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The Importance of Sleep for the Healthy and the Injured Brain


New research suggests quality sleep has a healing effect on TBI.

As a sports neurologist and pain medicine specialist, I have tremendous respect for the positive impact of quality sleep on Neurologic health across the lifespan. Whether it's training for the next game, recovering from injury, or healthy lifestyle maintenance, good sleep is imperative for everyone. Recently, I came across even more compelling evidence pointing to sleep quality as an essential recovery tool for people who have suffered a traumatic brain injury, commonly referred to as a TBI.

Nearly 3 million cases of TBI occur in the United States each year. People who have suffered a TBI may have specific sleep issues that need addressing, including insomnia, hypersomnia, sleep apnea, fragmented sleep, and other sleep disorders. New research published in the Journal of Neurotrauma suggests that sleep is an essential factor in TBI recovery in military veterans. A study of 56 veterans from Iraq/Afghanistan showed that poor sleep quality correlated with reduced clearance of perivascular waste from the brain in the study subjects. The glymphatic system is responsible for flushing the brain of toxins and waste products (like lymphatics in the rest of the body), and the lack of “housekeeping” appears to be related to functional recovery. I am personally interested in ways we can accurately measure this activity after injury and increase or restore glymphatic activity as an approach to improving recovery after TBI. Perhaps it’s not surprising that sleep related issues can negatively affect recovery from TBI, considering the fact that disordered sleep has been associated with an increasing number of health-related conditions, significantly contributing to and/or causing disease, disability, and death.

I believe that in addition to focus on the “facts and fear” warnings on the dangers of poor and disordered sleep, it’s helpful to understand the concept of sleep health, and its benefits. Sleep health has been described as a multidimensional pattern of sleep/wakefulness adapted to individual, social, and environmental demands, which promotes physical and mental well-being. Good sleep is characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours.

Almost every athlete I work with (whether weekend warrior, aspiring amateur, or elite/professional) understands the beneficial effects of musculoskeletal and cardiovascular health on performance. But many are surprised when I tell them that sleep health and optimization of sleep efficiency may be the most effective intervention an individual can make to optimize performance. It’s been demonstrated that less than six hours of sleep overnight is associated with decreased time to physical exhaustion, reduced aerobic output, reduced peak and sustained muscle strength, impaired metabolic capabilities, and increased injury risk. Conversely, sleep extension has been shown to significantly improve performance related to speed, power, accuracy, cognitive endurance, and speed of mental processing -all critical aspects of athletic, academic, and professional performance.

Many of my patients who have suffered TBI are searching for answers on how to restore function. Some of my clients are interested in optimizing athletic, academic, or professional performance. Others want recommendations on how to age successfully, maintain a high quality of life and optimize Neurological health across the lifespan. Understanding sleep health, with a goal of high-quality sleep is crucial for everyone.