Every year about 1.7 million Americans sustain a Traumatic Brain Injury (TBI). 80 to 90 percent of these are considered mild, with the majority classified as concussions. In fact, the annual incidence of sports-related concussion alone has been estimated at over one million a year. In football, it is estimated that 10 percent of college and 20 percent of high school players sustain concussions.
We also see a high incidence of traumatic brain injury associated with falls, motor vehicle accidents, and in our returning veterans. In fact, in a survey of 2,525 Army infantry soldiers returning from Iraq, 15% reported injuries consistent with traumatic brain injury.
What do all of these people have in common? They have a very high incidence of sleep disorders, with as many as 70% complaining of insomnia, excessive daytime sleepiness, or severely fragmented sleep. These sleep disorders are usually noted in the first few weeks and may persist for years. As a result, they contribute to moodiness, cognitive dysfunction such as memory impairment, and lack of sustained attention.
What is most interesting is the very high incidence of sleep apnea that is found in these individuals. In several studies, the proportion of persons with TBI who are found to have sleep apnea is 30 to 50 percent. In all of these studies, patients with TBI and sleep apnea performed much worse when it came to mood and memory. They were also much more likely to be excessively sleepy and/or fatigued during the day.
Unfortunately, sleep disorders are frequently overlooked or discounted after TBI. I have had numerous patients over the years whose sleep problems began with a frequently forgotten concussion. One particular case was that of a 27-year-old man who had sustained a concussion when playing college football. Afterwards, he had had trouble with fatigue and moodiness and had complained of disrupted sleep. His new girlfriend noted that he snored and urged him to come see me. We tested him and found that he had sleep apnea. Several months later, after treatment, he was no longer fatigued and irritable and he was sleeping through the night.
The point here is that TBI in America is at an all time high, with an estimated 3.5 million suffering from chronic symptoms such as fatigue, sleepiness, cognitive dysfunction, moodiness, and anxiety. In many of these individuals, an underlying sleep disorder may be the cause. Given the very high incidence of sleep complaints, people with TBI should be thoroughly evaluated for underlying sleep disorders.
