Are you having a hard time falling asleep, staying asleep, and/or waking up? You’re not alone – a lot of people struggle with sleep after brain injury. There are a lot of reasons for this, including:
- Depression and anxiety, which can keep you up at night
- Chemical changes in your brain, including the ones that help you sleep
- Sleep disorders and sleep syndromes
- Changes to breath control making it hard to stay asleep
- Physical pain/discomfort making it hard to fall or stay asleep
No matter what the cause is, a lack of sleep (or not being able to stay awake) can be really frustrating. It can also impact what you’re able to do and how you feel. Doing what you can to take charge of your sleep is really important, and can help support you on your recovery journey.
Let’s talk about:
Why is sleep so important?
When you have a bad sleep, it can be hard to stay awake in class, focus on your work, or have enough energy for your extracurriculars after school. You might feel grouchy, have trouble engaging with others, and just generally feel yucky.
If you aren’t getting enough sleep, you may experience:
- Bad moods or emotional lability (mood swings)
- Depression/anxiety
- Fatigue
- Headaches
- Increased difficulty thinking or remembering. Any cognitive challenges you are coping with may be worse on days when you aren’t getting enough sleep
- Physical discomfort, including aches
On the other hand, when you have a good sleep, you may notice:
- You’re in a better mood the next day
- You can stay awake during class
- You have more energy
- You can focus on homework better
Having energy and feeling rested are important for both daily life and for rehabilitation and recovery. The better rested you are, the better you’ll feel, and the more you’ll be able to participate.
Common sleep problems after a brain injury
The following are some common sleep problems that may happen after brain injury [1].
The brain helps control breathing. Most of the time we don’t even think about it. Brain injury can impact how your brain controls breathing while you sleep, which may result in things like sleep apnea (which is where you actually stop breathing for short periods of time). Some signs of sleep apnea include:
- You wake up choking, gasping, or with shortness of breath
- Snoring
- Breathing stops
- Insomnia (not being able to fall asleep and/or stay asleep)
There are machines that can help people with sleep apnea (such as a continuous positive airway pressure (CPAP) machine) that you can wear to bed to help with breathing issues.
You might not know if you have sleep apnea or other breathing problems when you sleep. While doctors will talk to you about sleep and safety at the beginning of your recovery, there are a few ways you can monitor your sleep, including:
- Recording yourself
- Keeping a sleep journal
- Asking someone you trust to check on you/sleep in the room with you if the doctor needs someone to confirm you’re having breathing trouble
This may be scary to read about, and we want to be honest – sleep apnea can be quite serious. But there are treatments, and specialists that can help make sure you sleep soundly and safely. If you have any worries or want more information, you should talk to your doctor and your parent(s)/guardian(s).
The brain releases different chemicals depending on what we’re doing. This includes getting ready to fall asleep. For example, the pineal gland in the brain regulates melatonin, which plays a role in falling asleep [2]. When there is damage to these brain functions, you may have trouble falling asleep or experience interruptions to your sleep because the chemicals aren’t working the same way.
This doesn’t mean you won’t ever have a good night’s sleep again. But it may mean you have to change how you get ready for bed. We talk more about this in our sleep tips section of this page.
If you are experiencing mental health struggles such as depression or anxiety, these can affect your sleep. And when you’re tired, that can actually impact symptoms of depression and anxiety. It becomes a really tough circle to be in.
Your mental health will always play a big role in other areas of your health, including sleep. There are some things you can do to support your sleep so you can continue to care for yourself.
Some medications have a side effect of interfering with sleep. They may also cause drowsiness when you are awake.
We have a medication tracker where you can record what you’re taking, potential side effects, and what you’re actually experiencing. You can share this with your medical team to make sure they have all the information. They may be able to prescribe you something else, or help you manage side effects so you feel as good as possible.
When you have pain in your body, an upset stomach, or a headache, you might struggle to go about your day-to-day activities. This includes sleep. Pain and discomfort make it really hard to fall and/or stay asleep.
Your doctors will be the best people to talk to about your pain and how to treat it. Some things you can do on our own (or with a parent/guardian) include:
- Making sure you have an appropriate mattress and pillow for your needs.
- Using tools like ice packs or heat packs for bodily pain.
- Sticking to any physiotherapy exercises you’re supposed to be doing.
There may also be some meditations you can listen to as you fall asleep to help take your mind off any discomfort you’re feeling. These don’t work for everyone, but they are an option.
When looking at a successful sleep-wake cycle, a person gets uninterrupted rest at night and is awake during the day. Sleep disorders are conditions that impact the amount an/or quality of sleep you get [3].
Studies have shown that brain injury and sleep disorders go hand in hand. Sleep disorders make it difficult to rest and brain injury recovery can suffer as a result.
It’s difficult to recognize a sleep disorder or a related sleep problem because it can include resting too much as well as not resting enough.
- Circadian rhythm sleep disorders make it difficult to follow a regular sleep pattern
- Hypersomnias can make someone extremely sleepy
- Insomnias make it difficult to fall asleep or stay asleep
- Parasomnias is a disorder that causes sleepwalking, talking, and bedwetting
- Sleep related breathing disorders cause difficulty breathing while asleep
- Sleep movement disorders cause unwanted movement like restless legs which can make it difficult to fall or stay asleep
Sleep disorders/syndromes are challenging to cope with but can improve over time by committing to good sleep routines. And problems with sleep should be shared with your doctor, because they can help you figure out treatments and/or supports.
After your brain injury, you might need to take more breaks because you don’t have as much physical or mental energy. This is something a lot of people go through. Part of a good sleep routine is listening to your body, and sometimes the body and brain do need a nap. But too much napping can make it more difficult for you to fall asleep at night. This leads to mixed up sleep patterns or poor sleep. Naps should be limited during the day and should be kept short.
Figuring out what’s impacting your sleep
You might not know right away what’s impacting your sleep. And you might not even realize right away that there is a problem. Everyone has a bad night of sleep every once in a while. But if you’re consistently struggling with sleep, that’s something that your doctor should know about.
They’ll want as much information as possible from you so they can give you the best recommendations. One way to do this is to keep a sleep journal. This can include information about what you did before bed, the number of times you woke up, and more. We have an example of a sleep journal template for you here:
You might want to develop and find your own sleep tracker. There are lots of different options out there, including smartphone apps. You can also keep track of sleep through technology specifically designed for that purpose. For example, some fitness trackers have sleep functions. They are designed to be as easy on your eyes and brain as possible (little-to-no blue light) and can tell you important information about periods of sleep, if you were restless, and if you woke up. Some even monitor heart rate!
[1] Information for this section sourced in part from msktc.org
[2] Healthlink BC