Sleep Hygiene and its Role in Brain Injury Recovery

Disruptive sleep is one of the most troubling realities of a brain injury. Normal sleep patterns are often disturbed, causing irritability, low energy, and poor concentration. Tired and unfocused, patients struggle to process vital information they receive during therapy. Eventually their goals of skill building and independence are compromised, which undermines long-term recovery.

Because normalization of sleep is essential to the patient’s success, CNS believes that evaluation and treatment are crucial components of the return to work, family and community.

Evaluations Aid in Comprehensive Care

Determining the presence of sleep deprivation is the first step in helping patients achieve healthy sleep. CNS’ clinical evaluation includes:

• Completion of a questionnaire that determines: the perceived hours of sleep per night, quality of sleep, difficulty breathing, and factors that hinder peaceful sleep
• Review of medications and environmental factors: bedroom temperature, room darkness, bed comfort, and ambient noise
• Analyzing the nighttime routine: activities before bed, food or fluid intake, and the use of digital devices before retiring
• Clinical staff also observe and report on overnight sleep issues, such as: restlessness, multiple
bathroom visits, snoring or frequent pauses in breathing

If results indicate disturbances in sleep patterns, patients are given a sleep evaluation, also known as a sleep study. Trained technicians monitor patients as they sleep in a home-like setting at each clinic’s rehabilitation residences.

The study records any sleep apnea episodes, or how many times the patient stops breathing in a night. It also records the patient’s sleep cycle, noting leg movement and the amount of oxygen desaturation overnight

Sleep Study Reveals Potential Obstructions

In addition, the study determines if the tongue or other physical abnormalities are obstructing the airway. It also reveals changes in brain function that are causing central sleep apnea.

If sleep apnea is identified, two types of non-invasive oxygen delivery solutions may be administered. Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) are the machines used, which connect tubing to a mask that is applied over the patient’s nose or mouth and nose. Both therapies help to deliver oxygen to the brain, which is critical in rehabilitation.

CPAP delivers a continuous single stream of pressurized air that remains consistent all night. BiPAP has two pressure settings, one for inhalation and one for exhalation. The dual settings allow patients to get more air in and out of their lungs.

Results of the study are shared with the patient’s sphere of support. A CNS physician then informs the patient about medication and/or lifestyle changes that may enhance sleep.

A New Foundation of Healthy Habits

Research has shown that factual information and procedures learned during the day are consolidated at night. If circadian rhythms and Rapid Eye Movement sleep are disrupted, this vital knowledge isn’t retained. Moreover, lack of sleep affects hormone production, a critical process in postacute recovery.

CNS’ approach to better sleep therefore includes a broad spectrum of solutions. Once an evaluation and sleep study are completed, patients are given a treatment plan for better nighttime rest:

• Sleep hygiene practices are introduced
• CNS dietitians help patients adapt to better food choices for quality sleep
• Effective habits are discussed:

Once sleep is stabilized, patients often reduce dependence on medications that promote sleep. This is cost effective in the long term and is another step toward independence that CNS advocates.

“Our purpose is to optimize the whole patient so they benefit from all therapies,” said Dr. Christine Johnson, CNS Medical Director of the Dallas, TX facility. “Their alertness is vital. Restful sleep gives them the energy and focus to succeed.”