Nearly all of my head-injured patients have some form of a sleep disorder. This is rather confusing because people with head injuries can also have a fatigue disorder. You would think people with a fatigue disorder would want to sleep all the time or would sleep like rocks. You can, however, have both problems.
First, let's recognize what happens with a typical sleep disorder caused by a head injury. Typically, you may go to sleep fairly easily, although sometimes people cant stop their thoughts in the evening and have difficulty getting to sleep. Once you have fallen asleep, you may feel that youre waking up as often as every hour. By about 4 or 5 in the morning, you're wide awake, even though you are dead tired. In addition, many people who have head injuries are easily awakened by small noises. I've had patients who would sleep though a fire alarm prior to their head injuries, but who now wake up when a cat walks by.
Sleep is very important to the healing process. If you don't sleep, you're going to be tired throughout the day. If you're tired throughout the day, your memory will get worse and you'll be more cranky and irritable. Lack of sleep makes the other head injury symptoms much worse. Sleep also has an important role in physical healing. People may sustain muscle strain as well as head injuries. Muscles may be pulled due to the violent nature of a car accident. You can feel the "knots" caused by these muscle pulls. One of the things that happens when you sleep (in particular, when you dream) is that you become paralyzed. If you didn't do that, you would act out your dreams. Did you know that an EEG (which measures electrical activity in the brain) taken when you're dreaming is identical to one taken when youre awake? The brain is going full blast when you dream. When you were young and your brain was not fully developed, you may have done things like sleepwalking. In other words, the part of the brain that kept you from acting out your dreams wasn't fully developed. As you got older, your brain developed and that paralysis prevented the sleepwalking.
When you're fully paralyzed in sleep, it allows your muscles to relax. When youre awake, you may think your muscles are relaxed when theyre really not. When your muscles get tense, they can stay tense. Someone may massage your neck and its painful because you've been tense without even knowing it. If you're sleeping poorly, you're not allowing those muscles to relax and heal. They're chronically in knots. One of the tough things about a muscle injury is that you can easily keep aggravating it. This can go on for years because you never allow it to heal.
There are medications that can help you with sleep problems. Although some medications are specifically designed to promote sleep (i.e. "Sleepers"), they are typically avoided by physicians who treat head injury. Many physicians use small doses of anti-depressant medications (e.g., Elavil or Desyrel) with their head-injured patients and have found it to be very effective. Typically, you take this medication a half hour before bedtime and you will sleep straight through the night. Sometimes this medication works too well and people sleep for 12 to 15 hours for the first 2 or 3 days. This is normal; your brain is trying to "catch up" on the sleep that its missed. However, some people report side effects. They may report that it's hard to wake up in the mornings. But once you get going in the morning, you will feel a lot better. You need to talk to your doctor about any side effects. Some of them are temporary and go away with time. After about a month or two of working great, the medication may seem to stop doing its job, and may need readjustment. See your doctor--most patients with head injuries can get effective relief from this problem.
There are things you can do to promote what's called "sleep hygiene." For example, go to bed at exactly the same time every night--even on the weekend. Do not vary more than 15 minutes. That may sound extreme, but if you go to bed at the same time and get up at the same time each day, your body will adjust to that pattern. Avoid caffeine. Caffeine has a negative effect on the brain, and for some people it may increase the likelihood of seizures. Avoid it especially in the evening. Try not to exercise late in the evening. If your room is too hot, that can interfere with the normal pattern of sleep through the night. If your room is too cold, you may do something called "turtling"--pulling the covers over your face and breathing the same air over and over again. That increases the carbon dioxide and may cause headaches or interfere with sleep. Make sure the room is very dark. This can be very important because light plays a critical role in your sleep pattern. Make sure it's quiet as well. Talk with family members about respecting your need to have quiet so you can sleep.
Is it good to take a nap during the day? If youre extremely fatigued, you may not have a choice. In general, resting is a good idea, but sleeping during the day tends to disrupt your evening sleep. For example, some people come home from school, sleep from 4:00 to 7:00, have dinner, and then can't sleep in the evening. It might be better to lie down and rest without allowing yourself to sleep. This will help to normalize your sleep pattern.
By Dr. Glen Johnson, Clinical Neuropsychologist
5123 North Royal Drive || Traverse City, MI 49684
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