Saturday, March 12, 2016

Treating Sleep Problems Following Traumatic Brain Injury

Bill Yates
Brain Posts
Posted 29th July 2014 

Sleep problems are common following traumatic brain injury (TBI).

In a previous post, I reviewed a study of the risk factors for sleep disorders following TBI.

The most severe TBI is a risk factor for hypersomnia. Anxiety and depression following TBI increase risk for insomnia complaints.

Few large studies of treatment for sleep problems after TBI exist.

However, a recent manuscript outlined the potential benefit of treatment of sleep disorders in a series of 12 subjects.

Catherine Wiseman-Hakes and colleagues from the University of Toronto described their experience with sleep and TBI in a manuscript in the journal Brain Injury.

Their study examined the impact of sleep disorder treatment in TBI on recovery of cognitive function including speech/communication. Treatment included sleep hygiene education, pharmacological treatment and continuous positive airway pressure (CPAP) for those with sleep apnea.

Twelve subjects with TBI completed a baseline assessment for presence of insomnia, communication function and neuropsychological performance. Subjects also completed a laboratory sleep study (polysomnography) for accurate diagnosis of specific sleep disorders.

Subjects then had treatment for sleep problems individualized to the specific sleep disorders diagnoses. After 2 to 4 months ofleep disorder treatment, follow up neuropsychological assessment was completed.
The key findings from the study included:
  • Sleep disorder diagnoses were diverse and included hypersomnia, obstructive sleep apnea, restless leg syndrome, circadian rhythm disturbances and insomnia
  • Treatment of sleep disorders produced a robust subjective reduction in insomnia severity ratings
  • Treatment of sleep disorders produced a reduction in depression, improved language function and increased speed of language processing
  • Pharmacological treatments selected by the treating physicians included modafanil, methylphendiate and fluoxetine for hypersomnia, trazodone for insomnia, pregabablin, gabapentin and pramipexole for restless leg syndrome
The authors note their findings "reinforce the necessity for routine screening for sleep disorders in persons with TBI".

Given the diversity of diagnoses in this study, screening in TBI needs to be linked to comprehensive sleep laboratory assessment.

This study supports sleep assessment and sleep disorder treatment as a key component of TBI rehabilitation. This component appears to have significant benefit to global cognitive and communication recovery after TBI.

Weaknesses of this clinical trial are the small sample size, lack of a control group and non-standardized pharmacological treatment.

Nevertheless, the results are impressive and point to the need for additional larger randomized clinical trials of treatment for sleep disorders in TBI.

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link in the citation below.

Photo of juvenile great blue heron is from the author's files.

Follow the author on Twitter WRY999.

Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, & Colantonio A (2013). Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain injury : [BI], 27 (12), 1364-76 PMID: 24070180.

See the original article:

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