Sleep Issues After TBI

Ask the Expert: Sleep Issues After TBI

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.


Posted on BrainLine March 18, 2009.

Comments (13)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I had a concussion/ whiplash injury 8 years ago and didn't sleep well for 3-5 years. I don't think I even had a dream for several years after the injury. For the last couple of years I've been sleeping more normally, though. To sleep well, I need to avoid getting too much exercise - this can keep my up for the entire night. I also need to avoid alcohol and caffeine obviously as those are terrible for sleep. My best sleeps are when I do some light exercise at around 5 pm, only about 25 mins at 70% of max heart rate. It's good to be back to normal, but it took years and years and i still need to be very careful with exercise and completely avoid alcohol and caffeine.

My current psychologist has me on Lunesta. Working wonders. He was the first one to figure out that my issues might be because I had not really slept in 22 years

In 2003 I suffered Severe tbi at the age of 17 an of course still suffer. I have had a couple of sleep studies done. The first one I forgot my meds and only slept 5 minutes yeah they just said your results looked normal will FAX them over ASAP. I got blown off? Luckily I have a psych now who will listen and is trying to help me to get in to a psych since the one I tried and tried over these past 12 years or so to get someone to listen send me to.someone for my awful headaches and sleep issues. Its seeming to get worse lately. I've been on vyvanse for almost a year now worked great to start off then I started right back to where I was falling asleep on the laundry I'm folding on the couch? Sitting on my bed to turn on the news and waking up 30 mins later.... I also had a second sleep study and do not go into a true sleep like someone stated up above. I've researched and researched this.... And others with common symptoms or identical are taking an narcaleptic medication along with a stimulant such as adderrall and certain vitamins and diet. The gap diet I believe is one I've seen several places for adhd and many other conditions has shown great improvmentsm.... but I am constantly tired, I know I have issues with vitamin d but I am on supplements and last labs we're normal. I have chronic pain as well which can exhaust you as well. I was given samples for nuedexta and I can say it does work but I am still in la la land from fatigue or sleep episodes. Its like mid morning I'll get this overwhelming urge to sleep and happens several times throughout the day. If I try an clean to occupy myself I find myself feeling frustrated And confused and I space out. Its hard but I'm hoping with some help finding the right combination for me I can at least feel like I'm living again.

I tried every new routine, every sleep medication, any idea we could find, for a year and half after my TBI, then my Neurologist tried, Vyvanse...changed my life !!! Abilities, function, memory, motivation, it may not be for everyone, but it was the correct path for me.

Have yourself evaluated for a condition Psuedobilbar disorder. I am on nudexta for my crying over nothing or when talking about an emotional situation. Research on the web to see if it could match what is going on with you. Best wishes. Bruce

I had a brain injury 8 months ago and have post concussive symptoms.  For many months I would go to sleep and wake up feeling completely exhausted.  With a reduced work schedule and afternoon naps I found it much easier to manage, but it never resolved the challenge with getting a restful sleep.   It's as if I can't turn off my brain.  When I describe this to friends/family/co-workers they couldn't related until I described the sleep as how you feel knowing you have an early morning flight to catch.  You sleep, but it's not entirely restful.  That was then, now, from a suggestion  of a fellow tbi patient, I use melatonin and have found I have been able to get a more restful sleep.  There is research on melatonin and tbi that indicates positive benefits, so I am surprised there isn't as much discussion on this.  While this helps me, I am no means a doctor, just providing an alternative option for others to look into.  

I suffered a tramatic brain injury about 22 yrs ago. I work in an accounting department and am a single mom both of which are demanding. Coffee keeps me going, it makes me happy! Caffeine is said to help tbi survivor with headaches and it definitely keeps me going. When I get overtired I get very emotional meaning I cry andthen try and pick out every problem in my life to be the issue why I am crying. This article has brought alot of perspective to me!

I also have sleep issues. Ambien has helped. Trazadone made me very off during the day. How can I be so tired and yet wide awake. I still wake up at least once.

I had a TBI about 3 years ago and have felt extremely fatigued ever since and really struggled to sleep at night, despite being so tired. I felt my brain was becoming active at the wrong times of day and I couldn't switch off.

At the beginning of the year a friend spoke to me about how ADHD sufferers use Ritalin to calm down their over-active brains. Ritalin is a stimulant so I tried having a strong coffee right before bed.

I haven't looked back! A strong coffee every night and I'm sleeping so much better, thus feeling much less fatigued in the day time. As a result I have found I'm getting fewer headaches and my mood and memory are much better.

I'd love to see if this works for others?

After a TBI, I slept ALL THE TIME but was still exhausted. After several sleep studies, sleep neurologists discovered the sleep center of my brain was severely damaged. I was 'resting' but never going into restorative sleep. I constantly stay in the 'twilight' stage of pre sleep. So, I'm never truly awake and never truly asleep. I take NuVigil in the daytime if I have to drive or do things requiring special attention so I am sure to not drift off. And at night, I take a small dose of Valium and Trazadone to help w a better quality of sleep. But I am still ALWAYS EXTREMELY EXHAUSTED FEELING. It is quite frustrating, as I was a very high energy person my entire life prior to the TBI. If I don't take the stimulants during the day, it's almost as if I'm drunk. Basically. I've been sleep deprived, severely for over 10 years now. So, I dare not EVER drive without taking it. I fear I would certainly doze off straight away and injure or kill someone or myself. As frustrating as it is, I am grateful to the sleep neurologist who finally figured out what was wrong. When I met her. She said she was so interested to meet me, as she had been practicing for over 30 years and never had a patient with sleep patterns like mine! She was quite excited about it. LOL. Me, not so much. I hope my experience may provide you some kind of guidance. Best of luck. No one else has a clue what we all truly endure. God bless.

VA keeps denying me for Sleep Apnea after having a mild traumatic brain injury in 2001. I was experiencing daytime sleepiness after this injury. This injury penetrated my head all the way down to the skull. I received Stitches on the inside of my head and they stapled it shut. No TBI treatment wat given, nobody cared that I had sleep issues, and they assumed the Migraines I was experiencing was the only thing resulting from the Head injury. Over the years my life got worse. Highly irritated, not thinking before i spoke or acted on something, 2 divorces, nightmares, insomnia, sleep apnea, depression, road rage, anger issues. Dog scared of me, kids scared of me, people at work say my demeanor stinks, I dont have close friends. On psych meds, sleep meds, using c-pap machine, but had no clue that all this was the after effect of the TBI. Years later after my life is a complete mess I learn about TBI and how it effects your sleep and can be the cause of migraines, VA is good about issuing Trazadone for sleep related issues like insomnia but forgets that Trazadone causes some people more problems. I guess it wasnt meant to take along with other meds needed for pain or major depression. I think the VA is trying to kill me!!

My daughter sustained a head injury at age 5or6. She sleeps to much, no motivation, hard to reason with, starts projects never finishes them and so angry all the time. She is now 28 with 3 kids living with me and Its killing me. Literally I don't know how much more I can take. The temper at times and I am so frustrated and exhausted. I want to just give up..

YES! Managing your sleep disorder after TBI is critical. As a 15 year survivor, I speak from personal experience. For years and years, I tried to just "sleep in" if I was tired (which totally didn't work because I never slept through the night regardless of how tired I was). It was not until I started practicing sleep-hygiene that I started sleeping better: 1. bed at same time every night, even on weekends 2. avoid naps if you can 3. eat healthy (no salt or sugar late at night) 4. prescribed sleep medication helps me (but not if I avoid the above sleep hygiene tips) When I get a good night sleep, I often forget I have a brain injury (okay, not really), but I feel almost normal much of the time. It's fantastic! Yay for sleep!