Research Reports - Fatigue and sleep disturbance following traumatic brain injury-their nature, causes, and potential treatments

J Head Trauma Rehabil. 2012 May;27(3):224-33

Ponsford JL, Ziino C, Parcell DL, Shekleton JA, Roper M, Redman JR, Phipps-Nelson, J, Rajaratnam SM

BACKGROUND: : Although fatigue and sleep disturbance are commonly reported
following traumatic brain injury (TBI), understanding of their nature and
treatment remains limited.
OBJECTIVES: : This article reviews a series of investigations of the nature and
causes of fatigue and sleep disturbance following TBI.
METHODS: : A large cohort of community-based patients with TBI, recruited from a
TBI rehabilitation program, completed measures of subjective fatigue and sleep
disturbances, as well as attentional measures. A subgroup of participants
completed polysomnography and assessment of dim light melatonin onset.
RESULTS: : Fatigue and sleep disturbance are common. Both are associated with
anxiety, depression, and pain. However, fatigue is also associated with slowed
information processing and the need for increased effort in performing tasks.
Sleep disturbances contribute to fatigue. Objective sleep studies show reduced
sleep efficiency, increased sleep onset latency, and increased time awake after
sleep onset. Depression and pain exacerbate but cannot entirely account for these
problems. There is increased slow-wave sleep. Individuals with TBI show lower
levels of evening melatonin production, associated with less rapid-eye movement
CONCLUSIONS: : These findings suggest potential treatments including cognitive
behavior therapy supporting lifestyle modifications, pharmacologic treatments
with modafinil and melatonin, and light therapy to enhance alertness, vigilance,
and mood. Controlled trials of these interventions are needed.

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