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Sleep Hygiene & Post-Concussion Syndrome

What is Sleep Hygiene?

Sleep is not just a state of unconsciousness - it is a dynamic process in which the brain goes through orderly stages of activity and when those stages proceed as they should, the result is “restful” sleep, or the kind of sleep which makes you feel rested and alert the next day. “Sleep hygiene” is the term used to describe good sleep habits that promote restful sleep. People who have sustained a concussion often have problems with sleep - especially with falling asleep and staying asleep.

The importance of good sleep after a concussion cannot be over-emphasized. Besides being beneficial for the fatigue that is common after a concussion, good sleep improves cognitive abilities, balance, and reaction time, and also makes driving much safer. Just as important is the benefit of quality sleep in lessening the risk for mood problems such as anxiety or depression that may develop in the weeks or months after a concussion.

There is much evidence to suggest that these strategies can improve sleep:

1) Get regular sleep. Go to bed and get up at more or less the same time every day. Try to stick to your usual sleep pattern plus add an hour or two to that.

2) Minimize or eliminate the use of technology, such as computers, texting, TV, and video games for about two hours before sleep. These things can make your mind “race”, making it harder to fall asleep. They can also worsen some of your post-concussion symptoms.

3) Get up and try again. If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring (not involving technology or TV) until you feel sleepy, then return to bed and try again. Sit quietly on the couch with the lights off (bright light will “tell” your brain that it is time to wake up), or read something boring like the phone book. Avoid doing anything that is too stimulating or interesting, as this will wake you up even more. Performing relaxing stretches or or slow breathing exercises before getting into bed may help you fall asleep more easily.

4) Avoid caffeine, nicotine, and alcohol. Alcohol actually interferes with the quality of sleep (making it less “restful”). 

5) Try not to nap unless a nap is part of your usual daily routine. There is a fine balance between the need to feel rested and not sleeping so much that you deviate from your usual sleep pattern. If you drive a car (and are told that it is safe to drive) it is better to get the sleep you need rather than drive sleepy. Sleepy driving is a common cause of motor vehicle accidents.

6) Take a bath! A hot bath 1-2 hours before bedtime can be helpful.

7) Make your space right: Your bedroom should be dark, quiet, and comfortably cool.

8) No clock-watching. Watching the clock only tells you how long you are not sleeping and makes you anxious about the fact that you are not sleeping.

9) Your doctor may recommend you keep a sleep diary but this involves watching the clock. It can be helpful for certain people.

10) Exercise? Your doctor may recommend an exercise regimen for you, depending on what post-concussion symptoms you have. Any exercise you do should not worsen your symptoms. Walking is good.

11) Try warm milk. A glass of warm milk (can flavor with vanilla and a little sugar) has tryptophan, an amino acid that can act as a natural sleep-inducer.

12) Expose yourself to bright light (or sunlight) on awakening for 20 minutes, and avoid bright light after 8 P.M.

(Thanks to the University at Buffalo Concussion Clinic for much of information on this page, and Jack Ringler, MD, of BMC's Sleep Disorders Center for his helpful information). 

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