Ask the Expert: Sleep Issues After TBI Dr. Celeste Campbell, BrainLine

My daughter was in a car accident 10 years ago when she was 17. She has had trouble sleeping since the accident and has tried many medications and has even had two sleep studies. She is working everyday but is always exhausted and sometimes cries uncontrollably and asks what's wrong with her. I think it's related to her brain injury. Could this be post-traumatic stress disorder?

Fatigue after a brain injury, even years later, is very common. After all, an injured brain isn't working at top efficiency. It still has to manage all the basic functions necessary to keep you going throughout the day, but operating on automatic pilot is no longer an option. Changes in the brain can slow information processing. Therefore, things we usually do automatically, like putting our shoes on after our socks, and more complex tasks, like following a conversation, take a lot more mental energy than they did before. One woman with a brain injury described her fatigue after getting ready in the morning as feeling like she had already put in half a day's work!

One of the most important tasks following a brain injury is learning to recognize when you are starting to tire, and then learning how to manage it. We often want to work through our fatigue, and prior to a brain injury, that is often possible. However, after a brain injury, pushing yourself can make the fatigue worse and can make you lose a whole day or even several days to complete exhaustion. It's important that your daughter learn to pace herself by building in breaks and opportunities to rest throughout the day.

Fatigue can also make it harder to regulate our emotions. The more tired we are, the more likely we are to overreact to even minor frustrations, conflicts, or disappointments. From your description, your daughter's behavior does not sound like post-traumatic stress disorder, but it may be a reaction to a decreased ability to manage daily stress. And yes, sleep is an extremely important factor. Even though she has been through several treatments and studies, it's important to seek professional help to manage sleep. Talking to a counselor or therapist who is knowledgeable about brain injury may be beneficial. That professional can talk to your daughter about how to manage anxiety, learn relaxation strategies, and establish positive sleep behaviors.

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Celeste Campbell, PsyD Dr. Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She completed a postdoctoral fellowship in Rehabilitation Neuropsychology at National Rehabilitation Hospital and has served as adjunct faculty for the George Washington University Graduate Certificate Program in Special Education and Traumatic Brain Injury.

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