Sleep and rest are effective ways to reduce the symptoms of fatigue, one of the most common effects of a brain injury. However, for many brain injury survivors, a good night’s sleep isn’t always easily achieved.
Despite being extremely tired, many people have difficulty falling asleep, staying asleep, or waking too early in the morning. A lack of sleep has many negative effects on a person’s physical and mental wellbeing, especially in the early stages of brain injury recovery. It may also exacerbate some of the symptoms of the brain injury, such as memory loss, lack of concentration, poor balance and mood changes.
It is important to remember that increased sleep need and napping in the daytime can be an important part of the brain healing process and this should not be interfered with in the early stages of recovery.
We’ve put together some top tips to promote a good night’s sleep:
1. Routine
Try to go to sleep and wake up at the same time each day. This helps to regulate your body’s internal clock.
If you work full-time during the week it might be tempting to lie-in late at the weekends, however doing so can disturb your natural sleep-wake rhythm.
2. Bedroom environment
The mind has a strong association between the bedroom and sleep. Therefore, it is important to create a relaxing environment free from electronic gadgets, bright lights and noise.
Ideally, the bedroom should be dark, quiet, tidy and kept at a temperature somewhere between 18C and 22C.
Thick curtains or black-out blinds can be useful for blocking out natural light and, if noise is a problem, consider investing in some earplugs.
3. Switch off technology
Electronic devices, such as TVs, mobile phones and computers, emit high levels of blue light.
Sleep experts recommend switching off such technology at least two hours before bed.
This is because blue light exposure can trick your brain into thinking it’s still daytime and reduce the quality of your sleep.
4. Don't consume caffeine too late
Used in moderation, caffeine maybe beneficial for enhancing focus and energy for some people. However, if consumed too late in the day it can have a negative impact on a person’s ability to fall asleep and on their sleep quality.
One study found that participants who consumed caffeine up to six hours before bed had a significantly reduced sleep quality.
Therefore, it is best to avoid drinking coffee, tea, or large quantities of caffeinated soft drinks after lunchtime.
If you enjoy a cup of tea or coffee in the evenings, stick to decaffeinated options. You can also try herbal or fruit teas, but speak to your doctor if you are on any medications to ensure they do not interact.
Remember that a lot of fluid consumed late in the day may cause rising during the night to visit the bathroom, this is a major cause of sleep disturbance. Try to limit fluid intake in the two hours before bed.
5. Reduce napping
It can be very tempting to nap during the day, and sometimes necessary, especially if you’re living with brain injury-related fatigue.
However, if you have difficulty falling asleep at night, long daytime naps might be the problem as they can confuse your internal clock and reduce your sleep drive.
It’s important to remember however, that the effects of napping depend on the individual. Some brain injury survivors might need to nap more than others as a result of their fatigue.
If you’re concerned about how napping might be affecting your sleep, speak to your GP about your circumstances.
6. Use relaxation techniques
If you have trouble falling asleep, relaxation techniques may help. Here are just a few that might help:
- Breathing exercises – Turn your attention to your natural breathing pattern and concentrate on the air leaving and entering your nose or mouth. Visualise your breath flowing through your body.
- Guided imagery – Focus your attention on a scene, memory or story that you find calming. For example, a favourite holiday destination or a relaxing activity. Whenever you find your mind drifting onto an unrelated thought slowly let it go and turn your mind’s eye back to your relaxing story.
- Progressive muscle relaxation – This involves purposely tensing different muscle groups before relaxing them again. Hold each muscle for five seconds, if you can, and then relax. Pause for ten seconds and breathe deeply in between each muscle tension.
- Meditation - Meditation involves sitting comfortably, focusing on breathing and clearing the mind of all concern. It can take practice and can be a challenge for those with intrusive thoughts. There are many online guides and smartphone apps that can help you to meditate, and meditation classes such as ‘mindfulness’ may be available from an NHS service near you.
7. Wind down in the evenings
Relaxing and winding down before bed is an important stage in preparing the body for sleep. There are lots of ways to relax and what works will vary from person-to-person. Here are just some suggestions from our social media followers:
- A warm bath
- Soothing music
- Reading or listening to an audio book
- Light exercise, such as yoga (avoid vigorous exercise as this will have the opposite effect)
- Writing a 'to do' list for the following day can help organise and clear the mind
8. Keep a sleep diary
Keeping a sleep diary can be a useful way to help you understand why you might be having difficulty sleeping.
There are many different sleep diary templates available. You can download one example here.
9. Reduce overall levels of stress
Being stressed can make falling asleep harder and can impact upon sleep quality. Aiming to reduce your stress levels could have a positive affect on your sleep. You can find advice on coping with stress after brain injury here.
10. Speak to your doctor
These top tips are not designed to replace expert medical advice. If you’ve been having difficulty sleeping for a while you should speak with your GP to rule out any underlying sleep disorders.
Your GP will be able to recommend techniques and treatments suitable for your unique situation and may prescribe medication, such as sleeping pills, in some cases.
Advice from an expert:
We asked psychologist and Clinical Director of Sleep Unlimited, Dr David Lee, for his expert advice on getting a good night's sleep following a brain injury.
Video
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first thing to think about with sleep is that it really loves a good routine so if you can get yourself to bed at the same sort of time in the in the evenings and the nighttime and get up at the same time in the morning and try and be very regular about that then your circadian rhythm your body's natural rhythm and your body temperature rhythm will synchronize together and sleep really likes that it gets on really well with that we kind of mess around with that rhythm though the synchrony of those rhythms twice a year when we change the clocks and everyone kind of knows what that feels like and sort of throws you for a couple of weeks good sleepers tend to have really good routines and they'll go to bed at the same sort of time and they'll get up at the same sort of time every day and have the same amount of sleep every day bad sleepers will tend to sort of have their routines will wobble around all over the place and they'll have good nights and bad nights
so the first thing to do is to get really good routine and a routine that's going to work for you so you will know how much sleep you want to get some people get by on six hours some people need nine you'll know how much sleep you kind of need to get if you have had an accident or an injury a fair while ago two or three years ago and you found that you're starting to sleep more over you know since you've been recovering and maybe try and get back to the amount of sleep that you used to get before you had your accident or your injury we can get into the habit of over sleeping and if you oversleep and I think everyone knows what this is like is whether you oversleep at the weekend you can wake up and you feel really groggy it's called hypersomnia and sleep I think is kind of unique in that if you get too much of it or too little of it insomnia or hypersomnia it brings the same symptoms
you feel tired groggy not really with it what you need to do is get the right amount for you but we can get sometimes into a habit that's over sleeping if your injuries been quite recent maybe you do need a bit more sleep and maybe you do need to nap a little bit during the day and I'll come back to napping in a second that's important for your brain healing process so if it's fairly soon after an accident or an injury a few months maybe up to a year maybe a bit longer in some cases where the accidents been quite severe you might need a bit more sleep and we wouldn't want to restrict that but if it's been a few years your brain may have healed but you might have got into the habit of over sleeping so we want to try and get you back to the amount of sleep that you needed before
your accident and you could be a short sleeper or a long sleeper kids need more sleep as well so bear that in mind the other thing sleep really likes is you being tired now I'm talking about napping a second ago if you're not tired then you won't be able to get to sleep so what we do when we're awake during the day is we build up what's called sleep pressure tiredness and then when we go to sleep at night we relieve that sleep pressure so in order to get off to sleep you've got to be tired it's important to be tired sleep needs you to be tired now if you nap during the day you will reduce your sleep pressure at night you'll be less tired and it'll be harder to get to sleep so if again after
a few years of having an accident or an injury you're getting into the habit of mapping in the daytime try and avoid that fatigue and cognitive fatigue of big symptoms and big issues for people who've had brain injuries and you may well feel that you need to rest during the day and that's fine try and rest at regular times but try and rest not sleep if you can stay awake during the day but rest if you need to that will keep your sleep pressure high at night and then you're more likely to get off to sleep quickly and also get good quality deep sleep during the night so try and avoid napping in the daytime if you can rest and rest in a room that's not your bedroom sit down in a chair in there in the sitting room something like that
with the exception if you've just had an accident or an injury maybe you do need a bit of napping in the daytime so if it's a few months or a year maybe a little bit more after your injury that and you feel that you need to nap then that's important we will to interfere with that but if it's been a few years maybe try and get back to the amount of sleep you had before the accident and also try and avoid napping in the daytime but rest if you need to so that's brew team and napping couple of other things I'll just leave you with before we draw this to a close a lot of people think we need to drink a lot of liquid and actually we don't we get most of the liquid that we need to survive from the food that we eat and a lot of people really common this getting up in the night time to use a bathroom now if you're in that situation try to restrict
your fluid intake in the evening before you go to bed so in that 2-3 hours before bed try not to drink too much if you if you feel that you've got a dry throat now you can chew gum to keep the saliva going around in your mouth or just take very small sips of liquid not too much and then you can go to the bathroom before you go to bed and hopefully get rid of a lot of the liquid that's in your system so you'd then more likely to sleep through the night and you won't wake up during the night so avoid fluid intake in the evenings alcohol is another one that can interfere with sleep try to moderate
your alcohol intake nicotine is a stimulant that wakes you up so try and avoid consuming nicotine at all if you can obviously we know the health benefits of that but certainly in the two hours before bed and a bit of exercise in the daytime is really good but again you need to cool down before you go to sleep so if you're eating too much or exercising too close to bedtime that can interfere with your sleep so in the two hours before bed try to get away from any eating any exercise cool down and also that includes the use of flat screen devices which emit blue light and that can trick your brain into waking you up so avoid flat screen device use in the evening as well if you're waking up in the middle of the night and you can't get back to sleep again it's quite common try and get out of the bedroom if you can and wait until your next dip in tired and a good way of finding out when you're tired is to follow your circadian rhythm which is a 90-minute cycle and if
you're yawning at say 8 o'clock at night in an hour a half after that hard past 9:00 you'll have another dip and that's a good time for bed an hour and a half after that 11:00 will be another dip good time to go to bed so notice when you yawn in the evenings and that will be a dip and then add 90 minutes on to that so if you're waking in the night don't panic it might take you 45 minutes to get into the next dip best thing to do if you don't drop off to sleep within 10 or 15 minutes is get to get up get out of your bedroom and only go back when you're tired and you know when you're tired when you're dipping because
you'll yawn so look out for yawning and try and get your routine set up around those dips that can be really useful fits with a good routine avoid napping think about fluid restriction in the evenings if you're worried or distressed at all talk to us talk to your friends talk to your family talk to your GP and there's a lot of help out there all you have to do is look around and ask for it
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