Sleep disruption is a frequent and often overlooked consequence of traumatic brain injury (TBI), especially following a concussion. Individuals who experience a concussion may develop persistent difficulties falling asleep, staying asleep, or feeling rested upon waking. These disruptions are not only frustrating - they can significantly affect cognitive recovery, emotional regulation, and overall quality of life.
Sleep issues following a TBI differ from general sleep disorders in that they are caused by injury to the brain, which interferes with normal sleep-wake cycles and neurological function.
Sleep Disruption Questionnaire
The STOP-Bang Methodology
What Is Sleep Disruption After Traumatic Brain Injury?
Sleep disruption following a concussion or TBI can present in various forms, including insomnia, fragmented sleep, excessive daytime sleepiness, or an irregular sleep-wake cycle. These issues are thought to stem from structural and functional changes in the brain—particularly in regions involved in regulating sleep, such as the hypothalamus and brainstem.
Brain injury may alter neurotransmitter activity and circadian rhythms, leading to a mismatch between the body’s natural biological clock and external sleep cues. This results in poor sleep quality, reduced restorative sleep, and long-term fatigue.
Sleep problems can occur immediately after a concussion or emerge weeks or months later, and they may persist even after other symptoms of brain injury have resolved.
Symptoms of Sleep Disruption After Concussion
Symptoms of sleep disturbances related to TBI can vary depending on the severity of the injury and the individual. Common signs include:
- Difficulty falling asleep or staying asleep
- Feeling unrefreshed after sleep
- Excessive daytime sleepiness or fatigue
- Trouble concentrating or memory problems
- Increased irritability or emotional instability
- Headaches upon waking
- Fragmented or restless sleep
- Difficulty maintaining a regular sleep schedule
If you or someone you know experiences these symptoms after a head injury - no matter how mild - it is important to consult a healthcare provider, and do not let someone sleep immediately after a head injury.
What Causes Sleep Disruption Following a Concussion?
Sleep disruption following a traumatic brain injury is caused by a complex combination of physical, chemical, and psychological changes in the brain.
Several factors can contribute to this condition, including:
- Damage to brain structures that regulate sleep: Injuries affecting areas such as the hypothalamus or reticular activating system can impair sleep-wake regulation.
- Altered neurotransmitter levels: Chemical messengers like melatonin, serotonin, and dopamine—critical for sleep regulation—may be disrupted.
- Pain or discomfort: Headaches, neck pain, or other post-concussion symptoms can make sleep more difficult.
- Mood disorders: Anxiety, depression, and post-traumatic stress—all common after TBI—can interfere with normal sleep.
- Lifestyle factors post-injury: Changes in routine, increased screen time, and decreased physical activity after a concussion may worsen sleep problems.
Diagnosing Sleep Disruption Due to TBI
Diagnosing sleep disturbances after a concussion requires a thorough medical evaluation that includes a detailed history and symptom review. Your healthcare provider will ask about:
- The nature and timing of the head injury
- Onset and type of sleep problems (difficulty falling asleep, waking often, excessive fatigue, etc.)
- Cognitive and emotional symptoms (memory issues, mood changes)
- Medication and substance use
- Daily routines and sleep habits
A physical exam may help rule out other contributing factors, such as pain or neurological deficits. In some cases, your provider may refer you for a sleep study (polysomnography) or actigraphy monitoring to evaluate sleep patterns and rule out other primary sleep disorders, such as sleep apnea or narcolepsy.
Additionally, a neuropsychological evaluation may be recommended to assess how sleep issues are impacting attention, memory, and emotional functioning after the injury.
Ultimately, your doctor can only diagnose TBI after conducting a medical examination.
What Is the STOP-Bang Questionnaire?
The STOP-Bang Questionnaire is a way that doctors can try to rapidly evaluate your risk of having Obstructive Sleep Apnea (OSA). By asking questions about health issues related to the risk of developing sleep apnea, the STOP-Bang Questionnaire is designed to help detect whether you might have undiagnosed OSA.
However, the STOP-Bang Questionnaire cannot diagnose obstructive sleep apnea. Your doctor must order a sleep study to determine whether you have OSA.
The STOP-Bang Questionnaire is a tool that doctors can use to quickly assess your risk of having obstructive sleep apnea. It involves a series of eight yes-or-no questions. These questions, reflected in the STOP-Bang acronym, relate to known risk factors for OSA.
S - Snoring - Loud and freuqent snoring is a common symptom of OSA.
T - Tiredness - People with OSA often feel very tired or doze off during the day.
O - Observed Apneas - OSA involves repeated temporary lapses in breathing; apneas.
P - Pressure - High blood pressure is frequently associated with OSA.
B - Body Mass Index - People with obesity are more likely to have OSA.
A - Age - OSA becomes more common with aging.
N - Neck Circumference - Having a larger neck is a risk factor due to fatty tissue.
G - Gender - People of male sex and women after menopause have a higher risk.
What Does a STOP-Bang Score Tell You?
The STOP-Bang score tells you wehther you have a low, intermediate, or high risk of having obstructive sleep apnea. This score is the total number of "yes" answers to the eight questions on the questionnaire.
STOP-Bang Score Risk of OSA
0 to 2 Low risk of obstructive sleep apnea
3 to 4 Intermediate risk of obstructive sleep apnea
5 to 8 High risk of obstructive sleep apnea
What Are the Benefits of the STOP-Bang Questionnaire?
The primary benefit of the STOP-Bang Questionnaire is that it is convenient to conduct. In most cases, it takes just a couple of minutes to go through the questions and calculate the results. For busy doctors, this makes the STOP-Bang Questionnaire a time-efficient way to assess a person's risk of sleep apnea.
The questions are straightforward, which means that the test is accessible to doctors who are not specailists in sleep medicine. Simple questions also make it easier for individuals to understand and respond to the survey.
In addition, while there are limitations to the overall accuracy of the STOP-Bang Questionnaire, doctors can generally be confident that people with very low scores do not have OSA. The questionnaire may also be helpful in specific medical situations, such as before a person has surgery.