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Chapter 20. Sleep Disturbance and Fatigue

Sandeep Vaishnavi, M.D., Ph.D.; Michael Makley, M.D.; Vani Rao, M.D.
DOI: 10.1176/appi.books.9781585624201.680108

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Excerpt

Sleep disturbance and fatigue are two common disabling symptoms that affect the recovery course and disrupt rehabilitation in patients who survive traumatic brain injury (TBI). Despite the ubiquity of these problems, objective data are scarce on the prevalence, pathophysiology, and treatment of these conditions in the TBI literature. The exact etiology of these disturbances is also unclear. Sleep disturbance and fatigue after TBI can be best conceptualized as primary effects of the trauma itself, which can cause neurohormonal and neurotransmitter dysfunction in the central nervous system or as secondary effects of neuropsychiatric disturbances associated with the TBI. Side effects of medications used to treat TBI and psychological distress associated with trauma may also influence sleep cycle integrity. Sleep disturbance and fatigue, although not well studied after TBI, are common and have important rehabilitation implications for patients (see Figure 20–1).

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Figure 20–1. Length of stay in a rehabilitation unit in those with sleep cycle disturbance present versus those with sleep cycle disturbance absent.Solid lines within boxes = 50th percentile or median value of data; error bars = 1 SD above and below mean of data.

Figure 20–2. Algorithm showing possible cause-effect relationship between traumatic brain injury, sleep disturbances, psychiatric symptoms, and fatigue.

Figure 20–3. Sleep efficiency and O-log scores over time in patients with posttraumatic amnesia.

Figure 20–4. Fatigue Impact Scale.Source. Modified from the Fatigue Impact Scale with permission of John D. Fisk. Copyright 1991 J. D. Fisk, P. G. Ritvo, and C. J. Archibald. The scale in any form should not be reused or reproduced without prior permission from Dr. Fisk.
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Table 20–1. Sleep states
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Table 20–2. Stages of non–rapid eye movement sleep
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Table 20–3. Evaluation of sleep disturbances in traumatic brain injury
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Table 20–4. Management of sleep disturbances
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Table 20–5. Sleep hygiene
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Table 20–6. Management of fatigue

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
 
Ancoli-Israel S, Cole R, Alessi C, et al: The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392, 2003
[PubMed]
 
Ashman TA, Cantor JB, Gordon WA, et al: Objective measurement of fatigue following traumatic brain injury. J Head Trauma Rehabil 23:33–40, 2008
[PubMed]
 
Attarian HP, Brown KM, Duntley SP, et al: The relationship of sleep disturbances and fatigue in multiple sclerosis. Arch Neurol 61:525–528, 2004
[PubMed]
 
Barroso J, Lynn MR: Psychometric properties of the HIV-related fatigue scale. J Assoc Nurses AIDS Care 13:66–75, 2002
[PubMed]
 
Baumann CR, Stocker R, Imhof HG, et al: Hypocretin-1 (orexin A) deficiency in acute traumatic brain injury. Neurology 65:147–149, 2005
[PubMed]
 
Baumann CR, Werth E, Stocker R, et al: Sleep-wake disturbances 6 months after traumatic brain injury: a prospective study. Brain 130:1873–1883, 2007
[PubMed]
 
Beetar JT, Guilmette TJ, Sparadeo FR: Sleep and pain complaints in symptomatic traumatic brain injury and neurologic populations. Arch Phys Med Rehabil 77:1298–1302, 1996
[PubMed]
 
Bertolone K, Coyle PK, Krupp LB, et al: Cytokine correlates of fatigue in multiple sclerosis. Neurology 43:A356, 1993
 
Beusterien KM, Rogers AE, Walsleben JA, et al: Health-related quality of life effects of modafinil for treatment of narcolepsy. Sleep 22:757–765, 1999
[PubMed]
 
Bigland-Ritchie B, Jones DA, Hosking GP, et al: Central and peripheral fatigue in sustained maximum voluntary contraction of human quadriceps muscle. Clin Sci Mol Med 54:609–614, 1978
[PubMed]
 
Borgaro SR, Kwasnica C, Caples H, et al: Fatigue after brain injury: initial reliability study of the BNI Fatigue Scale. Brain Inj 18:685–690, 2004
[PubMed]
 
Borgaro SR, Baker J, Wethe JV, et al: Subjective reports of fatigue during early recovery from traumatic brain injury. J Head Trauma Rehabil 20:416–425, 2005
[PubMed]
 
Boyeson M, Harmon R: Effects of trazodone and desipramine on motor recovery in brain injured rats. Am J Phys Med Rehabil 72:286–293, 1994
 
Branas P, Jordan R, Fry-Smith A, et al: Treatment for fatigue in multiple sclerosis: a rapid and systematic review. Health Technol Assess 4:1–61, 2000
[PubMed]
 
Breitbart W, Rosenfeld B, Kaim M, et al: A randomized, double-blind placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Arch Intern Med 161:411–420, 2001
[PubMed]
 
Breslau N, Roth T, Rosenthal L, et al: Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39:411–418, 1996
[PubMed]
 
Bruno RL, Zimmerman JR, Creange SJ, et al: Bromocriptine in the treatment of post-polio fatigue: a pilot study with implications for the pathophysiology of fatigue. Am J Phys Med Rehabil 75:340–347, 1996
[PubMed]
 
Bushnik T, Englander J, Katznelson L: Fatigue after TBI: association with neuroendocrine abnormalities. Brain Inj 21:559–566, 2007
[PubMed]
 
Bushnik T, Englander J, Wright J: The experience of fatigue in the first 2 years after moderate-to-severe traumatic brain injury: a preliminary report. J Head Trauma Rehabil 23:17–24, 2008a
 
Bushnik T, Englander J, Wright J: Patterns of fatigue and its correlates over the first 2 years after traumatic brain injury. J Head Trauma Rehabil 23:25–32, 2008b
 
Cantor JB, Ashman T, Gordon W, et al: Fatigue after traumatic brain injury and its impact on participation and quality of life. J Head Trauma Rehabil 23:41–51, 2008
[PubMed]
 
Castriotta RJ, Lai JM: Sleep disorders associated with traumatic brain injury. Arch Phys Med Rehabil 82:1403–1406, 2001
[PubMed]
 
Castriotta RJ, Wilde MC, Lai JM, et al: Prevalence and consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med 3:349–356, 2007
[PubMed]
 
Chandhuri A, Behan PO: Fatigue and basal ganglia. J Neurol Sci 179:34–42, 2000
 
Chokroverty S: Sleep, breathing and neurological disorders, in Sleep Disorders Medicine. Edited by Chokroverty S. Boston, MA, Butterworth–Heinemann, 1994, pp 295–335
 
Chokroverty S: Diagnosis and treatment of sleep disorders caused by co-morbid disease. Neurology 54 (suppl 1):S8–S15, 2000
 
Clinchot D, Bogner J, Mysiw J, et al: Defining sleep disturbance after brain injury. Am J Phys Med Rehabil 77:291–295, 1998
[PubMed]
 
Cohen M, Oksenberg A, Snir D, et al: Temporally related changes of sleep complaints in traumatic brain injured patients. J Neurol Neurosurg Psychiatry 55:313–315, 1992
[PubMed]
 
Comi G, Leocani L, Rossi P, et al: Physiopathology and treatment of fatigue in multiple sclerosis. J Neurol 248:174–179, 2001
[PubMed]
 
Damgen K, Luddens H: Zaleplon displays a selectivity to recombinant GABAA receptors different from zolpidem, zopiclone and benzodiazepines. Neurosci Res Commun 25:139–148, 1999
 
Danjou P, Paty I, Fruncillo R, et al: A comparison of the residual effects of zaleplon and zolpidem following administration 5 to 2 h before awakening. Br J Clin Pharmacol 48:367–374, 1999
[PubMed]
 
Dijkers MP, Bushnik T: Assessing fatigue after traumatic brain injury: an evaluation of the Barroso Fatigue Scale. J Head Trauma Rehabil 23:3–16, 2008
[PubMed]
 
Drake ME Jr: Jactatio nocturna after head injury. Neurology 36:867–868, 1986
[PubMed]
 
Elovic E: Use of Provigil for underarousal following TBI. J Head Trauma Rehabil 15:1068–1071, 2000
[PubMed]
 
Espinar-Sierra J: Treatment and rehabilitation of sleep disorders in patients with brain damage, in Neuropsychological Rehabilitation: Fundamentals, Innovations and Directions. Edited by Leon-Carrion J. Delray Beach, FL, St. Lucie Press, 1997, pp 263–281
 
Ferraro L, Antonelli T, Tanganelli S, et al: The vigilance promoting drug modafinil increases extracellular glutamate levels in the medial preoptic area and posterior hypothalamus of the conscious rat: prevention by local GABA receptor blockade. Neuropsychopharmacology 4:346–356, 1999
 
Fichtenberg NL, Millis SR, Mann RN, et al: Factors associated with insomnia among post-acute traumatic brain injury survivors. Brain Inj 7:659–667, 2000
 
Fichtenberg NL, Putnam SH, Mann NR, et al: Insomnia screening in postacute traumatic brain injury: utility and validity of the Pittsburgh Sleep Quality Index. Am J Phys Med Rehabil 80:339–345, 2001
 
Fisk JD, Pontefract A, Ritvo PG, et al: The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 21:9–14, 1994
[PubMed]
 
Frieboes RM, Muller U, Murck H, et al: Nocturnal hormone secretion and the sleep EEG in patients several months after traumatic brain injury. J Neuropsychiatry Clin Neurosci 11:354–360, 1999
[PubMed]
 
Garnock-Jones KP, Dhillon S, Scott LJ, et al: Armodafinil. CNS Drugs 23:793–803, 2009
[PubMed]
 
Gennarelli TA, Graham DI: Neuropathology of the head injuries. Semin Clin Neuropsychiatry 3:160–175, 1998
[PubMed]
 
Glass JR, Sproule BA, Herrmann N, et al: Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 23:260–268, 2003
[PubMed]
 
Good JL, Barry E, Fishman PS: Posttraumatic narcolepsy: the complete syndrome with tissue typing. J Neurosurg 71:765–767, 1989
[PubMed]
 
Goldstein LB, Davies JN: Clonidine impairs recovery of beam-walking after a sensorimotor cortex lesion in the rat. Brain Res 508:305–309, 1990
[PubMed]
 
Guilleminault C, Yuen KM, Gulevich BA, et al: Hypersomnia after head-neck trauma: a medico-legal trauma. Neurology 54:653–659, 2000
[PubMed]
 
Hillier SL, Sharpe MH, Metzer J: Outcomes 5 years post–traumatic brain injury (with further reference to neurophysical impairment and disability). Brain Inj 11:661–675, 1997
[PubMed]
 
Ingles JL, Eskes GA, Phillips SJ: Fatigue after stroke. Arch Phys Med Rehabil 80:173–178, 1999
[PubMed]
 
Jha A, Weintraub A, Allshouse A, et al: A randomized trial of modafinil for the treatment of fatigue and excessive daytime sleepiness in individuals with chronic traumatic brain injury. J Head Trauma Rehabil 23:52–63, 2008
[PubMed]
 
Kalonia H, Bishnoi M, Kumar A: Possible mechanism involved in sleep deprivation-induced memory dysfunction. Methods Find Exp Clin Pharmacol 30:529–535, 2008
[PubMed]
 
Keshavan MS, Channabasavanna SM, Reddy GN: Post-traumatic psychiatric disturbances: patterns and predictions of outcome. Br J Psychiatry 138:157–160, 1981
[PubMed]
 
Kreutzer JS, Seel RT, Gourley E: The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Inj 15:563–576, 2001
[PubMed]
 
Krupp LB, Coyle PK, Doscher C, et al: Fatigue therapy in multiple sclerosis: results of a double-blind, randomized parallel trial of amantadine, pemoline and placebo. Neurology 45:1956–1961, 1995
[PubMed]
 
Kryger MH, Roth T, Dement WC (eds): Sleep Medicine. Philadelphia, PA, WB Saunders, 2000
 
LaChapelle DL, Finlayson MA: An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Inj 12:649–659, 1998
[PubMed]
 
Lankford DA, Wellman JJ, O'Hara C: Posttraumatic narcolepsy in mild to moderate closed head injury. Sleep 17:S25–S28, 1994
 
Levin HS, Mattis S, Ruff RM, et al: Neurobehavioral outcome following minor head injury: a three center study. J Neursurg 66:234–243, 1987
[PubMed]
 
Lewy AJ, Ahmed S, Latham Jackson JM, et al: Melatonin shifts human circadian rhythms according to a phase response curve. Chronobiol Int 9:380–392, 1992
[PubMed]
 
Lezak MD: Subtle sequelae of brain damage: perplexity, distractibility and fatigue. Am J Phys Med 57:9–15, 1978
[PubMed]
 
Lin JS, Hou Y, Jouvet M: Potential brain neuronal targets for amphetamine, methylphenidate and modafinil induced wakefulness, evidenced by c-fos immunocytochemistry in the cat. Proc Natl Acad Sci U S A 93:14128–14133, 1996
[PubMed]
 
Mahowald MW, Mahowald ML: Sleep disorders, in Head Injury and Postconcussive Syndrome. Edited by Rizzo M, Tranel D. New York, Churchill Livingstone, 1996, pp 285–304
 
Makley MJ, English JB, Drubach DA, et al: Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit. Neurorehabil Neural Repair 22:341–347, 2008
[PubMed]
 
Makley MJ, Johnson-Greene L, Tarwater PM, et al: Return of memory and sleep efficiency following moderate to severe closed head injury. Neurorehabil Neural Repair 23:320–326, 2009
[PubMed]
 
Mann NR, Fichtenberg NL, Putnam SH, et al: Sleep disorders among TBI survivors: a comparison study. Arch Phys Med Rehabil 78:1055, 1997
 
Masel BE, Scheibel RS, Kimbark T, et al: Excessive daytime sleepiness in adults with brain injuries. Arch Phys Med Rehabil 82:1526–1532, 2001
[PubMed]
 
McLean A, Dikmen S, Temkin NR, et al: Psychosocial functioning at one month after head injury. Neurosurgery 14:393–399, 1984
[PubMed]
 
Middelboe T, Anderson HH, Birket-Smith M, et al: Minor head injury: impact on general health after 1 year: a prospective follow-up study. Acta Neurol Scand 85:5–9, 1992
 
Muller U, Czymmek J, Thone-Otto A, et al: Reduced daytime activity in patients with acquired brain damage and apathy: a study with ambulatory actigraphy. Brain Inj 20:157–160, 2006
[PubMed]
 
Neubauer DN: A review of ramelteon in the treatment of sleep disorders. Neuropsychiatr Dis Treat 4:69–79, 2008
[PubMed]
 
Nickels JL, Schneider WN, Dombovy ML, et al: Clinical use of amantadine in brain injury rehabilitation. Brain Inj 8:709–718, 1994
[PubMed]
 
Nierenberg A, Adler I, Peselow E, et al: Trazodone for antidepressant associated insomnia. Am J Psychiatry 151:1069–1072, 1994
[PubMed]
 
Okawa M, Nanami T, Wada S, et al: Four congenitally blind children with circadian sleep-wake rhythm disorder. Sleep 10:101–110, 1987
[PubMed]
 
Ouellet MC, Morin CM: Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design. Arch Phys Med Rehabil 88:1581–1592, 2007
[PubMed]
 
Ouellet MC, Beaulieu-Bonneau S, Morin CM: Insomnia in patients with traumatic brain injury: frequency, characteristics, and risk factors. J Head Trauma Rehabil 21:199–212, 2006
[PubMed]
 
Parcell DL, Ponsford JL, Redman JR, et al: Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study. Arch Phys Med Rehabil 89:843–850, 2008
[PubMed]
 
Parmeggiani PL: Physiological regulation in sleep, in Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. Philadelphia, PA, WB Saunders, 2000, pp 169–178
 
Patten SB, Lauderdale WM: Delayed sleep phase disorder after traumatic brain injury. J Am Acad Child Adolesc Psychiatry 31:100–102, 1992
[PubMed]
 
Philip P, Sagaspe P, Taillard J, et al: Maintenance of Wakefulness Test, obstructive sleep apnea syndrome, and driving risk. Ann Neurol 64:410–426, 2008
[PubMed]
 
Prins JB, Bleijenberg G, Bazelmans E, et al: Cognitive behavior therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 357:841–847, 2001
[PubMed]
 
Quinto C, Gellido C, Chokroverty S, et al: Posttraumatic delayed sleep phase syndrome. Neurology 54:250–252, 2000
[PubMed]
 
Rao V, Spiro J, Vaishnavi S, et al: Prevalence and types of sleep disturbances acutely after traumatic brain injury. Brain Inj 22:381–386, 2008
[PubMed]
 
Reppet SM, Weaver DR, Rivkees SA, et al: Putative melatonin receptors in a human biological clock. Science 242:78–81, 1988
 
Roecke U, Kappos L, Lechner-Scott J, et al: Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue. Neurology 48:1566–1571, 1997
 
Rosekind MR: The epidemiology and occurrence of insomnia. J Clin Psychiatry 53:S4–S6, 1992
 
Sakellaris G, Nasis G, Kotsiou M, et al: Prevention of traumatic headache, dizziness and fatigue with creatine administration: a pilot study. Acta Paediatr 97:31–34, 2008
[PubMed]
 
Sarhill N, Walsh D, Nelson KA, et al: Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. Am J Hosp Palliat Care 18:187–192, 2001
[PubMed]
 
Sateia MJ, Pigeon WR: Identification and management of insomnia. Med Clin North Am 88:567–596, 2004
[PubMed]
 
Schreiber S, Klag E, Gross Y, et al: Beneficial effect of risperidone on sleep disturbance and psychosis following traumatic brain injury. Int Clin Psychopharmacol 13:273–275, 1998
[PubMed]
 
Shekleton JA, Parcell DL, Redman JR, et al: Sleep disturbance and melatonin levels following traumatic brain injury. Neurology 74:1732–1738, 2010
[PubMed]
 
Simantov R: Gamma-aminobutyric acid (GABA) enhances glutamate cytotoxicity in a cerebellar cell line. Brain Res Bull 24:711–715, 1990
[PubMed]
 
Steele DL, Rajaratnam SM, Redman JR, et al: The effect of traumatic brain injury on the timing of sleep. Chronobiol Int 22:89–105, 2005
[PubMed]
 
Sutton DA, Moldofsky H, Badley EM: Insomnia and health problems in Canadians. Sleep 24:665–670, 2001
[PubMed]
 
Tariq SH: Herbal therapies. Clin Geriatr Med 20:237–257, 2004
[PubMed]
 
Tartaglia MC, Narayanan S, Francis SJ, et al: The relationship between diffuse axonal damage and fatigue in multiple sclerosis. Arch Neurol 61:201–207, 2004
[PubMed]
 
Teitelman E: Off-label uses of modafinil. Am J Psychiatry 158:970–971, 2001
[PubMed]
 
Thaxton L, Myers MA: Sleep disturbances and their management in patients with brain injury. J Head Trauma Rehabil 17:335–348, 2002
[PubMed]
 
van der Naalt J, van Zomeren AH, Sluiter WJ, et al: One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry 66:207–213, 1999
 
Vaughn MW: A psychiatric perspective on insomnia. J Clin Psychiatry 62 (suppl 10):27–32, 2001
 
Verma A, Anand V, Verma NP: Sleep disorders in chronic traumatic brain injury. J Clin Sleep Med 3:357–362, 2007
[PubMed]
 
Vermeeren A, Riedel WJ, van Boxtel MP, et al: Differential residual effects of zaleplon and zopiclone on actual driving: a comparison with low dose of alcohol. Sleep 25:224–231, 2002
[PubMed]
 
Webster JB, Bell KR, Hussey JD, et al: Sleep apnea in adults with traumatic brain injury: a preliminary investigation. Arch Phys Med Rehabil 82:316–321, 2001
[PubMed]
 
Wingerchuk DM, Benaroch EE, O'Brien PC, et al: A randomized controlled crossover trial of aspirin for fatigue in multiple sclerosis. Neurology 64:1267–1269, 2005
[PubMed]
 
Zafonte RD, Mann NR, Fichtenberg, NL: Sleep disturbance in traumatic brain injury: pharmacologic options. NeuroRehabilitation 7:189–195, 1996
 
Ziegler G, Ploch M, Miettinen-Baumann A, et al: Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia: a randomized, double-blind, comparative clinical study. Eur J Med Res 7:480–486, 2002
[PubMed]
 
Ziino C, Ponsford J: Measurement and prediction of subjective fatigue following traumatic brain injury. J Int Neuropsychol Soc 11:416–425, 2005
[PubMed]
 
Ziino C, Ponsford J: Selective attention deficits and subjective fatigue following traumatic brain injury. Neuropsychology 20:383–390, 2006
[PubMed]
 
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