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Sleep: More Important Than You Think

Service member in combat gear sleeps on the ground; click here to download the photo
U.S. Marine Corps photo by Lance Cpl. Sean Searfus

As a caregiver for a husband with traumatic brain injury (TBI), Rosemary Rawlins shares insights garnered from her own experiences along with insights from other caregivers and family members in her blog, “Learning by Accident,” on BrainLine. In this blog post, she talks about sleep — how poor sleep can affect you physically and mentally, and how simple changes to your daily routine can make for a good night’s rest.

Of all the physical reactions I experienced after my husband’s brain injury, I think exhaustion was the most difficult, most unbearable and hardest to overcome. From the moment I learned about Hugh’s accident, I couldn’t lie down in my bed without imagining that chaotic scene and the pain he must have felt. Many nights I left my bed and paced around the house, surfed the Web, or tried to meditate and forget the images in my mind. When those thoughts began to recede, worry took over. The silence of the night leaves much space for worry. Will he get better? Can we pay our bills? How’s this affecting the kids? It’s hard to admit that for six months after Hugh’s accident, I never slept through the night unless I took a sleeping pill.

In her article, “Goodnight. Sleep Clean.,” Maria Konnikova said, “… there is a difference between the kind of fleeting sleep loss we sometimes experience and the chronic deprivation that comes from shift work, insomnia and the like. In one set of studies, the Veasey lab found that while our brain can recover quite readily from short-term sleep loss, chronic, prolonged wakefulness and sleep disruption stresses the brain’s metabolism. The result is the degeneration of key neurons involved in alertness and proper cortical function and buildup of proteins associated with aging and neural degeneration.”

This explains why I felt 10 years older on nights when I tossed and turned for hours. For caregivers, sleep is essential. When we don’t sleep well, or don’t get enough sleep, we suffer any number of problems the next day — from feeling irritable to experiencing poor concentration, attention and judgment.

And it’s not only caregivers who are losing sleep. According to Dr. Robert S. Rosenberg, sleep medicine specialist, people with traumatic brain injury (TBI) may be losing sleep as well. “In several studies, the proportion of persons with TBI who are found to have sleep apnea is 30 to 50 percent,” he says.

Wow, what a combination! There are sleepy, irritable caregivers with sleepy, irritable loved ones.

Luckily, if people recognize this problem, they can find help. Signs of sleeping problems after TBI include fatigue, moodiness, sleep disruptions and snoring. Rosenberg mentions these signs as indications of a sleep disorder that can be treated. Getting a referral for a sleep evaluation is a good first step.

As a caregiver, here are a few strategies that helped me toss the sleeping pills and return to a normal sleeping pattern:

  1. Exercise tires my body and also helps me calm down. A walk after dinner became part of my routine with Hugh, and has helped us both sleep more soundly at night.

  2. Switching to decaf coffee and tea helped. I might have benefited even more from cutting back on dark chocolate, but I didn’t, so I’ll never know.

  3. Avoiding upsetting subjects like money problems or medical worries in the evening helped. It’s hard to fall asleep right after a tense discussion. Reserve the evening for winding down, reading or sweet pillow talk.

  4. Guided imagery recordings at bedtime occupied my mind so the negative thoughts that usually crept in were pushed aside.

  5. Counseling helped me better understand my own worries and anxieties, making it easier to manage them. Speaking to a professional about sleep problems could prove helpful for many caregivers.

Putting some extra effort into ensuring a good night’s sleep is worthwhile because the benefits are so great. Adequate sleep could help you and your loved one improve physically and mentally, and if everyone sleeps well, relationships may improve, too.

Wondering if you have a sleep problem? Check out this blog post on how you can take a sleep assessment. If you’re looking for more tips, review these 10 tips for better sleep.


Comments (6)

  • brian cadusch 29 Apr

    Been a Australian Vietnam Veteran, we were left out by the rinner, and left to die! Been sent to a phys, they said we did not have to have more sleep than 4 hours.. what about the nightmares etc.. I went on Stilnox, that was a great Sleeper, but Oh! did it have an effect on you...Brian
  • Kara 29 Apr

    My husband and I are both survivors of severe TBIs (he is 23 years post-injury and I'm 13 years post-injury) and sleep is essential for us to function.  One of the reasons we make a great couple is that we each understand why an early bedtime is so important.  Sometimes it's hard for other people (especially people in their 20s and 30s) to understand that 7-9 hours of sleep is something a TBI survivor HAS to have.
  • DCoE Public Affairs 29 Apr

    @Brian, Sleep plays a vital role in good health and well-being. So, it's important if someone is having sleep issues to work with their doctor to get their sleep back on track.

  • DCoE Public Affairs 29 Apr

    @Kara, Sounds like you and your husband have worked out a great sleep routine that works for the two of you. Thanks so much for sharing and we wish you both well!

  • Kathy 28 May

    My ex and father of my son is now an adult and at this moment in time is homeless. He has no one to help except me. I have known him for 36 years. His Dad, a Vietnam Vet passed away back in the mid 1980's. He first had a traumatic brain injury when he was a kid. Since that was back in the 1960's no one talked about TBI. Then he got in a motorcycle accident at 18 where he died 3 times and had no human face left. The girl on the back of the motorcycle died on impact. His life went into a downward spiral after the motorcycle accident. The substance abuse was so extreme I had to leave him when our baby was 3 months old. Still no one talked to him or his Mom about TBI. It seemed obvious he suffered a severe brain injury. I can remember him telling me his entire brain had shifted. I referred him to our local hospital's small TBI center. Neither he nor my Mom in law would believe he had TBI at that time. I think it was too permanent sounding for both of them to believe. He had somewhat straightened out his life for quite some time, remarried, owned a business etc. But substance abuse, erratic behavior, and anger outbursts were still prevalent in his life. His last TBI landed him in a coma and in the hospital for over a month. This last event changed him forever or so it appears 4 years later. It took me 3 years to find him a decent assisted living home after his estranged wife took him out of a good one he was in. Problem is she abandoned him quite literally. Now after just a few months, the home kicked him out for throwing the remote controller onto a chair. They did so without any notice and with only the clothes on his back. He doesn't even have his teeth in. They kept his money for the entire month. I had warned them repeatedly not to let him wander alone during nights and weekends. I said he can't be going out on his own. The home failed to get him to critical long overdue medical appointments for TBI as they assured us they would. Well now he's homeless. No assisted living home will take him due to "erratic behavior" and "noncompliance" and former substance abuse. He isn't non-compliant. He just doesn't understand the repercussions of decision makings. He cannot conceive cause and effect. What little of that "filter" as I called it, that was there before, is totally gone now. I feel I'm losing it because no one will help him. Every doctor, therapist, ALH, nurse, social worker and family member has failed him. Mostly due to a lack of knowledge about TBI. HIs brain has never even been imaged, no specialists, no OT, no one has referred him to the proper TBI programs that do exist. I feel very frustrated right now.

    I'm a social worker yet I'm family too. I couldn't sleep, wasn't eating and as was said above, I spent a lot of time browsing the web. Most of my browsing has been looking for resources for him. There is literally no housing for persons with TBI that also have behavioral and substance abuse histories. He ended up at our city shelter. This is the worst possible place for him and dangerous as well. After only a few days there, he became suicidal with a plan. The only reason he has a safe place to sleep at this very moment is due to being suicidal. I'm constantly worried and over-stressed right now. The plan on Thursday was as soon as a bed opened at the shelter they were going to send him back there. That scares me more than anything. I've spent every day, all day since the 5th of this month trying to help him find a place to go. His state social worker won't help. The reason I'm writing here is because he's the child of a Vietnam Vet, and I know that the VA has been on the front lines of working TBI patients (unfortunately and fortunately). I'm disabled and can't walk by myself after dinner. I'd like to walk again. I have found no matter what that I must turn off my computer by no later than 11:00 PM. I still have to take a sleeping aid. I'm worried about my own brain and overall health. I finally rested this weekend and didn't answer the phone or look for help for my loved one. I haven't even called his Mother. I don't want to. I'm upset with her for failing him too I suppose. I didn't realize this until about a week ago. We've been close for the last 36 years. I have one friend who is supporting me. There is little to no help in the area I live in for caregivers let alone TBI survivors. Thanks for allowing me to post here. I suppose just writing about it helps a little. I have BIAW helping him but I still don't know how. I can't let go of him because we are family and I'm all he has. I don't quit on people in need. Well it's a little past 11:00 PM so I must sign off. Thank you again. To all caregivers and survivors...let's take care of ourselves. Maybe saying this each morning will help you and me...
  • DCoE Public Affairs 28 May

    @Kathy, Thank you for sharing with us. We are sorry to hear about the struggles you are going through and that of your loved one. A traumatic brain injury, whether mild or severe, should be checked out and treated appropriately by a medical professional. And caring for someone with a TBI can be daunting, so it's very important that you do continue to take care of yourself. Please consider reviewing the materials available at www.brainline.org. The sections "Diagnosing & Treating Brain Injury" (http://www.brainline.org/landing_pages/categories/diagnosing.html) and "Caregiving & Brain Injury" (http://www.brainline.org/landing_pages/categories/caregiving.html) may be especially helpful. Additionally, if you're having trouble finding information and getting connected to resources in your area, you can contact the DCoE Outreach Center. The center is available to anyone, whether military or non-military, and is available 24/7 to answer questions related to psychological health or TBI. You can call 866-966-1020, email resources@dcoeoutreach.org or live chat with someone at www.realwarriors.net/livechat.


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