It’s a beautiful thing, but too often elusive when you have a brain injury. It’s not surprising, since nearly 60% of us have long-term sleep problems. Some people manage to be “up and about,” wishing they were in bed conked out – which they often do as soon as they can. And others just can’t stay awake long enough to even get out of bed.
Have you ever done a survey about your mood? There’s always a question about sleep or fatigue as both can be signs of anxiety or depression. On the other hand, lack of sleep can cause anxiety or depression. So which comes first, the chicken or the egg? With brain injury, you need a good diagnostician to figure it out.
So, what happens if you’re not sleeping with a brain injury?
If you don’t get enough sleep, the consequences creep into every nook and cranny of your life. You may react on a hair trigger, get overwhelmed, irritable, or deeply frustrated.
Exhaustion is debilitating, and exacerbates all of those things you already wish weren’t so difficult: concentration, organization, processing information, anxiety, memory, pain, balance, headaches, vision problems, and plenty more.
For instance, when I’m exhausted I can’t leave the house without my cane. Otherwise I’ll topple over at the first bump in the road.
I cry, weep when exhausted – in the shower, outside, after dinner, on the phone. Always.
I send emails well past my bedtime. If I read them the next day, I see the misspelled words and often-inappropriate tone. But they’re already in someone’s inbox, and it’s too late to take them back.
Despite sleeping with a brain injury for years, I don’t have insomnia; I sleep through the night, and get up each morning with an alarm. So I never thought I might have a sleep problem. But guess what? I do. I may get up when the alarm goes off, but I’m not ready to start the day. If I’m going out, I can’t decide what clothes to wear. I race through my routine and am almost late even before I’m even out the door. When at home I jump right into working (and don’t stop), talking (often to myself), or thinking too much too long (without a break). I’m not doing myself any favors. I can’t focus, words escape me, and my brain does too. So what’s the problem? I think I just don’t get enough sleep.
It’s stupid. I know why I don’t sleep enough, and how to fix it (it’s not that hard). But I just don’t. I guess it’s not “stupid,” it’s brain injury. But I still have to deal with it.
My doctor’s answer? “Sleep Hygiene”
(What’s up with that? Clean sheets? Purel? Brush your teeth before bed?). It’s a silly name for a serious process, basically a way to clean up your act and turn bedtime into sleep time.
My marching orders: I can’t do anything in the morning until my wake-up routine is done: #1: out of bed when the alarm rings; #2: morning ablutions (shower, teeth, etc.); #3: make bed, get dressed; #4: eat breakfast, take meds.
Once I figured it out I made a routine for nighttime using phone alerts. Smart idea, right? But guess what. Alert #1 goes off (make dinner), and what happens? I hit “snooze” a few times. When the alert starts making me crazy I hit “off” and forget about it. Then alert #2: call mom (same response); alert #3: take meds (ditto); and alert #4: go to bed (the same).
When I reach the point of no return, I turn the computer off and finally climb under the covers. But then I make one more mistake – a doozy. My phone is next to my bed. Now that is stupid. How can I resist a game? Or checking email, texts, Facebook, you name it. When the phone starts dropping out of my hand, I let it go and fall asleep. But the next morning my alarm rings and I start the day again. Exhausted.
But enough about me.
Sleep hygiene is pretty straightforward. You just need to make –and follow – rules for each morning noon and night. Come up with a schedule that works for you – one you can live with and will stick to.
Sleep Hygiene Basics: the morning
- Wake up and get out of bed at the same time every day
- Morning ablutions (bathroom, shower, teeth, hair, etc.)
- Eat breakfast, take meds if needed
- Review appointments – doctors, work, socializing, exercise, etc.
- Pace yourself; don’t skip meals, get fresh air, take breaks
- If you’re tired, take a short nap (15 or 20 minutes) – enough to power up, not lay awake at night.
Sleep Hygiene Basics: the evening
- Go to bed at the same time every night
- Closing time: three hours before bedtime: finish work, active exercise and avoid caffeine, alcohol, and heavy food
- Respect your inner clock: turn computer off and dim lights.
- Wind down – relaxing music, warm bath, meditation, herbal tea, etc.
- Cellphones? Out of sight, out of mind.
- If you can’t fall asleep or wake in the night, get out of bed, keep lights dim, and do anything relaxing – better yet boring – until you’re sleepy again.
Last but not least, beds are for sex or sleep only. That means no TV. None. At all.
With that, I can say “Goodnight, my friends.”
Sleeping with a brain injury? To learn more about the causes, effects, and how to help yourself, go to the Sleep & TBI Resources, or copy and paste tbitolife.wordpress.com/brain-injury-and-sleep into your browser bar. Resources include web sites, tip sheets, research, and other sleep-related information.
Disclaimer: This is not meant to replace advice from a medical professional. Talk to your health care provider if you have concerns, persistent sleep disturbances, or excessive fatigue.
 Sleep and Traumatic Brain Injury, 2010. Model Systems Knowledge Translation Center
Photo credit: 2016 (c) Laurie Rippon