Sweet dreams? Getting a good night's sleep after brain injury

After a busy day of juggling the various responsibilities of life, most of us want nothing more than to go to bed and have a good night’s sleep.

The pace of life can leave us exhausted at the end of the day, and this may be felt even more by those affected by brain injury, who have any number of additional concerns and challenges to navigate while managing the effects of their injury.

Sleep is something we all depend on. But for many of those affected by brain injury, no amount of sheep counting can help them to drift off to the Land of Nod, and there may be little or no nocturnal respite to be found in the small hours.

In this feature, we will look at the ways in which sleep can be affected by brain injury, and what can help.

How does a brain injury affect sleep?

Everything that we do is controlled by the brain. Even if we think our brains are ‘quiet’ while we sleep, it is still actually active, but in a different way. Getting to sleep in the first place is also controlled by the brain and a complex sequence of hormones that regulate our sleep patterns.

Sleep can be affected by brain injury in several different ways.

It may be that there is damage in areas of the brain that are directly responsible for sleep activity. Some of the parts of the brain involved in sleep are the hypothalamus, basal forebrain, and a bundle of nerves in our brainstems called the reticular activating system.

Injury to any part of the brain can result in a range of physical, cognitive, emotional and behavioural effects, and it may be these issues that are causing a survivor to have sleep problems. For instance, pain from headaches may make it difficult for someone to relax enough to sleep, while issues such as incontinence may cause someone to wake frequently through the night to use the toilet.

One common effect of brain injury, fatigue, may cause survivors to take late naps during the day that subsequently interfere with their ability to sleep at night.

A survivor may be on medication to cope with some of these effects of brain injury – but sadly, sleep problems may be a side effect of medication, too.

Other consequences of brain injury, such as being unable to return to work, relationships being affected, or relying on welfare benefi ts, may also cause anxiety or preoccupy one’s thoughts so that they are too distracted thinking about these issues to sleep.

There are many ways that a brain injury can affect a survivor’s sleep. And there are many different types of sleep problems that can occur as a result...

Types of sleep problems

Insomnia

One of the most common sleep-related complaints after brain injury is insomnia, which means struggling with getting to sleep. People with insomnia may toss and turn for hours in bed, being unable to drift off. They may be unable to sleep until very late, wake frequently through the night, or wake up too early in the morning.

Insomnia can leave someone feeling tired, irritable, and struggling to concentrate on things through the day. Of course, these are issues commonly experienced by brain injury survivors anyway, and so a lack of sleep can exacerbate these issues and other effects of brain injury.

Quality of sleep

Sleep quality may be affected after brain injury, so that even when a survivor does sleep, they do not feel refreshed upon waking. There may be a general feeling of increased need of sleep, known as pleisomnia. Sleep might be broken so that the survivor frequently wakes through the night.

Excessive daytime sleepiness

On the other end of the sleep spectrum, some brain injury survivors may struggle with staying awake through the day. This is known as excessive daytime sleepiness. There may be a spontaneous need for sleep so that the person is unable to stay awake during the day, often during inappropriate times with no particular cause, and may suddenly fall asleep.

Unusual dreams/nightmares

Some survivors report having unusual and vivid dreams after their brain injury, which may leave them feeling confused upon waking. Nightmares can be experienced more regularly, especially if someone is experiencing trauma related to the brain injury incident.

Find out more

Explore the links below to download our Sleep problems after brain injury factsheet, get top tips for managing sleep problems, personal stories and an insight into how dreams are affected by brain injury.

You can also contact the Headway helpline on 0808 800 2244 or helpline@headway.org.uk if you'd like to discuss any of the issues covered here.