Nonpharmacological management of sleep disturbances after traumatic brain injury

Abstract

BACKGROUND: Sleep plays an integral role in several physiologic functions such as cognition and functional ability. Sleep disturbances are common after brain injury and can interfere with rehabilitation and recovery. There are several pathways by which sleep is initiated, and thus various ways to target common complaints as well. OBJECTIVES: To review alternative and non-pharmacological treatment approaches to sleep disorders following TBI. METHODS: The authors present a review of the literature on various alternative treatment methods for treating sleep disorders, and discuss evidence for safety and efficacy. CONCLUSIONS: Typical management include conservative measures and pharmacologic treatment. This article provides a review of the available nonpharmacologic treatment options for sleep disorders in patients with traumatic brain injury. There are a number of non-pharmacological treatment methods available for treatment of sleep disorders in this population.

<p>Impact of traumatic brain injury on sleep: an overview</p>

“…It is important to start by ruling out modifiable causes of sleep disturbances like pain, bowel/bladder issues, and mood disturbances 8…”

“…Sleep hygiene is the first factor to address, including avoiding stimulating activities before bed, fixed schedules, and avoiding late afternoon caffeine and alcohol. If the patient is not asleep within 30 mins of being in bed, he or she should engage in any stimulating activity in another room and return to bed only when drowsy 1,8. Regular aerobic exercise has also been shown to improve sleep quality in TBI patients 8…”

“…Cognitive behavioral therapy (CBT) is also a technique that helps alter a patient’s negative associations with sleep. Examples include relaxation training and CBT 8. CBT for insomnia (CBTi) is considered the first-line approach for management of insomnia.…”

“…It works by targeting and altering dysfunctional beliefs and attitudes about sleep 3,27. It is associated with increased total sleep time and decreased sleep–onset latency as evidenced by objective sleep measurements like actigraphy and polysomnography,28 and it has been found to be superior to pharmacological therapy 3,8…”

“…It is important to recognize and manage sleep disorders in TBI patients because untreated sleep disturbances translate to longer hospital stays, higher cost of rehabilitation, and more disability 8…”