Traumatic Brain Injury and Sleep Apnea

If you are a brain injury survivor (or not - you don't have to be a survivor to share knowledge. ), please feel free to post pertinent links here. I'm posting this to try to find some answers for my sleep disabilities - and possibly some actions to improve things.

I'll post links to this here and there as I find them. If you have anything to add, subtract, link to, correct, cover with opinion, discuss - please feel free.

Sleep Disorders Associated With Traumatic Brain Injury
Richard J. Castriotta, MD, Jenny M. Lai, MD
ABSTRACT. Castriotta RJ, Lai JM. Sleep disorders
associated with traumatic brain injury. Arch Phys Med Rehabil
2001;82:1403-6.
Objectives: To investigate the frequency of sleep disorders
in traumatic brain injury (TBI) patients with hypersomnia and
to discern the relationship between posttraumatic sleep disorders
and pretraumatic sleep symptoms.
Design: Prospective cohort study using the criterion standard
to diagnose sleep disorders in a consecutive sample of TBI
patients.
Setting: Academic medical center with level I trauma center,
rehabilitative medicine services, and accredited sleep disorders
center.
Patients: Ten TBI patients with subjective excessive sleepiness.

To continue reading: http://fibromyalgia.idd01.com/sleep.pdf

jnk wrote:http://www.craighospital.org/repository ... _sleep.pdf

I read this and there were a few things that I didn't consider - and now will pay more attention to, like stretching for a while before I go to bed. I stretch when I work out and after in the morning - but never really thought about doing so before I go to bed. If I do, the hip pain will probably be reduced quite a bit and maybe I'll have less wake ups.

I also didn't know that antihistamines are a no-no for brain injury peeps. I wonder if that is during the time of recovery or if it's for the rest of life.

http://www.sciencedaily.com/releases/20 ... 075044.htm

Oh, how truly wonderful. . .no improvement in daytime sleepiness. They have to be missing something . . .somewhere.

quietmorning wrote:http://www.sciencedaily.com/releases/20 ... 075044.htm

Oh, how truly wonderful. . .no improvement in daytime sleepiness. They have to be missing something . . .somewhere.

I wouldn't take that "no improvement in daytime sleepiness" to mean much of anything since this study leaves more questions than answers. Maybe a formal abstract rather than an article about it would reveal more. First of all, the number of people treated with CPAP was 13. While the reduction in apneas is noted, at what point in the 3 months of treatment was a therapeutic pressure and mask compatibility achieved? For comparisons to be valid, I would have to believe that all 13 got their pressure exactly right in their sleep study and all were equally successful with mask choice and timing of the beginning of consistent effective treatment. And we're not told if the patients' hours of CPAP sleep were comparable, nor if their sleep stages were comparable.

And I don't think the 9 with other sleep disorders were a distinctly separate group. We see over and over on here the overlap of sleep disorders. Besides, if this is a study about CPAP, why would they have given medication to those 9 unless they were also part of the CPAP group? Anyhow, a predetermined medication that is not titrated in dosage based on its effectiveness in a particular patient sounds pretty worthless to me. And then there's my soapbox issue that a person showing only OSA on a sleep study who resolves that with CPAP just might on further sleep studies be discovered to have PLMD/PLMS that had previously been masked by the OSA.

Just saying, not all studies are created equal in reliability or statistical significance, or even in their motivation for research. Don't let one shape your thinking until it has withstood critical scrutiny. I don't think there's any doubt that traumatic brain injury can precipitate sleep issues. Individual prognosis for improvement has too many variables for a 3 month glimpse into the beginning of treatment to forecast gloom and doom. Because these 13 people weren't less sleepy at 3 months doesn't mean they wouldn't, with individualized attention, be better at 4 months.

I was expecting there to be a focus on central sleep apnea after brain injury. Was just a bit surprised to find it is OSA. Makes sense that previously undiagnosed OSA and its low oxygen with events makes it harder for the injured brain to heal. That makes more sense to me than that the injury caused new OSA. At any rate, the discussion about TBI is interesting to me, and any true insights into the after effects could be life changing for those affected.

quietmorning wrote:If you are a brain injury survivor (or not - you don't have to be a survivor to share knowledge. ),

Thanks for the invite. Nothing to share yet.

First, I would argue that there is no such thing as a non-injured brain in this age of modern stresses and polution, even without known direct trauma.

Second, I would argue that the brain has many parts and functions, all of which can be injured to differing degrees with wide variations in healing potential, depending on the individual's state, heredity, and a myriad other related factors.

Third, I would argue that there is such an incredible lack of scientific consensus on the relationship between brain injuries and sleep and causation and treatment, that practical, commonsense, individual approaches are much more likely today to result in immediate benefits to patients than waiting and watching too closely for cutting-edge insights from recent studies on the matter, interesting though they may be. For now, anyway. There just isn't enough money being thrown at it at the moment, I don't think, since no exciting direction of study has presented itself.

Fourth, I agree with the following assessment expressed in the context of a comparison of "reductionism" versus "holism" in the "conclusions" made about research into such matters:

"It could be argued that the current body of research largely overlooks the role of ‘sleep' in patients with sleep apnoea . . . We believe this is pertinent for the holistic understanding of the involved neurocircuitry in these patients."--http://jp.physoc.org/content/591/2/389.short

I think that as long as OSA gets relegated by many researchers and clinicians as merely a breathing problem that happens to occur during sleep (one that might hurt O2 and CO2 levels at worst), instead of seeing it as the pervasive, complicated, profoundly debilitating problem that it can be (particularly when severe and left untreated), little headway is likely to be made in understanding the full nature of it, let alone what causes it or what else it causes.

In some ways, the fact that the obstruction itself is so easily solved (by PAP) appears to have worked against researchers' giving the condition as much thorough study as it deserves.

In my opinion as some brain-damaged guy on the Internet.

I have no evidence of it. But I believe I am brain injured from ten years of untreated sleep apnea. Its just common sense. Ten years of repetitious oxygen desaturations and chronic sleep deprivation could not have helped my brain out.

Eric

Eric, I think I should have put 'Traumatic Brain Injury' - as there are some specific issues with the traumatized brain that should be looked at BEFORE the patient receives their cpap unit. For instance, my first cpap machine very clearly stated in the directions that a person that has had a TBI in the past should not use that specific machine - yet my doctor NEVER asked me if I had ever had a TBI.

I'm hoping to educate myself (and others) on the issues of dealing with a brain that doesn't work in the same way as prior to the injury. For instance, changing pressure for most here would be fine, and probably the wisest thing to do, but someone who has survived a significant traumatic brain injury really runs risk. Its also something that needs to be told to the sleep specialist. Why they didn't ask me, why they don't ask is beyond me.

I'm not saying that your brain is not injured - of course it is. . . it's just a very different type of injury from what this post is about.

.

One set of definitions:

http://www.biausa.org/faqretrieve.aspx?id=43913

First, I would argue that there is no such thing as a non-injured brain in this age of modern stresses and polution, even without known direct trauma.

Oh my goodness. It is sad to have to live life as a human.

If you are talking about classic TBI, Ive known several folks with "that" kind of TBI. I used to lifeguard with a girl who survived an absolutely horrific car wreck. Her brain was...battered is a kind way to put it. They did not think she was going to survive but she did. And actually ended up working again as a lifeguard in her mid twenties. It was a few years ago.

Another guy I know is a retired 82nd Airborne Master Sergeant, retired. He lives in Fayetteville, NC outside of Fort Bragg. He served in too many combat zones around the world over a twenty year period and ended up with both TBI and PTSD. He got the TBI from too many explosions that went off too close to him, its the barometric pressure changes the explosions cause he told me. It damages the brain, damages the ears. He is partially disabled, I think.

Modern day Neurologists will tell you that the "brain has tremendous ability to heal and adapt, given the chance." They will talk about "neural plasticity." Old school Neurologists did not believe like that. They believed if the brain is damaged, while a certain amount of recovery is sometimes possible, overall, the damage is done. Nervous tissue just does not heal that well.

Im of the latter school of thought. I believe the best way to deal with brain damage is prevention. Once it happens, you will never be the same. Maybe if you are filthy rich and can afford constant, nonstop medical care from the very best Neurologists, therapists and other medical professionals, you might get some real recovery. For the rest of us, the best approach is prevention. Thats why I believe sleep apnea should be diagnosed and treated as soon as it is suspected. Holding off on treatment is a recipe for future disaster and future disability.

Eric