Fatigue and Sleep Disturbance following TBI
Tom M. McMillan, Rodger Ll. Wood in Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury, 2017
Similar to fatigue, the aetiology of sleep disturbances following TBI has not been established and is likely multi-factorial. Injury to brain regions, pathways, and neurotransmitter systems associated with sleep regulation, including the suprachiasmatic nucleus, hypothalamus, midbrain and ascending reticular activating system may occur (Baumann et al., 2009). Circadian Rhythm Sleep Disorders and delayed circadian timing have been reported in patients with mild TBI and insomnia (Ayalon, Borodkin, Dishon, Kanety & Dagan, 2007). The timing of sleep is regulated by the circadian (~24-h) pacemaker in the hypothalamic suprachiasmatic nuclei, which generate and maintain circadian rhythms, including pineal melatonin synthesis. Melatonin plays a role in the circadian regulation of sleep-wakefulness. Shekleton et al. (2010) found lower levels of evening melatonin production in individuals with TBI, associated with REM sleep, but not sleep efficiency or night-time awakenings. This finding suggests the circadian regulation of melatonin synthesis may be disrupted following TBI.
Botanicals and Dietary Supplements
Hilary McClafferty in Integrative Pediatrics, 2017
The best evidence to date for melatonin use in children is in insomnia caused by circadian rhythm sleep disorders. Other conditions such as poor sleep hygiene, depression, anxiety, or other mental health or social issues should not be treated with melatonin as a primary agent. Lack of clear evidence regarding efficacy, dose, and long-term safety remains a relevant concern. Theoretical risk of hypothalamic-gonadal axis suppression and delayed puberty exists, although this was not shown in a follow-up study of 57 Dutch adolescents who had used melatonin for a mean of 3 years (range 1–4.6 years) at a mean dose of 2.69 mg (0.3–10 mg). Recurring headache was reported in 38% of this study population as a primary adverse effect (van Geijlswijk et al. 2011).
Sleep dysfunction after traumatic brain injury
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
Circadian rhythm sleep disorders are important to consider when dealing with insomnia and/or EDS due to their common occurrence in patients with TBI.74 Numerous research studies to date have reported a delayed sleep phase syndrome, which can potentially be confused with insomnia if the person with TBI goes to bed at a socially acceptable time. Ayalon and colleagues investigated complaints of insomnia following mild TBI and reported 36% of people to be diagnosed with circadian rhythm sleep disturbances (CRSDs).75 Clinical presentation (i.e., insomnia, excessive sleepiness, or both) is expected to depend on whether an individual schedules sleep according to their internal circadian clock or in accordance with a socially accepted schedule. Llompart-Pou and colleagues applied cerebral microdialysis techniques in order to study brain interstitial cortisol levels at 08:00, 16:00, and 24:00 hours in the acute phase of TBI in ten patients (median GCS score after resuscitation was 5 [range 3–10]). Intra-individual analysis showed that circadian variability was lost in all patients, both in serum and brain interstitial cortisol samples.76 The study of the circadian rhythm in TBI patients warrants further investigation.
Correlation among clock gene expression rhythms, sleep quality, and meal conditions in delayed sleep-wake phase disorder and night eating syndrome
Published in Chronobiology International, 2019
Atsushi Haraguchi, Yoko Komada, Yuichi Inoue, Shigenobu Shibata
The present study focused on clock gene expression rhythms of delayed sleep-wake phase disorder (DSWPD) and night eating syndrome (NES). DSWPD is characterized by delayed sleep onset and offset sleep times compared to healthy subjects (Regestein and Monk 1995). The disorder is found among both general and clinical populations of patients with circadian rhythm sleep disorders (Schrader et al., 1993). Previous study indicated that melatonin rhythm is delayed in DSWPD patients compared to healthy subjects (Shibui et al., 1999). In contrast, NES is characterized by episodes of conscious night eating (Inoue 2015), and the prevalence of NES is reported to be relatively low (Striegel-Moore et al., 2006). Melatonin rhythm in DSWPD patients is delayed for about 4 h compared with healthy subjects (Shibui et al., 1999); in the NES patients, the delay is about 1 h (Goel et al., 2009). Moreover, studies using a morningness/eveningness questionnaire (MEQ) revealed that almost all DSWPD patients show an eveningness chronotype (Abe et al., 2011), whereas the chronotype of NES patients varies among individuals (Harb et al., 2012). Based on these studies, it is unclear whether clock gene expression rhythms in NES patients are delayed compared with healthy subjects, although these rhythms are probably delayed among DSWPD patients. Thus, to assess peripheral clocks in NES patients, we measured and compared clock gene expression rhythms using hair follicle cells in NES, DSWPD, and healthy subjects.
Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria
Published in Chronobiology International, 2021
Jakob Weitzer, Isabel Santonja, Jürgen Degenfellner, Lin Yang, Galateja Jordakieva, Richard Crevenna, Stefan Seidel, Gerhard Klösch, Eva Schernhammer, Kyriaki Papantoniou
Chronic insomnia was defined by four criteria, established by the International Classification of Sleep Disorders, 3rd edition (Sateia 2014): 1. Report of difficulty initiating sleep and/or difficulty maintaining sleep and/or waking up earlier than desired without being able to fall back to sleep. 2. Sleep disturbance and associated daytime symptoms (of sleepiness) occurring at least three times/week. 3. Symptoms have been present for at least 3 months. 4. Report of daytime impairment related to nighttime sleep difficulties. Chronic insomnia was present if all four criteria applied (Weitzer et al. 2020). Doctor-diagnosed sleep disorder was defined as a self-report of having been diagnosed with chronic insomnia or a circadian rhythm sleep disorder by a physician. Other diagnoses of sleep problems, for example, sleep apnea, movement disorders, hypersomnia, and parasomnia, were excluded from the case definition in the main analysis. In sensitivity analysis, these diagnoses of other sleep disorders were also excluded from the analysis. Having ever asked for medical help or for treatment for a sleep problem [Yes; No] was also reported. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) (Åkerstedt et al. 2014). Participants were classified as sleepy (score ≥7) or alert (score <7). Average sleep duration was calculated based on self-reported sleep duration on workdays and days off. [Average sleep duration = (Sleep duration on workdays*5) + (Sleep duration on days off*2)/7.]
Circadian phase, circadian period and chronotype are reproducible over months
Published in Chronobiology International, 2018
Thomas Kantermann, Charmane I Eastman
Another example besides shift work is medicine. One branch of medicine in which an individual’s circadian phase is taken into account is using bright light and/or melatonin to treat patients who have various circadian rhythm sleep disorders (Auger et al. 2015; Emens and Eastman 2017; Sack et al. 2007). Or, how about identifying an individual’s best time of day for a medical intervention or surgery? Imagine one could have surgeons work at their “best time” and most restored, with also the patient being under surgery when her/his body is most restored. It has successfully been shown that appropriately timed medication and chemotherapy enhance the effectiveness of a treatment in both experimental and clinical situations (Halberg et al. 1980; Hrushesky 1990; Ortiz-Tudela et al. 2016; Truong et al. 2016). Of course, most hospital routines would need to be restructured to permit such flexibility. Furthermore, exceptions are emergency cases when urgent surgical help is needed. In addition, often there is a gap of several days or even weeks between the day of a medical diagnosis and the day of a treatment (e.g. the surgery). Similarly, health checkups for shift workers can be weeks before the actual shift employment begins. Therefore, any assessment of a circadian clock parameter to be used for any individually timed action (e.g. light therapy, chemotherapy, surgery or shift-work scheduling) requires reproducibility and stability of that same parameter. The reproducibility, ideally, is independent of the time that has passed by since the first assessment of that parameter.
Related Knowledge Centers
- Advanced Sleep Phase Disorder
- Circadian Rhythm
- Delayed Sleep Phase Disorder
- Entrainment
- Sleep Disorder
- Suprachiasmatic Nucleus
- Zeitgeber
- Circadian Clock
- NON-24-Hour Sleep–Wake Disorder
- Irregular Sleep–Wake Rhythm Disorder