Many traumatic brain injury (TBI) patients also experience sleep disturbances, especially with regard to their sleep-wake cycle. New research reports that these two conditions should be treated simultaneously for optimum recovery. These findings are published in the online journal, Neurology, from the American Academy of Neurology.
One of the lead authors of the study, Nadia Gosselin, PhD, from the University of Montreal in Canada notes that the results indicate monitoring sleep cycles may be a good tool for evaluating the recovery from TBI. It was noted that people who suffered a brain injury and were not able to gain a specific level of consciousness that allowed them to stay aware of their surroundings were more likely to have sleep-wake cycle disruptions. However, researchers note that as those patients recovered, their sleep quality got better.
Having a good sleep-wake or circadian sleep cycle means that one is alert, awake, and active throughout the day and have uninterrupted sleep throughout the night.
There were 30 participants in this study, all aged between 17 and 58 years. All participants were hospitalized in the intensive care unit for moderate to severe TBI, and most were comatose on admission. Injuries were the result of car accidents in 20 of the participants, falls for seven people, sports or recreational injuries two, and a head injury by a blow from an external object for the last person. Average hospital admission lasted 45 days, and monitoring for this study started approximately 21 days into their admission.
Scientists used the Rancho Los Amigos scale to monitor each person for approximately 11 days to evaluate thinking abilities and level of consciousness. The scale has scores ranging from 1 to 8. In addition, each participant wore an activity device on their wrist that monitored and measured their sleep.
Findings showed a linear relationship between quality sleep and thinking abilities and increased levels of consciousness.
The daytime activity ratio is one of the measures the researchers used, which showed percentage of activity throughout the day. It showed that right after the injury, a lot of activity was happening during both day and night. The results found that once participants came out of the minimally conscious state, they had a daytime activity ratio of 80% and they had a decent sleep-wake cycle.
Unfortunately, though, many participants still had a poor cycle with a score of 5 on the Rancho Los Amigos scale, meaning they were often confused and gave incorrect or inappropriate responses to commands and stimuli. The sleep-wake cycles normalized and improved at the same time that the participants scored at least a 6 on the Rancho Los Amigos scale. This measurement indicates that the person could give adequate responses with a little outside help and direction. At the 6 level, participants could remember and relearn tasks; however, they still were unable to remember new ones.
Adjustments were made for time passed since the injury and the types of medications used on them in the ICU; however, the results remained the same.
Dr. Gosselin notes that there may be similar brain mechanisms involved in the recovery from sleep deprivation and TBI. Additional studies will be performed to examine how the hospital setting, like lighting and noise, plays a role in sleep quality in TBI patients.
Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.
© 2020 American Sleep Association.