Optimizing sleep during a brain injury is essential, yet difficult. Sleep disturbances are common, affecting 30 to 70% of individuals. Insomnia, fatigue, narcolepsy and sleepiness are the most frequent post brain injury sleep complaints. In addition, depression and anxiety often co-exist with insomnia and greatly influence sleep quality. Even more, people with CTE (chronic traumatic encephalopathy) report significant difficulty with sleep.
There’s no secret that we need sleep to repair our body. Research strongly shows that healing of our brain occurs primarily during sleep, it behooves us to optimize our sleep. It’s important to get at least 8 hours of sleep per night (in most cases), and achieve proper deep sleep cycles. Circadian rhythms are disrupted from a lack of sleep. Many of the soldiers from wars report difficulty getting to sleep, and then having excessive daytime sleepiness, to the point it impairs them from working or living a normal life. And post brain injury insomnia is very difficult to treat, even by experienced medical doctors. These patients are often treated with sleeping pills like Xanax (a benzodiazepine). Eventually, medications like Xanax do not work anymore, and the dose keeps climbing higher and higher.
Optimizing sleep is complex and has many steps. With the proper help, it is often manageable. Apart from the many supplements that exist for sleep, it is important to be sure that you do not have apnea during sleep, which is one thing that can happen to people who have brain injuries. You can actually purchase monitors for in home use to see if you have apnea or not. This would be well worth the investment. The reason this is so important, is that during an apnea episode, there is a short duration of what is called hypoxia, or not enough oxygen. One or two of these episodes is probably fine, but in someone with severe apnea, can have as many as 100 or more hypoxia episodes per night. If this goes on for one year, that’s 36,500 hypoxia episodes! It’s not hard to see that this is bad for the brain!
If you are diagnosed with sleep apnea, you should probably be treated with a CPAP machine. CPAP stands for continuous positive airway pressure. You can get diagnosed and your insurance will often pay for the machine and teaching. But also realize that refurbished CPAP machines exist and can be purchased for less than a 100 dollars. All you need to buy is new tubing and a mask. Contact the guys at O2CRS if you have any interest.
Strategic naps are quite useful for those with brain injury. Even if the nap is only some minutes, that will help better than nothing at all. Ideally, a nap should be about 20 minutes or so. Just long enough to feel refreshed. It is important to not sleep to long during a nap and wake up lethargic. Sleeping too long during the day can affect night time sleep. Remember, each case will be different.
Acupuncture for insomnia has been studied and shown to be useful in some cases. If you work with a sleep doctor or clinic, they usually have references for acupuncturists who specialize in insomnia. Ask around and many are surprised at how effective acupuncture can be.
Magnesium can help with sleep when taken before bed. Taking a magnesium tea such as Natural Calm can help as a sleep aid. Magnesium can decrease the excitatory nerve firing in the brain and nerves. The important thing is to take the right dose. For most people, it will likely take more than less. Work with your doctor on the dosing.
Another thing that works great for optimizing sleep is Doc Parsleys Sleep Cocktail. It is a mixture of magnesium, B vitamins, and melatonin. It gets great reviews and I have found it to work. It contains a bit of melatonin as well. Its comes as a powder to mix in hot or cold water, so it is not another pill that you have to swallow.
Melatonin is known as the sleep hormone. It is not the only one, but it certainly gets the most press. It is the hormone that anticipates the daily onset of darkness and is very important in the functioning of circadian rhythms. Melatonin is made in the brain and released by the pineal gland. Besides it functions to synchronize our internal clocks, melatonin also acts as an anti-oxidant, interacts with our immune system, binds to heavy metals and decreases the temperature in our brains. One reason why it is thought that sleeping in a cold environment may be a good thing.
Blue light (wavelength of 460 – 480nm) actually suppresses melatonin production and this is what messes with your sleep cycles. Thus wearing blue light blocker glasses an hour before you go to bed may help with this. It is interesting that melatonin is sold over the counter in the US and Canada, but not in countries like Australia. Oral melatonin can be quite effective for sleep, especially in the short term. But it not advised to take every day, as this can disrupt the normal physiology of melatonin produced by the pineal gland. Some foods are said to contain melatonin such as pineapple, bananas, and oranges.
Dark and cold room
No, I am not writing about a morgue! But since we sleep about a 3rd of our lives, it is important to optimize the place where we sleep. I am amazed at how many people do not do this. There are many resources online on how to optimize the bedroom for sleep. Basically it comes down to decreasing any external light that may come into the room through the windows. Temperature control is very important as well. Interestingly, people who only use minimal covers on the bed are reported to sleep better. Sheet and bed spreads are a product of the middle ages when we were exposed to the elements and did not have central climate control like we have now. A former NASA researcher, Ray Cronise, has written a lot on this topic.
If you truly cannot get to sleep, then you might consider a prescription sleep medication like Ambien or Lunesta. Sometimes stronger sleep medicines can get you through difficult periods and are worth the investment. You need a consultation and prescription for these types of medications from your doctor. I have only brushed the surface of sleep in this short blog post, please consult a sleep professional if you have trouble sleeping, it can help greatly.