Surreal illustration symbolizing the connection between sleep, brain health, and TBI recovery, featuring a brain surrounded by clouds with one side vibrant and the other entangled, emphasizing hope and serenity.

Sleepless After Injury? How to Improve Sleep and Recovery After a TBI

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Discover how sleep disturbances impact recovery from traumatic brain injuries and what steps you can take to improve your sleep and neurobehavioral health during rehabilitation."

Sleep disturbances are a common consequence of traumatic brain injuries (TBIs), affecting a significant percentage of individuals. This disruption in sleep patterns can greatly influence recovery, potentially exacerbating cognitive and emotional difficulties. It's essential to address these sleep-related issues to support overall rehabilitation and improve the quality of life for those recovering from a TBI.

Research indicates a strong link between sleep quality and cognitive functions such as memory, attention, and decision-making. When sleep is compromised, these critical functions can suffer, slowing the rehabilitation process. Additionally, poor sleep can impact emotional well-being, leading to increased irritability, anxiety, and depressive symptoms, all of which further complicate recovery.

Given the significance of sleep in recovery, healthcare professionals are increasingly focused on integrating sleep management strategies into TBI rehabilitation programs. This involves accurately assessing sleep patterns, identifying specific disturbances, and implementing tailored interventions to promote restorative sleep. By prioritizing sleep, rehabilitation teams aim to enhance cognitive and emotional recovery, leading to better overall outcomes for patients with TBIs.

The Link Between Sleep and Neurobehavioral Impairments After TBI

Surreal illustration symbolizing the connection between sleep, brain health, and TBI recovery, featuring a brain surrounded by clouds with one side vibrant and the other entangled, emphasizing hope and serenity.

A recent study explored the relationship between sleep and neurobehavioral impairments during inpatient rehabilitation after a traumatic brain injury. The study focused on how total sleep time (TST), measured using both wrist actigraphy and observational sleep logs, correlated with neurobehavioral assessments.

Researchers at an academic inpatient rehabilitation hospital enrolled twenty-five subjects undergoing rehabilitation for traumatic brain injury. They monitored the participants' sleep using wrist actigraphy, a method that tracks movement to estimate sleep patterns, and observational sleep logs, where nursing staff recorded hourly observations of whether patients were asleep or awake.

Neurobehavioral Assessments: Participants were evaluated using the Neurobehavioral Rating Scale-Revised (NRS-R), a comprehensive tool that assesses various aspects of neurobehavioral function.
Data Collection: Wrist actigraphy was conducted over seven consecutive days, and TST was calculated using the Cole-Kripke algorithm. Nursing staff also recorded sleep logs during the nights preceding the NRS-R interviews.
Data Analysis: Researchers performed correlation analyses to compare TST, as measured by actigraphy and sleep logs, with NRS-R scores.

The study revealed a significant negative correlation between total NRS-R scores and TST calculated from observational sleep logs. This means that as total sleep time increased, neurobehavioral impairments, as measured by the NRS-R, decreased. However, no significant correlation was found between total NRS-R scores and TST as calculated by wrist actigraphy.

Practical Implications and Next Steps

This research underscores the importance of addressing sleep disturbances during inpatient rehabilitation for TBI patients. While observational sleep logs appear to provide valuable insights into the relationship between sleep and neurobehavioral impairments, actigraphy may have limitations in this population due to factors such as patient movement and the validity of sleep detection algorithms. Further studies are needed to refine sleep monitoring techniques and explore the potential benefits of tailored interventions to improve sleep and neurobehavioral outcomes in TBI rehabilitation.

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Everything You Need To Know

Why is it important to address sleep disturbances after a Traumatic Brain Injury (TBI)?

Sleep disturbances are frequently observed after a Traumatic Brain Injury (TBI), and they can significantly impede recovery. This disruption affects cognitive functions, such as memory and attention, and emotional well-being, potentially leading to increased irritability and anxiety. Addressing these disturbances through accurate sleep assessment and tailored interventions is essential for optimizing rehabilitation and improving overall quality of life.

What is the Neurobehavioral Rating Scale-Revised (NRS-R) and how is it used in the context of Traumatic Brain Injury (TBI) rehabilitation?

The Neurobehavioral Rating Scale-Revised (NRS-R) is a comprehensive tool used to evaluate various aspects of neurobehavioral function in individuals undergoing rehabilitation after a Traumatic Brain Injury (TBI). It assesses impairments that may arise from the injury. Higher scores on the NRS-R indicate greater neurobehavioral impairment. This scale helps healthcare professionals to quantify the impact of the TBI on a patient's behavior and cognitive abilities.

What does Total Sleep Time (TST) mean, and why is it important to measure it during Traumatic Brain Injury (TBI) rehabilitation?

Total Sleep Time (TST) refers to the total amount of time a person spends asleep during a given period, often measured in hours. In the context of Traumatic Brain Injury (TBI) rehabilitation, monitoring TST is crucial because it is linked to cognitive and emotional recovery. Adequate TST is essential for cognitive functions like memory and attention. Measuring TST accurately can help healthcare providers assess the effectiveness of sleep management strategies and adjust interventions as needed to optimize patient outcomes.

What is wrist actigraphy and how does it compare to observational sleep logs for monitoring sleep in patients with Traumatic Brain Injury (TBI)?

Wrist actigraphy is a method used to estimate sleep patterns by tracking movement via a device worn on the wrist. While actigraphy offers a non-invasive way to monitor sleep, its accuracy can be limited in patients undergoing rehabilitation for Traumatic Brain Injury (TBI). Factors such as patient movement and the specific algorithms used to detect sleep can affect the validity of the measurements. Observational sleep logs, where nursing staff record hourly observations of whether patients are asleep or awake, may offer more reliable insights into sleep patterns in this population.

Why is sleep management important in Traumatic Brain Injury (TBI) rehabilitation programs?

Integrating sleep management strategies into Traumatic Brain Injury (TBI) rehabilitation programs is crucial for enhancing cognitive and emotional recovery. By accurately assessing sleep patterns, identifying specific disturbances, and implementing tailored interventions, rehabilitation teams aim to promote restorative sleep. Prioritizing sleep can lead to better overall outcomes for patients with TBIs, improving their neurobehavioral health and quality of life. Sleep management strategies might include environmental modifications, relaxation techniques, and medication management.