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By: Shane Creado, MD, BPT on June 2nd, 2022

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Go to Bed, Sleepy Head: The Relationship Between Head Injuries and Sleep Problems

A2Zzz | sports-related concussions | concussions and sleep

“It's raining, it's pouring,

The old man is snoring,

He bumped his head and went to bed,

And couldn't get up in the morning.”

—The Little Mother Goose 


Reflecting on this nursery rhyme taught to me by my parents at age two, I now see how apt it is, almost four decades later. Head injuries have been a huge focus in the sports world since at least 2009 when numerous studies showed that repeated head trauma in athletes in the National Football League (NFL) could have serious consequences and downstream effects in players, including the increased risk of
violence, mental health problems, spinal cord injuries and even dementia (chronic traumatic encephalopathy [CTE]).

In this article, I will discuss the bi-directional relationship between head injuries and sleep problems so that sleep professionals are aware of the right questions to ask and the associated sleep disorders to look for. Equipped with this understanding, sleep professionals can better serve their patients, and anybody they know who is dealing with post-concussional syndrome (PCS).

What Is a Concussion?

The Centers for Disease Control and Prevention (CDC) defines a concussion as “a type of traumatic brain injury — or TBI — caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

TBI is considered mild, moderate or severe depending on the scoring of the symptoms using the Glasgow Coma Scale. The damage can range from light blows to the head with local bruising to hematomas (small blood clots), cerebral edema (brain swelling) and even as significant as shearing/tearing injuries of white matter to specific areas of damage (frontal, temporal, occipital lobes).

Even minor hits to the head that are brushed off as bumps or not even considered as hits can cause “fraying” of the brain and add up in terms of overall damage with severe long-term consequences.

Thus, an umbrella term like “concussion” is woefully inadequate. We have to take into account the severity of an injury, number of injuries, areas affected, loss of consciousness (or not), specific symptoms (indicating areas of the brain affected), duration of complete recovery from those symptoms and other factors impacting brain health (medications, substance use, sleep, inflammation, genetics, hormones, neurotransmitters, mental health, diet and others).

MRIs and CT scans may be normal in many cases. Thus, more sensitive testing such as single-photon emission computerized tomography (SPECT) imaging (functional brain imaging, that can tell us about blood flow and activity levels) is important to establish baseline measurements, quantify the degree of damage and create specific plans to help the brain heal.

To learn more about the relationship between head injuries and sleep problems,  read the 2022 Q1 issue of A2Zzz.