Sleep Disturbances in Traumatic Brain Injury

Traumatic brain injury (TBI) disrupts the intricate regulation of the sleep–wake cycle, leading to a spectrum of disturbances that can prolong recovery and diminish quality of life. Insomnia, characterised by difficulty initiating or maintaining sleep, and hypersomnia, manifesting as excessive sleepiness, are among the most prevalent complaints following TBI. Alterations in sleep architecture, including changes in the proportion of rapid eye movement (REM) and non-REM sleep, often accompany fluctuations in sleep efficiency and circadian misalignment. Neurobiological sequelae such as axonal damage, microglial activation and neuroinflammation further perturb the homeostatic and circadian systems governing restorative sleep. These disruptions may exacerbate cognitive deficits, mood disorders and fatigue, thus creating a bidirectional relationship whereby impaired sleep hinders neurological rehabilitation and vice versa. Objective measures, notably actigraphy, have revealed prolonged sleep latency, fragmented sleep periods and diminished slow-wave sleep across acute, subacute and chronic phases post-injury. Clinically, these findings underscore the need for systematic assessment of sleep parameters within TBI management protocols and for targeted interventions that address both the biological and behavioural dimensions of sleep disturbance.

Research from Nature Portfolio

A cross-sectional study of patients hospitalised after road traffic injuries in an urban Vietnamese setting reported that individuals with TBI exhibited significantly higher rates of poor sleep quality than those without brain injury. Utilising standardised scales, researchers identified that female sex, coma at admission and elevated psychological distress scores were independent predictors of sleep disturbance. More than half of respondents slept fewer than five hours per night, and habitual sleep efficiency fell below 85% in a substantial proportion. The study advocates for holistic treatment pathways integrating sleep assessment and psychological support, especially in resource-limited contexts where mental health services are unevenly distributed.

Sleep Disturbances in Traumatic Brain Injury publication trend

The graph below shows the total number of articles in sleep disturbances in traumatic brain injury across all publications each year (not limited to Nature Index journals).

Technical terms

Traumatic Brain Injury (TBI): Physical insult to the brain resulting from external mechanical force causing neurological dysfunction.

Insomnia: Persistent difficulty initiating or maintaining sleep leading to daytime impairment.

Actigraphy: Non-invasive wrist-worn device that tracks movement to estimate sleep–wake patterns.

Sleep Efficiency: Ratio of total time spent asleep to time in bed, expressed as a percentage.

Neuroinflammation: Activation of the brain’s immune response, characterised by microglial activation and release of inflammatory mediators.

Blue Light Therapy (BLT): Exposure to blue-wavelength light to regulate circadian rhythms and enhance alertness.

References

1. A review of sleep disturbances following traumatic brain injury. Sleep Science and Practice (2018).
2. The Putative Role of Neuroinflammation in the Interaction between Traumatic Brain Injuries, Sleep, Pain and Other Neuropsychiatric Outcomes: A State-of-the-Art Review. Journal of Clinical Medicine (2023).
3. Sleep disorders among patients suffering from road traffic injuries in an urban setting of Vietnam: an exploratory study. Scientific Reports (2023).
4. Concussion and the Sleeping Brain. Sports Medicine - Open (2024).
5. Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial. BMC Medicine (2018).
6. Daily Morning Blue Light Therapy for Post-mTBI Sleep Disruption: Effects on Brain Structure and Function. Frontiers in Neurology (2021).