When my husband was in his early to mid-twenties, he sustained three concussions in combat. Two were from incidents involving improvised explosive devices, the third was from a parachute jump that left him unconscious for less than thirty seconds.
He appears to function rather normally, but his sleep is disrupted and he remains agitated more often than prior to his concussions. He worries that his superiors may think that he is attempting to renege on his deployment obligation if he seeks medical advice regarding TBI. He has not been thoroughly evaluated for his concussions, nor can I compel him to visit a doctor for advice. What can be the consequences of delaying or foregoing treatment for someone like my husband?
Your husband should be evaluated by a neuropsychologist to assess his neurocognitive and neurobehavioral status. There are a number of behavioral treatments for both sleep problems and neurobehavioral disorders, as well as medications that could be useful. The neuropsychologist should also take a more detailed sleep history to determine further assessment of his problems. The neuropsych evaluation should also assess the possibility that your husband is having some persistent issues with post-traumatic stress disorder.
If your husband is concerned about the impact of any diagnosis on his work status, he could seek consultation from sources outside of the military. Delaying assessment and/or forgoing treatment for non-restorative sleep pattern could negatively impact both cognitive and behavioral functions.
Nathan Zasler, MD is CEO and medical director for Concussion Care Centre of Virginia, Ltd. as well as CEO and medical director for Tree of Life Services, Inc. He is board certified in physical medicine and rehabilitation and fellowship trained in brain injury.