Summarized by Dr. Hannah Park
December 2023
Poor sleep is very common after a traumatic brain injury (TBI), and it affects more than 50% of patients. These sleep disturbances can include less total time sleeping, waking up from sleep more frequently, having poor quality sleep, and not feeling well-rested after sleep. Insomnia, or difficulty falling asleep, is the most common sleep disorder seen after a TBI and affects 50-70% of patients.
The reason why sleep disturbances develop after a TBI is not fully understood, but several theories include changes in hormones that affect our sleep/wake cycle, including melatonin and orexin/hypocretin. Also, TBI patients can develop mood disorders like anxiety and depression that makes it more difficult to get good quality sleep. Melatonin is a hormone naturally produced in the brain by the pineal gland. It has been used to help treat patients with circadian rhythm disorders such as insomnia, and it has been shown to improve the quality of sleep, how long it takes to fall asleep, and reducing waking up during the night.
The Utility of Melatonin for the Treatment of Sleep Disturbance After Traumatic Brain Injury: A Scoping Review. This study from 2023 looked at other research articles studying melatonin use after TBI, and they chose 9 articles to evaluate with a total of 251 participants including adults and kids. These studies were from all around the world and included all severities of TBI, from mild to severe. For the medications, they used either melatonin, Circadin (an melatonin that is slowly released throughout the day), or Ramelton (a drug that activates melatonin receptors) at doses between 2 to 10mg, and they took these medications for 3 to 12 weeks.
8 out of the 9 studies reported positive outcomes after melatonin treatment. Overall, patients had improved sleep duration, sleep quality, and daytime alertness. Melatonin also improved some mental health symptoms (anxiety and depression), cognitive function, and memory. Patients who had worse sleep patterns before starting melatonin had better responses. There were no serious adverse events with treatment of melatonin in adults and children up to doses of 10mg.
Interestingly, the medications studied caused some TBI patients to take the same amount of time to fall asleep or even more time to fall asleep by up to 5 minutes. This is different from other studies in non-TBI patients, where the medications helped patients to fall asleep more quickly. More research needs to be done to further examine this effect of the melatonin medications.
In conclusion, sleep disturbances are commonly seen after TBI, especially mild TBI. They can last for several years after an injury and make recovery more difficult because the brain doesn’t get proper rest and time to heal. Feeling tired during the day can also make it more difficult to participate in the therapies that will help with recovery. Melatonin and its related medications can help to reduce the effects and symptoms of sleep disturbances and has been well-tolerated in adults and kids. We need to do more research comparing the efficacy of these medications with other interventions like cognitive behavioral therapy, improved sleep hygiene, and alternative medications. For now, if you have a loved one who is suffering from sleep disturbances after TBI, it is reasonable to try adding melatonin under the direction of your doctors.