- Does sleep get affected following a concussion?
- Is my child allowed to sleep after sustaining a head injury?
- Should he/she be sleeping in an upright position, eyes open or closed?
It may sound ridiculous to some of you but these are the common sleep related questions I have come across in the process of assisting athletes with head injury.
We will tackle these questions in my future posts, but let’s lay our eyes on one of the most common lingering symptoms seen after mild traumatic head injury- Insomnia.
For those of you not sure of what it means, Insomnia, is defined as habitual sleeplessness. People with insomnia often face difficulty falling asleep, sleeping for a specific duration of time or feeling refreshed after sleeping.
Insomnia however cannot be defined by a specific number of hours of sleep because it varies widely across the population and is subjective.
Most common triggers/causes of Insomnia are
- Post traumatic stress
- Impaired mental health status
- Chronic intake of drugs , alcohol to name a few.
Hence, I am not surprised insomnia after concussion is a common finding.
- A recent study showed that two-thirds of adolescents with slow recovery from concussion had a small degree of insomnia while one-third of the population suffered from moderate to severe insomnia.
- Things looked worse if you had overlapping post concussion syndrome with symptoms of headache, dizziness, anxiety, depression , problems with attention and memory to name a few.
Treatment for insomnia could be pharmacological or non-pharmacological.
There are numerous prescription medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies, like when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone.
Combining more than one form of therapy is critical in patients with concussions as some of these medications might aggravate other existing symptoms.
The most commonly used sleeping pills are listed in the following sections including over-the-counter medications and natural sleep aids.
Some over the counter drugs include:
- Anti histamine drugs with sedative properties
Prescription drugs include the following
- Benzodiazepine sedatives:
- Nonbenzodiazepine sedatives:
- Orexin antagonists:
- Ramelteon (Rozerem)
- Some antidepressants (for example, amitriptyline [Elavil, Endep] and trazodone [Desyrel]) have been used for the treatment of insomnia in patients with co-existing depression because of some sedative properties.
- Sleep hygiene – This is a form of behavioral therapy wherein you dedicate to a certain routine of providing your body with optimal rest , nourishment and sleep by taking the following measures:
- Not going to bed hungry
- Staying hydrated
- Not forcing yourself to sleep
- Adjusting the light, noise and temperature in the room
- Keeping a fixed sleep schedule
- Avoiding caffeinated drinks/food after a certain time of the day
2) Psychotherapy– Although very poor evidence supports this form of therapy, a certain treatment trial found that cognitive behavioral therapy CBT-1 provides remission of insomnia in 80 to 90 percent of patients that suffered from prolonged insomnia.
3) USE YOUR BED ONLY FOR SLEEPING!
The american academy of pediatrics recommends that bedrooms should be a 100 percent media free zones ie all pieces of electronics must be removed from your child’s bedroom to ensure healthy sleeping habits.
4) Taking herbal medication: Valerian is a popular herbal medication used in the United States for treating insomnia with possibly some benefit in some patients with chronic insomnia.
Many other forms of treatment are available but will vary depending on the presence or absence of other symptoms related to post concussion syndrome.