Research Shows Sleep Is a Critical Part of Traumatic Brain Injury Recovery

Getting enough quality sleep at night is crucial for your overall health and wellbeing. And now, researchers at the Oregon Health & Science University found that sleep also plays an essential role in the healing of traumatic brain injuries.

In the February study, the researchers used MRIs on military veterans to observe the perivascular spaces that surround blood vessels in the brain. Enlargement of these spaces typically occurs in aging and is associated with the development of dementia.

The study found that veterans who had enlarged perivascular spaces slept had poorer sleep and more post-concussive symptoms. On the other hand, veterans who did not have these enlarged spaces tended to sleep better and experienced fewer post-concussive symptoms. The February study was published in the Journal of Neurotrauma.

"It's a very compelling study because this gives physiologic evidence that people who have traumatic brain injury often have difficulty with poor sleep, impair of sleep, or disrupted sleep," Vernon Williams, MD, sports neurologist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, tells Verywell.

Sleep Issues and Traumatic Brain Injuries

While the study published in the Journal of Neurotrauma shows how sleep physically affects a person's recovery from a head injury, previous research indicates how the lack of sleep affects a concussed person. A May 2018 study published in the Archives of Physical Medicine and Rehabilitation journal found that sleep disturbances in young athletes, who had sports-related concussions, resulted in worse:

•  Migraines
• Cognitive symptoms
• Neuropsychological symptoms

People with traumatic brain injuries may experience different types of sleep issues. A 2016 study linked head injuries to insomnia, hypersomnia, sleep apnea, fragmented sleep, and other sleep disorders.

Philip E. Stieg, PhD, MD, the neurosurgeon-in-chief of New York-Presbyterian/Weill Cornell Medical Center and the chairman of Weill Cornell Medicine Brain and Spine Center, tells Verywell that the benefits from getting enough sleep are the same reason why sleeping around eight hours a night is important for most adults.

"It is the time for your brainwaves to slow down, it is time for the neurons to slow down, and it is time, just like after exercise, for the brain, like a muscle, to clean up the metabolic waste products," he says. "There's a reduction in the secretion of cortisol, which is an inflammatory agent, so, again, it allows the brain to recover."

Why Non-Fragmented Sleep Is Important

When people sleep eight hours a night, they move through different stages of sleep. If sleep is fragmented, then they may not go through cycles of sleep. The National Institute of Neurological Disorders and Stroke lists describes these stages of sleep as the following:

•  Stage One: Your brain waves begin to slow from their daytime wakefulness patterns. This is non-rapid eye movement sleep.
• Stage Two: Your heartbeat and breathing slow, and muscles relax even further. Brain wave activity slows but is marked by brief bursts of electrical activity. 
• Stage Three: Your heartbeat and breathing slow to their lowest levels during sleep, and your muscles are relaxed.
• REM sleep: Mixed frequency brain wave activity becomes closer to that seen in wakefulness. Memory consolidation requires you to have both REM and non-REM sleep.

"If you have fragmented sleep it will disrupt that sleep architecture," Williams says. "It will disrupt the brain's normal cycling in and out of those different stages." Fragmented sleep can also cause people to experience symptoms that are common in traumatic brain injuries, whether they have a concussion.

"Impaired sleep can cause really significant issues," he says. "We know they can affect mood, it can affect focus and concentration, [and] it can result in difficulties with increased headache pain."

How to Sleep Better

If you find yourself having trouble sleeping at night whether or not you have a heady injury, Stieg tells Verywell that there are easy positive changes you can adopt.

"Positive things you can do is avoid excessive coffee or tea at night," he says. "Number two is getting a regular sleep cycle. Don't go to bed at 10 [p.m. one night], the other night midnight, [the next] one in the morning. Get yourself a regular sleep pattern."

Limit These Before Bed

Consuming alcohol before bed may also result in fragmented sleep or insomnia.

Returning to exercise can be an important step in recovery from a traumatic brain injury, but people should be mindful of when they decide to work out. "You don't want to go out for a five-mile run before you're going to bed," Stieg says. "You're going to need some time to come down and again that comes to having a regular sleep cycle."

Health professionals generally recommend that people limit their screen time after a heady injury, although some research suggests that some usage can actually be beneficial. But, if you are going to be on your computer, try to avoid it before bed. "A lot of computer time with the glare and the lights, just if you do that right before you go to bed, you're not going to get to sleep," Stieg says.