Fatigue and Sleep After TBI

Question: 

My 12 year-old daughter had a mild traumatic brain injury during a soccer match about seven months ago. She’s gotten a lot better but she is tired ALL the time. The irony, too, is that she can’t sleep more than 2-3 hours without waking up and then not being able to go back to sleep. How can we help her with her sleep/fatigue problems … they seem like a vicious circle?

Answer: 

Severe persistent fatigue following mild traumatic brain injury is not common. So the first step is to rule out other issues before deciding that the fatigue is directly due to the brain injury itself. Given that your daughter’s injury was seven months ago, her fatigue is most likely a consequence of inadequate sleep; the deeper stages of sleep, which she doesn’t seem to be reaching, are the most restorative to brain function.

She could be experiencing problems getting regular and restorative sleep for a variety of reasons, including persistent pain, depression, anxiety, changes in breathing control, or physical inactivity. You can help by making sure these strategies are in place:

  • Getting up at the same time each day and going to sleep at the same time at night
  • Not napping for more than 20 minutes during the day
  • Avoiding eating or drinking caffeinated beverages several hours before bedtime
  • Getting regular exercise and eating a healthful diet
  • Creating a restful atmosphere in the bedroom

That said, to get to the bottom of your daughter’s sleep/fatigue problems, find a specialist with a background in TBI who can give her a full evaluation. Depending upon the results of the work-up, further diagnostic testing such as a polysomnogram might be helpful.

Posted on BrainLine October 11, 2011.

Nathan Zasler

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.

Comments (22)

I had a severe TBI 20 years ago in a car accident..... Anything can be related to a tbi. Your brain runs and operates your entire body.

HELP. As like someone above I sleep well but can't wake/get up. I set loads of alarms and just turn them off and sleep if not made to get up. On weekends I will sleep until at least lunchtime. This is now causing problems at work and at home. I don't need to nap and do go to bed a lot earlier than I used to. Nobody understands and I can't explain it. I'm worried I will lose my job and morning appointments are a nightmare.

It has been 8 yrs since mine. It takes forever for me to fall asleep. The most sleep I get a night still is 3 hrs a night. After I have worked 3 twelve hour shifts my day off I go to sleep and could sleep 12 hours but always tired and fatigue is awful!!!

Do you guys think that taking cannabis (mostly indica strains ) might help resolve the issue of TBI sleep deprivation? 

I'm 7 months post TBI and I'm having the same problem as the original question describes. It's not inactivity because I run from appointment to appointment all day and I'm a single parent of 2 young children. I'm exhausted and I do not have time to nap during the day. When I try to sleep at night I sleep for as long as the pain medication keeps me asleep and then I'm wide awake for the rest of the night but still physically and mentally exhausted.its incredibly frustrating & my neurologist tells me it's perfectly normal and to be expected.

I'm 19 years out from my aneurysm.,,,was diagnosed with sleep apnea years after. Even with a cpap I get few hours of quality sleep.

There are so many issues to consider in regards to brain injury. Mild, moderate, severe-doesn't matter. A brain injury disrupts pathway function, and unfortunately, the majority of the dysfunction occurs in our vital centers of the brainstem, unless severe. Fatigue typically results from inadequate firing from your RAS (reticular activating system) in the midbrain. Funny thing is that the cerebellum and vestibular attempt, as well as the frontal lobes all connect to that area for increased function. Blood sugar regulation is a big piece of the puzzle. Dampening inflammation and triggers of symptoms is another. Thyroid function is a 3rd, adrenal function is a 4th. Blood pressure is a 5th, with too low of blood pressure you can have poor brain function and fatigue. If you all have any concerns about TBI, please visit chandlerconcussion.com and leave a message and we would be happy to answer any questions you may have.

Have you considered Neurofeedback? It could work wonders for your daughter.  eeginfo.com

wow, im not the only one.  been 4 yrs now from tbi and ive finally gotten to sleep most of the time but always tired. no energy at all. take vitamins, was going to the gym and even take naps some. always tired. and try to eat healthy, sometimes,lol.

I also have fatigue issues. I have to manage my energy. My neurologist told me this is part of finally stages of healing from a tbi. Everybody healing process is different. The length of the healing process is different for everyone. I'm 3 years into recovery.

cannabis 

Strange, my husband is 4 years post TBI and fatigue is a huge issue, during the rehab classes we also discovered it is quite common for others as well?

I tried everything but did not find relief until I started taking over the counter Melatonin from Costco!  I have severe TBI and mental fatigue is the battle I have and founf melatonin helps me get to sleep.  Now I don't sleep like I used to but nothing is "like I used to"...

I agree with the advice given. I've had too many to count mild tbi growing up(football, wrestling, dirt bikes)I didn't have any long term effects.. not saying it isn't possible, but that's not where I would go first.I do have these issues amongst many others, that I've been working through for over a year From a traumatic sub arachnoid hemorrhage. That's a whole another creature in itself though.

I can't sleep either. I've always had insomnia but nothing like this after my tbi. If I don't nap some days I can not function at all. Gonna be the tbi and it's been 4 yrs.

I wholeheartedly agree with the march 26 comments. this is brain injury related, mild or not. 5 1/2 years for me and still always tired. can't help but nap 1 1/2 to 5 hours per day. sleep sometimes only 3 hours and sometimes 12 or more hours at night. yet this is all still an improvement from after my accident when I couldn't stay awake more than a couple hours per day. please support your daughter. fatigue (that doesn't respond to most tips and treatments) is a common factor in tbi. (*I think this is the first time I've disagreed with brainline)

I'm 11 years post-SEVERE tbi, and chronic fatigue is still one of my worst remaining symptoms.  I typically get 8-9 hours of good sound sleep each night, but I still have many instances of fatigue related problems during most days (horrible short term memory, pour balance, pour problem solving skills, general inattention, etc).  I too believe your daughter’s fatigue is from something else other than a mild-tbi, but everyone’s brain IS different.  So, best of luck to you in finding out the cause.

I am four years post and too have issues sleeping regularly! I won't take pills so I just try to exercise to exhaust myself.

I've had a TBI for over 16 years.  Before the TBI I slept fine.  Since the TBI, fatigue and sleep are some of the hardest issues.  I, too, am fatigued off and on all day and evening.  Though lots of suggestions are helpful like no caffeine, good diet and exercise, the bottom line is I and others are dealing with something that does not really respond to these tactics.  The brain waves sleeping patterns are severely impaired.  My family does not understand this and constantly guilts me on it.  We are not lazy, crazy or stupid.  My insomnia became and can become so severe that I'm depressed, manic, hallucinate, etc.  My neurologist finally put me on 20 mg. of Ambien and 500 mg. of Traxadone at night.  The combination gets me to sleep and keeps me asleep.  It quiets those brain waves.  I no longer go through sleep deprivation like I did for many years.  I had a pharmacist just 2 weeks ago say something about my taking Ambien.  I told her I had a brain injury and this medication was keeping me from hallucinating.  I got away from her so fast that I don't remember which one she is.  Too bad because I would make a complaint about her.  People think it's OK to butt into my medical business all the time.  Please support your daughter.  These are symptons of a brain injury.  Mild or not. Thank you

I had a TBI at age 2yrs old and I sleep like I am in a coma, get fatigued easily, have a hard time awaking from sleep. It has been the BIGGEST battle in my life. It takes 5 alarm clocks to get me up, and now the fatigue is so great I can no longer work and function properly. I am 38yrs old now and I feel like I am getting worse instead of better. I also have one of the highest ADDs as a result of my TBI. So I ware myself out before I get started!LOL....Do you have ANY articles on this?
I agree with eating a "healthful diet," but add to that to drink plenty of water to flush out the chemicals in the system that the medicines put into the system. All those chemicals cause a chemical imbalance that the body is not used to having.
couldn t fatigue be related to tbi,depending on where in brain injury occured?even in mild?i ve heard many accts like this .