For hardworking businesswoman Sally Smith, 31, sleep was something that came second to her thriving work life. The few hours a night she would squeeze in between a busy schedule were enough to keep her going through a fast-paced world of running a business and often working overtime for clients. But this would change following a fateful bang to the head.
“Before the injury, I was often described by friends as a workaholic,” recalls Sally. “I ran a successful freelance translation business since graduating and had lived in several different countries. It wasn’t unheard of for me to pull all-nighters if the circumstances required it. I had a good social life and went to meetups and events/classes several evenings a week. My life was full and I was happy.”
It was while doing a relatively mundane chore one day in 2018 that Sally sustained a bang to the head.
“In August I moved to the Netherlands to start a fast-track law degree,” she said.
"Unfortunately, one day I was sorting laundry in my room and, when standing up with the laundry basket, managed to launch myself right into the sloped ceiling; this type of ceiling is very typical in the Netherlands.
I hit the ceiling and ricocheted off, and my ears were ringing just like in the cartoons. I woke up the next morning with a headache and a bump. I thought nothing of it at first, but as the week went on it was as if I was slowing down.
Over the course of a week, Sally began to slur her speech, became increasingly clumsy and started forgetting things. Following an appointment with her doctor, she was referred to the local neurology team who diagnosed her with mild TBI.
Among a range of symptoms that Sally now experienced, including sensitivity to lights and sound, fatigue, problems with coordination, feeling emotional, was an inability to get to sleep.
“Immediately after the injury, I slept a lot – almost constantly. I was extremely exhausted. However, after a couple of weeks, the situation had reversed dramatically, and I found that it was almost impossible to sleep.
“For the first 1.5 to 2 years, I was so sensitive to noise that the slightest thing could set me off – and once symptoms reached a certain level, it was impossible for me to sleep at all. This means that I entered a vicious cycle; if a flatmate was especially noisy, I might spend the next two to three weeks not sleeping at all.
I did a lot of late-night walks trying to tire myself out, and on at least one occasion I disabled the heating to the entire house in mid-winter... my room was in the top floor with all the heating pipes and the banging and clunking that was previously not an issue was driving me mad. The house woke up to 12 degrees inside, but I had at least managed to sleep!
“I tried a number of things during the last 3 years to improve my sleep. Ear plugs to block out amplified noises, both during the day to dampen symptoms and sensory overload, and at night. This caused my ears to get quite sore, so I experimented with many different brands.
“No screens in bed, only books – and more generally, a rigid sleep and bedtime routine, including always trying to go to sleep at the same time.
“Headspace meditation and sleepcasts; this helped me to feel like I was doing something when I was doing nothing – it helped to keep me calm and in the present moment... you spend so much time with a brain injury thinking about the way things were and how things may be in the future, which is really stressful.
“Before I could read, I could listen to audiobooks. I would find readings on YouTube and fall asleep to them.
“Weightless by Marconi Union, a 10 hour version on YouTube; it’s a song scientists created to be the most relaxing in the world. This seemed to work for me to calm me if I felt anxious in bed and didn’t seem to trigger symptoms like other music.
“Low lighting, especially in the hours leading up to bedtime.
“Trying not to stress if I woke up a lot or too early.
“Pacing my daily activities to account for the sleep I got.
“Painkillers for headaches.
“Showers before bed and a cool bedroom to help trick my body into wanting to sleep.
“Making sure I’m well fed/watered to minimise other concussion symptoms throughout the day, since being symptomatic was the thing most likely to trigger sleep disturbances that would start the vicious cycle of symptoms.
“Exercise once I was able to do this again so I was physically tired, not just mentally tired. At first even very basic exercise like going upstairs caused severe nausea and fatigue, but I later found that if I stayed on top of food/drink I could do more.
“Naps before 4pm; I have ever been a napper, but I found this could do the trick for me if I was really tired/fatigued. I’ve learnt to read and listen to my body in a way I never did before, and I think it’s the greatest silver lining I could have gotten from the injury.
“And no more coffee!”
Although her sleep has generally improved over the years, Sally still experiences some effects of her brain injury, but has learnt ways to manage these, as well as to slow down if that’s what her body needs.
“If I start feeling tingling, a headache or tiredness, I have to just stop. It’s all about pacing yourself and managing energy levels.
“I would ask all brain injury survivors to try to have compassion for yourself. Try to understand that you took some damage and have to spend some time now putting yourself and your body first to get better, whether better means a complete recovery or just getting to a new normal.
“Be patient – try to think of it as a marathon, not a sprint. And try to get a sense of humour about the things you get wrong. It seems a bit trite, but it really does help to see the funny side when you forget or do something stupid!
Finally, do reach out to other brain injury survivors. Everyone is affected differently, and everyone has a lot of understanding for what each other have been through, which is really comforting when you’re afraid and not feeling understood by those around you.”
*Name changed at author's request.
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