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Sleeping Patterns

Sleeping Patterns

Julie
Sam deals with migraines right now on a daily basis, and I think that stress is a big part of it. He can’t deal with too much at any one time. He gets overwhelmed. It really helps when we can persuade him to take a nap.

Carl
Julie’s right. I think his stress level is the key. And it really seems to help if he gets a good night’s sleep. 

Tracy
So how is Sam sleeping?

Julie
Well at first he hardly slept at all, and when he did it was during the day, when we were trying to meet with the doctors and communicate with family. Then, he’d stay awake all night. And we felt that we should be awake, too, so Carl and I weren’t getting any sleep either.

Tracy
Altered sleep patterns are... they’re very common after TBI. It can be hard to fall asleep, or to stay asleep. And some people sleep much more than usual, and then others sleep very little. So the first several weeks to months even after the injury are usually the worst. Initially the sleep patterns can be totally off, but try to stay hopeful. Most people with TBI usually resume a more normal sleep routine, similar to the one that they had before the injury. Now I know you are probably really tired of hearing this, but it just takes some time.

Carl
You’re right Tracy. Sam’s sleeping definitely improved, but it took awhile. Those first couple of months were rough, for all of us…

Tracy
It does get better over time. I know everyone is at a different phase in their recovery, so some of the strategies may not apply.  Now if your loved one is in the hospital or in a rehab facility, work with the health care team to establish healthy sleeping patterns. And once you transition home you’ll have to determine what works best for your daily schedule considering appointments, therapy, that sort of thing.

Napping may be an issue, so if it seems like your loved one is napping on and off all day they may suggest that you limit daytime naps.  That will promote better sleeping at night. If your loved one becomes agitated or frustrated, it may be that a nap is needed during the daily routine. Other recommendations for better sleep are to avoid caffeine, energy drinks of course, exercise, video games, fluids too close to bedtime.

And establishing a consistent routine also helps. So have your loved one wake up and go to bed at the same time every day. Time, patience, creative problem solving… that’s all going to really help.

Carl
One of the therapists suggested making some changes in Sam’s room, like turning the clock away from the bed, using room-darkening shades, keeping the bedroom cool. So far these have helped, but sometimes Sam just can’t sleep no matter what.

Tracy
Well, if Sam simply can’t fall asleep or stay asleep, maybe you could have him get out of bed, watch TV, read, if he’s able to, you know until he feels really tired and can just sleep naturally.

You can also talk with a member of the team about temporarily using a sleep medication or some kind of alternative therapy to establish that sleep schedule.

Carl
We’ve tried most of those things at one time or another. Some things work better than others. It just seems to depend on the day, and how Sam’s feeling. Like I said before, it does get better, so don’t get discouraged.

Spasticity

An injury to the brain can cause an abnormal increase in muscle tone called spasticity. A spastic muscle does not easily relax the way a normal muscle does.

This effect is most common with a severe and/or penetrating brain injury.

Regular stretching, splints to keep limbs in proper position, and medications are common treatments.

Severe spasticity can be painful so pain management may be in order.

What you might see:

  • Involuntary muscle tightness and stiffness 
  • Muscle contractions 
  • Decreased range of movement and abnormal posture

How you can help:

  • The physical therapist will develop a stretching program for your family member. Ask the physical therapist to teach you this program.
  • Post diagrams of the stretches. Help your family member do the recommended stretches.
  • If splints are used, learn how to apply them. Find out how long they are to be worn each day.
  • Monitor your family member’s skin for pressure points from the splints. Alert nurses to areas of redness and breakdown.
  • Tell the health care team if the spasticity gets worse. This could be a sign of an underlying problem.
  • If spasticity is so severe that it interferes with comfort, positioning, and general functioning, ask the doctor about treatment options. These include implanting a muscle relaxant pump.
Related Information:
Sleep Changes
Other Physical Effects
Glossary
Frequently Asked Questions
"In the very beginning, I didn’t want to know anything because I was so scared. But a little while later… the doctors would throw out tidbits to me, like he might never speak again and he might never walk again… but I couldn’t understand why. So then I wanted to understand the part of the brain that was injured and why he was having these symptoms or why he was having this diagnosis." -  Patty H.

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