Insomnia is one of the most commonly reported symptoms after a concussion. Approximately 30-70% of concussed individuals report sleep disturbances following an injury. These sleep disturbances are often categorized as either excessive sleepiness during the day, insomnia, or feeling unrefreshed when waking up in the morning. Overall, 40-65% of the individuals who have sustained concussion are experiencing insomnia.
What Is Insomnia?
Those who are suffering from insomnia, tend to experience one or several of the following symptoms: poor sleep quantity or quality, delayed sleep onset, nocturnal awakening, early rising, or failing to feel rested regardless of having a full night of sleep. In order to receive a diagnosis of insomnia, the individual must be experiencing these symptoms to such an extent that it is causing distress or impairment during waking and sleeping hours.
Is Insomnia Experienced Immediately or Gradually?
Researchers have noted that there is often a gradual shift from hypersomnia to insomnia. Shortly after sustaining a concussion, individuals report feeling overly sleepy and requiring naps throughout the day. However, 2-3 weeks following the head trauma, they report experiences that are more characteristic of insomnia: having trouble sleeping and waking up earlier than desired. Interestingly, despite persistent reports of sleep disturbances following a concussion, changes in sleep behaviour are often overlooked in the concussion recovery process.
It is unclear whether insomnia is typically over- or under-reported. Studies have shown that individuals with milder head injuries tend to report insomnia symptoms more than those with more severe injuries. This discrepancy is often justified by two common explanations. The first explanation states that people with mild concussions are typically forced to resume their regular activities much sooner than those with severe brain injuries, thus insomnia may be perpetuated by an insufficient recovery. The other interpretation postulates that individuals with greater injuries are often less aware of their deficits and underreport any difficulties with sleep. The first theory highlights the importance of a well-timed recovery; a quick reintegration to daily life can intensify any deficits, stress levels, and sleep issues. The second explanation reinforces the need for proper recovery; a more severe injury or lack of recovery may mean that comorbidities of concussion such as insomnia are overlooked.
Why Does Insomnia Occur?
Insomnia can be exacerbated when experienced in combination with the other symptoms of a concussion, and the lack of sleep only worsens fatigue and frustration. Insomnia is the result of the biochemical changes that take place after any kind of neurotrauma occurs. A head injury, such as a concussion can cause dysfunction in the sleep control areas of the brain. The biochemical alterations include lowered evening melatonin production as well as changes to hypocretin-1, dopamine and serotonin levels, which are all instrumental in sleep modulation.
Long-Term Insomnia
Those who suffer from insomnia due to a concussion can report persisting symptoms up to 3 years post-injury. Pervasive insomnia can impact memory, attention, and executive functions. The ongoing sleep impairment can lead to cognitive decline and impede cognitive ability and community integration. Addressing and successfully treating sleep disturbances like insomnia could facilitate neurocognitive recovery and a smoother return to regular functioning.
Written by Anne Mburu
References:
Zhou, Y., & Greenwald, B. D. (2018). Update on insomnia after mild traumatic brain injury. Brain sciences, 8(12), 223.
Viola-Saltzman, M., & Watson, N. F. (2012). Traumatic brain injury and sleep disorders. Neurologic clinics, 30(4), 1299-1312.
Mosti, C., Spiers, M. V., & Kloss, J. D. (2016). A practical guide to evaluating sleep disturbance in concussion patients. Neurology: Clinical Practice, 6(2), 129-137.
Loewen, J. (2019.). Post-Concussion Syndrome & Sleep: Why You’re Suffering and What to Do About It. Retrieved January 19, 2021, from https://www.cognitivefxusa.com/blog/post- concussion-syndrome-sleep-what-to-do