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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.

Sleep Changes

Altered sleep patterns are very common after TBI. This problem is usually worst in the first several weeks to months after injury.

Many people with TBI sleep during the day and are awake at night. They may nap now, when before they did not.

Stay hopeful. Most people with TBI do usually resume a more normal sleep routine similar to the one they had before the injury.

Time, patience, and some creative problem-solving help. Developing a consistent routine, using medications on a temporary basis, and changing the bedroom can improve sleep.

What you might see:

  • Difficulty falling or staying asleep (insomnia) 
  • Awake at night, sleeping during the day 
  • Frequent naps 
  • Sleeping too much or too little

How you can help:

  • Work with the health care team to establish healthy sleeping patterns. 
  • Encourage your service member/veteran to:
  • Limit daytime naps (talk to the health care team first).
    • Avoid caffeine (coffee, tea, energy drinks, dark soda) after the morning.
    • Exercise during the day; avoid exercise too close to bedtime.
    • Avoid fluids two hours prior to bedtime.
    • Try to eat the last meal of the day four hours before bedtime.
    • Go to bed at the same time every night and get up at the same time every morning.
    • Avoid use of bed for activities other than sleep and sex (e.g., watching TV).
    • If worrying or nightmares are contributing to poor sleep, consult a doctor or nurse.
  • Monitor the bedroom: turn the clock away from the bed, use room-darkening shades. Most people sleep better in a cooler environment.
  • If your service member/veteran simply cannot fall or stay asleep, have him or her get out of bed and watch TV or read (if easy to do without assistance) until he or she feels tired and is ready to try again.
  • Talk with your service member/veteran’s doctor about temporarily using sleep medication or complementary/alternative therapies to help establish a sleep schedule.
  • Make sure to tell your doctor if your service member/veteran is taking an over-the-counter medication.
Related Information:
Sleep Changes
Other Physical Effects
Glossary
Frequently Asked Questions
"A really super thing for us in terms of communicating with the hospital staff—and the hospital already had this installed in the room—is a big dry erase board. Some people use it and some people don’t. We use it to make a list of all the things we want to talk about with the doctors. That way, if I’m not in the room when the doctors come by on their rotation, they’ve got the big list right there and they can see it clearly. That helps keep the communication going." -  Anna E.

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