New recommendations to treat sleep problems following concussion

The Defense and Veterans Brain Injury Center has released new clinical recommendations and support tools to assist in the identification and treatment of a sleep disturbance occurring in patients after a concussion (mild traumatic brain injury or mTBI). The suite of products assists health care providers in the identification of a sleep problem and provides recommendations for its treatment.

"Sleep disorders are common after a person sustains a concussion," said Col. Sidney Hinds, II, M.D., DVBIC's national director. "The prompt identification and treatment of sleep disorders are an important part of the recovery process for concussion. Sleep is critical to the brain's healing and recovery processes. Research shows that if sleep is regular and adequate, restorative processes are promoted."

Since 2000, more than 300,000 U.S. servicemembers have sustained a traumatic brain injury.

Common sleep disorders associated with TBI include insomnia, circadian rhythm sleep wake disorder and obstructive sleep apnea. Insomnia is the most common sleep disturbance after concussion.

Restorative sleep is critical in any brain injury recovery, said Dr. Heechin Chae, the director of TBI National Intrepid Center of Excellence program at Fort Belvoir. Many servicemembers who have been deployed to combat zone already have interrupted sleep which increases the chance of not recovering properly after concussion. It is important to notify the physician if sleep is interrupted or one does not feel rested in the morning after a concussive event.

The new Management of Sleep Disturbances following Acute Concussion/Mild TBI Clinical Recommendations suite is composed of clinical recommendations, a clinical support tool, a provider education slide deck and a patient education fact sheet.

"These clinical recommendations advise that all patients with concussion symptoms should be screened for the presence of a sleep disorder," said U.S. Public Health Service Capt. Cynthia Spells, DVBIC's clinical affairs officer. "Patients should be asked if they are experiencing frequent difficulty in falling or staying asleep, excessive daytime sleepiness or unusual events during sleep. The initial step in the diagnosis of a sleep disorder includes a focused sleep assessment."

Non-pharmacological measures to treat insomnia that focus on stimulus control and good sleep hygiene are the preferred methods of treatment. Short-term use of sleep medication may be necessary in addition to these measures if they are not effective by themselves.

Spells said stimulus control means controlling your environment to help promote sleep. Examples of stimulus control measures include relaxing before bedtime, going to bed only when sleepy, getting out of bed when unable to sleep, removing electronics (TV, smart phone, computer) from the bedroom and using the bedroom only for sleep and intimacy.

Sleep hygiene habits include avoiding caffeine and other stimulants close to bedtime, daily physical activity but not exercising close to bedtime, arising at the same time every morning, getting natural light exposure every day, and avoiding alcohol, nicotine and large meals close to bedtime.

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New recommendations to treat sleep problems following concussion