Abstract
Mild traumatic brain injury (mTBI) is a significant public health problem. Insomnia is one of the most common symptoms of TBI, occurring in 30–50% of patients with TBI, and is more frequently reported in patients with mild as opposed to moderate or severe TBI. Although insomnia may be precipitated by mTBI, it is unlikely to subside on its own without specific treatment even after symptoms of mTBI reduce or remit. Insomnia is a novel, highly modifiable treatment target in mTBI, treatment of which has the potential to make broad positive impacts on the symptoms and recovery following brain injury. Cognitive-behavioral therapy for insomnia (CBT-I) is the front-line intervention for insomnia and has demonstrated effectiveness across clinical trials; between 70 and 80% of patients with insomnia experience enduring benefit from CBT-I and about 50% experience clinical remission. Examining an existing model of the development of insomnia in the context of mTBI suggests CBT-I may be effective for insomnia initiated or exacerbated by sustaining a mTBI, but this hypothesis has yet to be tested via clinical trial. Thus, more research supporting the use of CBT-I in special populations such as mTBI is warranted. The current paper provides a background on existing evidence for using CBT-I in the context of TBI, raises key challenges, and suggests considerations for future directions including need for increased screening and assessment of sleep disorders in the context of TBI, examining efficacy of CBT-I in TBI, and exploring factors that impact dissemination and delivery of CBT-I in TBI.
Highlights
Mild traumatic brain injury is a significant public health problem for many populations including children, adolescents, young adults, older adults, athletes, and military personnel. mTBI is associated with numerous negative sequalae including mental and physical health, work and social functioning, and financial burden to the injured individual and society
This study provides some preliminary evidence Cognitive-behavioral therapy for insomnia (CBT-I) may be useful in this population but is limited by small sample size and inclusion of a range of traumatic brain injuries (TBI) severities
We have summarized some of the potential challenges here: 1. Patients with mTBI struggle with attention, concentration, mental fatigue, or forgetfulness which may complicate the implementation of behavioral changes at home
Summary
Mild traumatic brain injury (mTBI) is a significant public health problem for many populations including children, adolescents, young adults, older adults, athletes, and military personnel. mTBI is associated with numerous negative sequalae including mental and physical health, work and social functioning, and financial burden to the injured individual and society. MTBI is associated with numerous negative sequalae including mental and physical health, work and social functioning, and financial burden to the injured individual and society. Untreated insomnia is associated with numerous mental and physical health sequelae [3], increased healthcare utilization [4], work problems [5], and financial burden on both the individual and society [6]. Judging from anecdotal reports of high referral volume and extensive waitlists within clinics providing behavioral sleep medicine services, it is likely that the current demand for CBT-I exceeds capacity. Side effects of common hypnotics (e.g., benzodiazepines, non-benzodiazepine receptor agonists) are concerning for patients with mTBI given overlap with symptoms of mTBI including daytime sleepiness, fatigue, dizziness, headache, mental slowing, and attentional and memory difficulties. Given the potential risks of hypnotics, CBT-I is a clear first choice for treatment of insomnia in patients with mTBI, they need not be mutually exclusive treatments and can in some circumstances be used together effectively
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
