In 2015, I fell over 20 feet out of a redwood tree, and to add insult to my severe traumatic brain injury (TBI), my already poor sleep deteriorated further. But this came as no surprise to the team of therapists at the outpatient day treatment program I attended for four months following my inpatient hospitalization.
After all, according to a study in Nature and Science of Sleep, sleep disorders “affect 46% of individuals with traumatic brain injuries.” Although it wasn’t my experience, the study notes that medical professionals often overlook sleep issues when it comes to the treatment of TBIs — in a sleep-deprived nation, insomnia becomes normalized. Plus, depending on an individual’s deficits, sleep regulation may not be the primary priority for a return to routine.
Immediately after my fall, I spent 10 days in a coma in an intensive care unit in Northern California. During my coma, doctors drained the various fluids inside of my skull that were putting pressure on my brain. Paradoxically, a closed-head injury can end up causing more damage to a person’s brain than one that penetrates the skull because of this pressure. In a closed-head injury, the brain also ricochets off the insides of the hard skull. Instead of simply concentrating on one localized point, the force reverberates throughout, jostling deeper areas of the brain.
This is referred to as a diffuse axonal injury and, as the study in Nature and Science of Sleep describes, it can negatively affect the sleep regulation system, the hormones involved in sleep, and the hypothalamus, brain stem, and reticular activating system. In short: traumatic brain injuries can have a holistically detrimental effect on someone’s ability to sleep properly.
I first noticed my escalating sleep problems during my outpatient rehabilitation. Pre-injury, I was a 25-year-old transfer student completing an undergraduate degree, which meant I pulled all-nighters and drank too much. In no way did I have a consistent sleep schedule — or restful sleep, as alcohol is known to reduce the quality of sleep. But I could bounce back after a long night or function decently on a few hours of sleep. Post-injury, this was not the case.
I experienced fitful nights that were followed by fatigued days. Sometimes, I would fall asleep mid-activity in the dayroom of the outpatient program. The staff never roused me when this happened, citing sleep as a critical factor aiding my brain in its recovery. Unfortunately, I’d typically only sleep for short intervals, waking 20 minutes later, which didn’t allow my brain to enter the deep REM sleep needed to bolster the human immune system.
A fact sheet from the University of Washington Model Systems Knowledge Translation Center claims that “60% of people with TBI experience long-term difficulties with sleep,” including not only insomnia but also delayed sleep phase syndrome and narcolepsy. But because brain fatigue and intermittent napping are so common in brain injury patients, narcolepsy is only formally diagnosed if the somnolence continues for longer than three months.
I wasn’t the only one in the day treatment program falling asleep during journal group or unable to sleep longer than 20 minutes at a time. Everyone — from patients in their early 20s who had hit their head skateboarding to middle-age individuals who had suffered a hemorrhagic stroke — reported some sort of disturbance to their sleep pattern.
Even mild traumatic brain injury, known informally as concussions, can cause bouts of insomnia. A study published in Neuropsychiatric Disease and Treatment found that “of 452 patients with traumatic brain injury, 50% endorsed insomnia symptoms.”
The treatment program included sessions about sleep hygiene and the importance of going to bed and rising at the same time each day. All of the tips and tricks people paste across the internet but never follow — avoid screens before bedtime, engage in adapted daily exercise, don’t nap more than 20 minutes a day — became my modus operandi.
Although my quality of sleep improved, I still had trouble falling asleep at night and staying cognizant during the day. Despite never drinking caffeine pre-injury, I began drinking copious amounts of coffee to make it through the day, becoming groggy as soon as I finished my last cup.
It wasn’t until I moved across the country for graduate school in 2017, and my balance improved enough not to require aid, that I finally was able to nail down the last piece of my sleep puzzle. I enrolled in LoveYourBrain’s free yoga class designed specifically for people with traumatic brain injuries. Between the class’s focus on mindfulness meditation, which University of Gothenburg’s Department of Clinical Neuroscience and Rehabilitation found helps alleviate mental fatigue, and a psychiatrist stabilizing me on antidepressants, I began falling asleep easier at night and waking up feeling rested — something that had evaded me even in the years leading up to my accident.
Seven and a half years post-injury, people tell me they can’t even tell I’m disabled — I seem energized — and they can’t notice my limp. They believe this is because I can compensate for my deficits by taking the time to ensure my body is rested and prepared to handle them. It’s a trade-off.
I still drink too much coffee, but I always stop by 1 p.m. My morning routine includes mindfulness meditation and an adapted yoga practice next to a piece of furniture I can grab when I inevitably lose my balance. My dog and I go for a daily walk in the afternoon, I read before bed every night, and I always try to be asleep by 8:30 p.m. My regimen is strict and unchanging, but it allows me the freedom to feel good.
“I couldn’t do that,” people have told me, but I disagree. With a simple shift of priorities, anything is possible, and anyone can implement a sleep schedule that works for them and their body. Besides, I’d rather have the energy to take my dog for a walk than stay up late, any day of the week.