Return to graphic version of TBI and Sleep
Infocomic Main Characters
Javier: A young adult Spanish man with short black hair who uses a wheelchair.
Marry: A young adult White woman with shoulder-length light hair. She is married to Javier.
Dr. Cushing: A middle-aged White woman with chin-length light hair and square-frame glasses.
Infocomic Story Description
Traumatic Brain Injury and Sleep
Sleep is complex and involves many parts of the brain. A traumatic brain injury (TBI) can cause many different types of sleep problems. We all have an “internal clock” that helps our bodies know when to sleep and wake up. TBI can cause our brains to send these messages at the wrong time.
Too little sleep can increase the risk of depression and make car accidents more likely.
Marry is speaking to the reader. “Javier has a hard time falling asleep. His lack of sleep has made his anxiety worse. He also gets tired and irritable easily. It has really made our lives harder.”
Javier says to the reader, “Not getting enough sleep can also lead to poor performance or accidents at work.” In the background, a person is driving a forklift and spilling a pallet of material.
Our bodies make chemicals that help to control our sleep cycles. A TBI can change the way that these chemicals affect us.
Javier is having trouble falling asleep. He leaves bed to go watch TV, have a beer, and smoke a cigarette.
Marry comes out. “What are you doing up? It’s 3 a.m.”
“I couldn’t sleep, so I got up to watch a movie and have a beer or two to help me relax,” Javier admits.
“I didn’t realize that this was still happening,” Marry says. “Maybe we should talk to Dr. Cushing.” she suggests.
“That’s a good idea,” Javier says. “I’ll call her tomorrow.”
More than half of people with TBIs have sleep problems. Issues with sleep become more common as people grow older.
Getting a Consultation
Javier gets a consultation from Dr. Cushing.
Dr. Cushing says, “We call not being able to fall asleep insomnia. It often becomes less of a problem as you recover from a TBI.”
“So, what causes it?” Javier asks.
“Lots of things,” says Dr. Cushing. “Anxiety, depression, a medication, or even your bedtime routine can be an issue. I think your TBI may be causing your problem.”
Javier asks, “Is there a pill I can take or something?”
Medications and Sleep Problems
Dr. Cushing says, “There are medications that will help with sleep. But we don’t recommend many of them for people with TBI.”
“Why not?” asks Javier.
“Good question,” Dr. Cushing tells him. “Most nonprescription sleeping medications contain antihistamines. They can cause memory problems and other side effects.”
Some other common side effects are trouble learning new things, dry mouth, constipation, retaining urine, and nighttime falls.
Dr. Cushing tells Javier, “Some medications can make sleep more difficult. Drugs for asthma, depression, and daytime drowsiness can all cause insomnia. On the other hand, some medicines can make people tired during the day.”
You can often address this by working with your doctor to adjust when you take your medication. You can also change your prescription.
Evaluating Sleep Problems
Your doctor will talk to you about your medications and how long you’ve been having sleep problems. They will also explore possible causes of your sleep problems, like pain and depression.
Javier asks, “So, what can I do?”
Dr. Cushing tells him, “Well, I’d like to evaluate your sleep problems. First, I’ll do a physical exam. Next, we’ll talk about your bedtime routine.”
Dr. Cushing talks to the reader. “Javier doesn’t have this, but TBI can also change how your brain controls your breathing. This can cause loud snoring and sometimes even brief pauses in breathing during sleep. This is known as “sleep apnea.”
Sleep apnea causes your brain to get less oxygen. That can lead to headaches and fatigue. You are more likely to have sleep apnea if other people in your family have it or if you are overweight.
Other Sleep Disorders
People with delayed sleep phase syndrome fall asleep and wake later than normal.
Narcolepsy makes people fall asleep suddenly during the day.
Post-traumatic hypersomnia can cause people to sleep more hours than normal.
Sleepwalking is walking or doing other things while asleep.
Restless legs syndrome (RLS) is a strong urge to move your legs because they’re uncomfortable. It usually happens when you are sleeping or lying down.
Excessive daytime sleepiness is extreme drowsiness during the day.
Bruxism is grinding your teeth at night.
Periodic limb movement disorder is the involuntary movement of your arms or legs during sleep.
Later…
Dr. Cushing hands Javier a book called Relaxation Therapy. “Well, Javier, I think that your insomnia is being caused by your anxiety,” she says. “How do you feel about talking to a counselor?”
“I’m not sure,” he says. “I’m not really into touchy feely stuff.”
Dr. Cushing tells him, “Counseling for anxiety has two goals. The first is to look at the sources of your anxiety and come to terms with them. The second is to train your body to calm down when you feel anxious.”
“I guess I could give it a shot,” he says.
“Great!” Dr. Cushing responds. “I’ll get you some names on the way out. I don’t always do this, but I’d like to refer you to a sleep lab to make sure that there isn’t anything else going on.”
“What’s a sleep lab?” asks Javier.
“You’ll stay overnight in a clinic where they will monitor your sleep cycles. That will help me figure out if you have other issues with your sleep.”
Ok, I’ll do that, if you think it will help,” Javier tells her.
Dr. Cushing says, “It will help me to put together a treatment plan. In the meantime, counseling will likely help with your anxiety. Here’s a list of some other things that will help you get better sleep.”
WHAT CAN I DO?
- Use an alarm to wake up at the same time each day. Try to go to bed at the same time every night.
- Exercise daily. People with TBI who exercise regularly have fewer sleep problems.
- Don’t eat right before bed or go to sleep hungry. That way, you won’t wake up because you’re too hungry or full.
- Don’t eat, watch TV, or read in bed.
- If you don’t fall asleep in 30 minutes, get up and do something relaxing or boring until you feel sleepy.
Javier is at a store that sells supplements. He says, “Marry read that some people find that natural remedies help them sleep. Some worked for me, others didn’t do much.”
These are available at most natural food or drug stores. Be sure to tell your doctor if you’re taking any of these because they may interact with some medications.
Begin to Improve Your Sleep by Changing Your Behavior and Environment
Javier has a list of things he does to help him sleep. Speaking to the reader, Javier says, “I made all the changes Dr. Cushing suggested. Marry did some research and found some other things that I’ve tried.
- I have removed distractions and reduced noise near my bed. I also keep the temperature cool and block light from my sleeping area.
- I have a bedtime routine that I do every night before bed.
- I used to have a couple of beers before bed every night. Now I avoid drinking too much before bed.
- I’ve cut down on the TV I watch, and I never watch it in bed anymore.
- I try to do meaningful things every day.
- I don’t have caffeine or nicotine within 5 hours of bedtime. They are both stimulants that interfere with my sleep.
- I go outside for some sun every day. When it’s cloudy, I use a light box.
Marry says to the reader, “I’m so glad we talked to Dr. Cushing. Javier’s Insomnia made other problems worse: He had trouble thinking and learning things when he wasn’t getting enough sleep. He also got frustrated or angry easily. It was hard for everybody. Things aren’t perfect now but they’re better.”
Ask your doctor about these other treatments:
Sleep restrictions restrict the time you spend in bed to the time that you’re sleeping. This treatment may help to improve your sleep patterns.
Phototherapy is the use of special bright lights at strategic times in the day. This treatment can help you to have more normal sleep starts and finishes.
AUTHORSHIP AND ILLUSTRATION
This infocomic was written by Silas James and illustrated by Matthew Cory in collaboration with the Model Systems Knowledge Translation Center. This infocomic was adapted from the factsheet titled Sleep and TBI, which was developed by Brian Greenwald, MD, and Kathy Bell, MD, in collaboration with the University of Washington Model Systems Knowledge Translation Center (https://msktc.org/tbi/factsheets/sleep-and-traumatic-brain-injury). Portions of this factsheet were adapted from materials developed by the New York Traumatic Brain Injury Model System, the Carolinas Traumatic Brain Injury Rehabilitation and Research System, and from Picking up the Pieces After TBI: A Guide for Family Members,” by Angelle M. Sander, PhD, Baylor College of Medicine (2002).
Source: The content in this infocomic is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this infocomic were developed under grants from the National Institute on Disability and Rehabilitation Research (NIDRR), Department of Education (grant numbers: H133A120028 and H133A110004). However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government.
Copyright © 2015 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.