TBI and Sleep-Wake Disorders: Pathophysiology, Clinical Management, and Moving towards the Future

After experiencing a traumatic brain injury (TBI), the majority of patients will develop sleep-wake disorders (SWD). These can include insomnia, pleiosomnia, excessive daytime sleepiness, obstructive and/or central sleep apnea, circadian sleep-wake disorders, and potentially a variety of parasomnias. Untreated SWD may impede the recovery process and can negatively impact attention, executive function, and working memory. Importantly, these patients tend to misperceive their posttraumatic sleep problems. Consequently, interviews performed in standard clinical practice will not sufficiently capture SWD patients, potentially compromising safety and productivity. In this review, the authors outline the state of current TBI-related SWD, highlighting proposed mechanisms, treatment modalities, and areas for further clinical investigation. They highlight data examining a role for slow wave sleep (SWS) in the enhancement of neural repair. They also examine the utility of enhanced cohort recruitment and SWD biomarker discovery via use of social media, smart-devices, and data-sharing networks.