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After Traumatic Brain Injury, Sleep Apnea Is Common-and Often Debilitating

More than half of people who experience a traumatic brain injury (TBI) report sleep disturbances in the weeks and months following their injury. Because a good night’s sleep is thought to speed the brain’s healing process, chronic poor sleep can impair a person’s ability to quickly and fully recover from a TBI, potentially limiting their ability to complete everyday tasks, maintain healthy social relationships, and remain productive at work. Research suggests that many people who experience sleep disturbances after TBI report a significantly lower quality of life than those who sleep soundly.1 As a result, health care providers need fast, effective ways to identify and treat patients who are at high risk for experiencing sleep disturbances after TBI.

Recently, neuroscience researchers have turned their attention towards a particular kind of sleep disturbance known as sleep apnea, a serious disorder that causes breathing to start and stop during sleep. In most cases, it occurs when the throat and tongue muscles temporarily relax, which closes the airway and prevents breathing.2 An estimated one-third of people with TBI suffer from poor sleep quality as a result of sleep apnea,3 which may further exacerbate the cognitive and neurological complications that usually occur after a TBI. When left untreated, the disorder also significantly increases a person’s risk for other serious health conditions, such as heart attack and stroke.4

A recent study among veterans and service members determined that even a mild TBI (also called a concussion) can significantly increase a person’s risk for sleep apnea. Researchers found that people with TBI who were diagnosed with sleep apnea performed significantly worse on measures of processing speed, memory, and other important measures of cognitive performance. Additionally, cognitive outcomes worsened as the severity of sleep apnea increased, indicating that even a concussion can cause sleep disturbances severe enough to limit a person’s overall functioning and quality of life.5

Fortunately, health care providers have developed safe, effective treatments for sleep apnea. One of the most common treatments is the continuous positive airway pressure (CPAP) machine, a mask device that supplies a constant stream of air pressure that gently props the airway open, preventing the sporadic muscle collapse that causes sleep apnea. Another treatment option is the mandibular advancement device (MAD), which reposition the lower jaw during sleep to reduce airway obstructions.6 Other helpful lifestyle changes include weight loss and side sleeping position.2

Given the serious health concerns associated with sleep apnea, consistent adherence to a treatment protocol is important. The Centers for Medicaid and Medicare Services (CMS) recommend that people who use CPAP for sleep apnea should use the machine for at least four hours per night on at least 70% of nights. However, research suggests that less than half of people who use CPAP for sleep apnea actually meet the adherence criteria and receive the full benefits of this treatment—and people who use CPAP to treat sleep apnea after TBI are even less treatment-adherent than the general population. According to a recent study, less than one-third of TBI patients using CPAP were treatment-adherent by the CMS adherence criteria. People with severe TBI were more likely to adhere to CPAP treatment than people with milder TBI, suggesting the need for educational initiatives to inform patients that even a minor concussion may cause debilitating sleep apnea that can dramatically reduce quality of life.7

Nearly half of all TBI survivors will experience sleep apnea after their injury, slowing the brain’s healing process and increasing their risk of developing other serious health conditions. Because sleep apnea can also impair cognitive functioning and may limit a person’s ability to engage in daily activities, early intervention and good treatment adherence are critical for improving health outcomes during the recovery period. In the weeks and months following TBI, patients (and their sleeping partners) are encouraged to monitor excessive snoring or gasping episodes, which can indicate that a person is suffering from sleep apnea. People recovering from TBI should report these symptoms (or any other changes in sleep quality) to a health care provider as early as possible. The importance of high-quality sleep cannot be understated—especially after a brain injury.

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