Sleep-Wake Disorders After Traumatic Brain Injury: Pathophysiology, Clinical Management, and Future

After experiencing a traumatic brain injury (TBI), the majority of patients will develop sleep-wake disorders (SWD). These can include insomnia, posttraumatic pleiosomnia (increased sleep need), excessive daytime sleepiness (EDS), obstructive and/or central sleep apnea, circadian SWD, and a variety of parasomnias. Untreated SWD may impede the recovery process and can negatively impact mood, metabolic health, cognitive function, and immune function among other processes. Importantly, these patients tend to misperceive their posttraumatic sleep problems. Consequently, interviews performed in standard clinical practice may not sufficiently capture SWD patients, potentially compromising safety and productivity. In this up-to-date review, we outline the state of current TBI-related SWD, highlighting proposed mechanisms, treatment modalities, and areas for further clinical investigation. We discuss data supporting the role of slow wave sleep in the enhancement of neural recovery and strengthening of healthy neural circuits. We also examine the utility of enhanced cohort recruitment and SWD biomarker discovery via the use of social media, smart devices, and data-sharing networks, and call for increased research in the intersection of TBI and SWD.