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Sleep-wake disorders in patients with traumatic brain injury

Miranda M Lim, MD, PhD
Christian R Baumann, MD
Section Editor
Thomas E Scammell, MD
Deputy Editor
April F Eichler, MD, MPH


Sleep-wake disturbances are among the most prevalent and persistent sequelae of traumatic brain injury (TBI) [1,2]. Patients suffering from TBI of any severity, in both the acute and chronic phases, commonly report excessive daytime sleepiness, increased sleep need, insomnia, and sleep fragmentation [3-5]. Identification and treatment of sleep disorders in patients with TBI is important and can complement other efforts to promote maximum functional recovery.

The clinical features, evaluation, and treatment of sleep-wake disorders in patients with TBI are discussed here. The classification of TBI and management of other complications of head injury, including the postconcussion syndrome, are reviewed separately. (See "Traumatic brain injury: Epidemiology, classification, and pathophysiology" and "Concussion and mild traumatic brain injury" and "Postconcussion syndrome" and "Management of acute severe traumatic brain injury".)


In the acute and subacute phases after mild TBI, sleep-wake complaints of any kind are reported by approximately one-third of patients within the first 10 days after injury and up to 50 percent at six weeks post-injury [6-8]. The prevalence is even higher among individuals with severe TBI [9,10]. In a prospective study of 205 patients admitted to an acute rehabilitation hospital after severe TBI, 84 percent had sleep-wake disturbances upon admission and 66 percent continued to have disturbances at one month post-injury [10].

Sleep-wake disturbances are also common in the chronic phase after injury. In a meta-analysis of 1706 survivors of TBI across 21 studies, the most common sleep disturbances were [11]:

Insomnia (50 percent)


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Literature review current through: Sep 2016. | This topic last updated: Jul 28, 2016.
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