Army Spec. Daniel Peña had trouble sleeping at night and often felt tired during the day. Sleep can be a problem for service members who chug caffeinated drinks to stay awake during long shifts and then pop pills to help them sleep.
But Peña’s problem was a little different. A sleep study found that during a six-hour period when Peña thought he was asleep, he actually woke up 529 times after he stopped breathing, a condition known as sleep apnea.
The cause? A head injury he suffered more than two years earlier. When an improvised explosive device blew out the left front tire of his armored vehicle in Afghanistan, Peña suffered a concussion. It wasn’t bad enough to knock him unconscious, but it was enough to cause injury and affect his sleep.
Concussions are known to cause headaches and problems concentrating, but their effect on sleep is less understood, according to Lt. Col. Kate E. Van Arman, medical director of the Fort Drum, New York, traumatic brain injury clinic. Nearly every service member with a TBI reports trouble sleeping afterward, Van Arman said in a presentation at the 2015 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) Summit in September.
A variety of factors contribute to sleep issues in TBI patients. They have low levels of hypocretin-1, a neuropeptide that regulates alertness and the sleep-wake cycle; and melatonin, a hormone that regulates night and day cycles, in their brains. Treatments that may help others sleep can interfere with healing in TBI patients, she said, including some insomnia aids and antidepressants.
It’s less clear why concussions cause obstructive sleep apnea, in which someone repeatedly stops breathing or takes shallow breaths while sleeping, but about a third of concussed patients have apnea that they didn’t have before a blast injury, compared to 7 percent of civilians who have suffered concussions, Van Arman said.
“I have to believe there’s something about the blast that changes the structure of sleep mechanisms in the brain,” she said. Recent research has uncovered a unique structural change in the brains of service members with blast injuries, she said.
Meanwhile, service members with sleep apnea can benefit from a continuous positive air pressure (CPAP) face mask, Van Arman said.
Some medications are also helpful. Taking 1 to 3 milligrams of melatonin, which is available over the counter, can help. It’s necessary to take it five or six hours before bedtime so it has time to work, she said. (Make sure to check with your doctor before taking melatonin as there are possible negative side effects.)
Prazosin, a medication often prescribed for nightmares, also often helps TBI patients, she said. A DCoE webinar, “Treating Sleep Problems in PTSD and TBI,” reviewed studies which found that prazosin reduced headaches, headache intensity, and daytime sleepiness, and increased restful sleep and cognitive scores, Van Arman said.
Some additional resources related to sleep and TBI are below.
- “10 Tips for Better Sleep after Brain Injury” – A DCoE Blog post offers tips for better sleep following a brain injury
- “Mild TBI Symptom Management Fact Sheet: Healthy Sleep” — A DVBIC fact sheet with suggestions for managing sleep after TBI
- “Sleep in the Military: Promoting Healthy Sleep Among U.S. Service Members” — A research report sponsored by DCoE that explores the reasons so many service members don’t get enough sleep
- DVBIC also hosted a webinar presentation to discuss the roles sleep, activity and nutrition play in TBI recovery
- The DCoE Outreach Center is available 24 hours a day seven days a week to answer questions and point you to resources in your area. Call 866-966-1020, email firstname.lastname@example.org or live chat
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