurorehabilitation and Neural Repair, 22(4), 341–347.
Masel, B. E., Scheibel, R. S., Kimbark, T., & Kuna, S. T. (2001). Excessive daytime sleepiness in adults with brain injuries. Archives of Physical Medicine and Rehabilitation, 82(11), 1526–1532.
Mathias, J. L., & Alvaro, P. K. (2012). Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis. Sleep Medicine, 13(7), 898–905.
Menon, D. K., Schwab, K., Wright, D. W., & Maas, A. I. (2010). Position statement: definition of traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 91(11), 1637–1640.
Milroy, G., Dorris, L., & McMillan, T. M. (2008). Sleep disturbances following mild traumatic brain injury in childhood. Journal of Pediatric Psychology, 33(3), 242–247.
Ouellet, M. C., & Morin, C. M. (2006). Subjective and objective measures of insomnia in the context of traumatic brain injury: a preliminary study. Sleep Medicine, 7(6), 486–497.
Ouellet, M. C., & Morin, C. M. (2007). Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design. Archives of Physical Medicine and Rehabilitation, 88(12), 1581–1592.
Ouellet, M. C., Savard, J., & Morin, C. M. (2004). Insomnia following traumatic brain injury: a review. Neurorehabilitation and Neural Repair, 18(4), 187–198.
Ouellet, M. C., Beaulieu-Bonneau, S., & Morin, C. M. (2015). Sleep-wake disturbances after traumatic brain injury. The Lancet Neurology, 14(7), 746–757.
Ponsford, J. L., Downing, M. G., Olver, J., et al. (2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. Journal of Neurotrauma, 31(1), 64–77.
Singh, K., Morse, A. M., Tkachenko, N., & Kothare, S. V. (2016). Sleep disorders associated with traumatic brain injury – a review. Pediatric Neurology, 60, 30–36.
Sommerauer, M., Valko, P. O., Werth, E., & Baumann, C. R. (2013). Excessive sleep need following traumatic brain injury. A case-control study of 36 patients. Journal of Sleep Research, 22(6), 634–639.
Verma, A., Anand, V., & Verma, N. P. (2007). Sleep disorders in chronic traumatic brain injury. Journal of Clinical Sleep Medicine, 3(4), 357–362.
Worthington, A. D., & Melia, Y. (2006). Rehabilitation is compromised by arousal and sleep disorders: results of a survey of rehabilitation centres. Brain Injury, 20(3), 327–332.
Written By The Better Sleep Clinic
Reviewed By Dan Ford, Sleep Psychologist
