Sleep-related treatments to improve mild traumatic brain injury (mTBI) are in the beginning stages of discovery with a national group of brain injury and sleep specialists. Specific tests to develop these treatments are underway. Created by a sleep specialist out of the University of Maryland School of Medicine, along with the assistance of military and private industry and other experts in medicine, the recommendations for these sleep-related treatments have been published online in Neurotherapeutics.
Emerson M Wickwire, PhD, chairman of the group and assistant professor of medicine and psychiatry, states that clinical practice guidelines are not up to standard for mTBI and concussions, despite the fact that tens of millions of dollars have been spent on research over the past 10 years alone. Medicine is still unable to improve long-term outcomes and effects of concussion.
The director of the Insomnia Program at the University of Maryland Medical Center, Dr. Wickwire has called for more attention to be brought to the study that would increase the effort of improving outcomes for mTBI patients. Those who specialize in TBI have identified four areas as potential pathways that would improve mild traumatic brain injury. These four areas are neuropsychiatric disease, chronic pain, disturbed sleep, and neuroinflammation.
Dr. Wickwire has discovered that brain injury and sleep share some overlapping brain circuits, which means that those structures that were damaged in the mTBI may alter sleep-wake cycles. Additionally, Wickwire states that sleep disturbances decrease one’s quality of life, and they are reported in more than half of the people with TBI. This makes treatment very difficult and may change how the brain heals itself in the long-term.
Given this overlapping brain circuitry, it is believed that treating clinical sleep disorders may serve as treatment targets that are able to be modified for improved quality of life in mTBI patients.
TBI results from severe force to the head or body. It is usually categorized as mild or moderate to severe, based on what is assessed at the time of the injury. This includes how long the person was unconscious, their level of responsiveness, neuroimaging findings, and how long their post-traumatic amnesia lasted. The primary focus of this particular publication and study, however, is mild TBI.
This group of researchers in Maryland has created recommendations that they believe will improve sleep in patients with mTBI. These recommendations include the following:
- Frequent assessment of mTBI patients at different times after their injury to identify those individuals who may be developing sleep disorders
- Create a data repository for sleep-specific information that could be worked into existing TBI repositories and brought together across multiple points
- Further research target treatments for individuals with mTBI sleep disorders
- Education about sleep-specific issues and head injury for those in the medical field
- Provide access to treatment for sleep disorders and head trauma.
In regards to treatment, Dr. Wickwire believes there are still some unanswered questions. It is their goal to determine if sleep alone is therapeutic, and whether or not they can manipulate sleep patterns through medication or other means that will lead to the brain healing itself after injury.
Additionally, more questions regarding clinical sleep disorders such as obstructive sleep apnea, insomnia, and circadian rhythm disorders have arisen as well. These disorders affect parasomnias like sleep walking, fatigue, and sleep scheduling after the injury. There are effective treatments for these conditions in patients who do not have a TBI; however, these treatments need to be studied and adapted to meet the unique needs of a TBI patient. Additionally, Wichwire says, there may be sleep disturbances in those with mTBI that do not exist in other patients.
It will take a great deal of research from multiple areas of study to succeed in improving mTBI outcomes, says one of the researchers Dr. E. Albert Reece. The recommendations offered by this team give a clear gateway to reach this goal.
About 1.7 million Americans suffer a TBI every year, according to the Centers for Disease Control and Prevention. About 1.2 million (70%) are mild. Since many cases go undiagnosed, Dr. Wickwire believes that number to be much higher. The estimated healthcare costs of mild TBI is $21.5 billion per year.
Author: Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, fishing, and reading.