Connect with us
Elysium

News

Brain injury in the new normal: How to get a good night’s sleep during the pandemic

Consultant clinical neuropsychologist Dr Keith G Jenkins and Dr Jenny Brooks, consultant clinical psychologist on how to sleep well during the pandemic.

Published

on

Getting a good night’s sleep is important all of the time, as we know from our work with people with brain injury, but some people have seen their sleep pattern alter during the pandemic.

This change to the normal time people go to bed and fall asleep and/or wake up in the night, may be due to several factors, including changes to the way the person spends their day in terms of education, work, meeting up with family and friends, seeing support workers and / or attending rehabilitation sessions. Also they are perhaps exercising, playing sport or doing other activities less.

Lower mood, such as feeling sad, having worries or feelings of uncertainty, can also impact on your ability to get to and stay asleep.

Changes to our sleeping habits can lead to a poor sleep-wake cycle, otherwise known as our body clock. Not getting enough sleep, or good quality sleep, can cause fatigue and tiredness throughout the day. You might feel unwell as a result, and this can increase anxiety and worries further, making getting through the day more difficult. It might also mean that relaxing to sleep becomes harder, and a vicious downward spiral can follow.

Fortunately, there are some very simple things we can all do to support a good night’s sleep. These include going to bed and getting up at the same time each day to support your body clock, exercising during the day if you can safely do so and trying not to exercise too close to bedtime. Avoiding caffeine or nicotine close to bedtime – or reducing them if you can’t stop completely – can also help.

Be aware that alcohol might mean that you fall asleep faster, but it can disrupt the second stage of sleep, meaning that the quality of your sleep may be reduced, which can then lead to you feeling tired the next day.

It’s generally best to avoid things that may cause you upset or stress before your usual bedtime, like a difficult phone call or a scary TV programme. It is also important to reduce your exposure to blue light, for example from smartphones and laptops, before bedtime.

Blue light tricks your brain’s body clock into thinking it’s daytime and suppresses the production of melatonin. This is the hormone you need to feel sleepy.

Try to have a bedtime routine that supports you in winding down, whether that means a bath, listening to music or a relaxation CD. It’s also really important to ensure that your bedroom supports your sleep, so consider things such as lighting and temperature. Most people tend to find that a tidy bedroom can help the room feel more relaxing too.

Of course, many people with an acquired brain injury tend to experience fatigue and often find having a nap in the day can help them to manage this. But an afternoon nap should end before half past three in the afternoon at the latest, with your next sleep being in bed for the night. Headway has a very helpful section on its website regarding managing fatigue.

While bedrooms should predominantly be for sleeping, some people have been spending more time in them during the pandemic doing other things – perhaps using them as a quiet space to complete education or work.

For those in hospitals or care homes, increased bedroom time may be due to isolation procedures. If this is the case, perhaps consider having a chair or a beanbag to sit on, rather than lying on your bed during the day. Where possible, try to come out of your room for meals.

If you find it is taking a long time to get to sleep, try getting out of bed and doing something else, like reading a book or a magazine, and then return to bed when you are feeling sleepy.

The advice we have given here is in line with the recommendations on the NHS website.

A good night’s sleep is crucial to thinking at our best, which is especially important if you are working or being educated at home; and there are some other simple things that you can do to boost your productivity in these scenarios.

Firstly, make sure you have a shower and get dressed rather than working in pyjamas or dressing down. Getting dressed helps you to psychologically get into work mode. Have a designated workspace and, if possible, keep the area tidy.

Have a timetable of when you’re going to work and try to stick to it. As we’ve mentioned, writing a timetable down and ticking off jobs completed supports feelings of achievement. Make sure you schedule regular breaks during which you move away from the workspace. You might go into your garden or make a drink, for example.

Try to minimise distractions. That might mean moving your mobile phone out of reach, turning off the TV and considering where the quietest places are. If you live with other people, you might want to consider how to ensure they don’t disturb you. This might just mean letting them know what your work timetable is.

One distraction that can’t be ignored, however, is the need to wash our hands to prevent the spread of the virus.

We hope you have found this guide useful and wish you a safe and happy summer as we all continue to rise to the challenges presented by COVID-19.

This is one of five blogs in a series on living in the new ‘normal’ with a brain injury, based on a webinar produced for ABI London (ABIL). See below for links to other articles in the series. Dr Keith G Jenkins is consultant clinical neuropsychologist at St Andrew’s Healthcare and chair of Headway East Northants. Dr Jenny Brooks is a consultant clinical psychologist working independently and a director of The ABI Team. For any questions about this topic email update@standrew.co.uk. 

Fitting COVID-19 guidelines into your routine

Keeping a check on your wellbeing

How to keep in touch with loved ones during the pandemic

How to keep a routine during the pandemic

Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

News

Repeated head injuries linked to depression – study

Repeated head impacts may be associated with depression symptoms and worse cognitive function later in life, new research suggests.

Published

on

It’s well established that a traumatic brain injury (TBI) can cause memory and cognitive problems, as well as depression, but now, researchers have looked at the consequences of repetitive head impacts.

They found that people exposed to repetitive head impacts may be more likely to experience difficulties with cognitive functioning and depression years later.

The researchers analysed data from the Brain health Registry on 13,000 adults, five per cent of whom reported having had repetitive head impacts through contact sports, abuse or military service.

They were asked about depressive symptoms and completed cognitive tests.

The paper, by researchers at Boston University and the University of California, San Francisco, reveals that participants who’d had repetitive head impacts and TBI reported greater depression symptoms than those who hadn’t.

Repetitive head injuries were a stronger predictor of depression than TBI, and those who had a history of repetitive head impacts and TBI with loss of consciousness reported the most depressive symptoms.

“The findings underscore that repetitive hits to the head, such as those from contact sport participation or physical abuse, might be associated with later-life symptoms of depression.

“It should be made clear that this association is likely to be dependent on the dose or duration of repetitive head impacts and this information was not available for this study,” said Michael Alosco, associate professor of neurology at BU School of Medicine (BUSM).

Those who’d experienced repetitive head impacts or TBI also performed worse in some of the cognitive tests.

“It should be noted that not all people with a history of repetitive hits to the head will develop later-life problems with cognitive functioning and depression,” says Study author Robert Stern, professor of neurology, neurosurgery and anatomy & neurobiology at BUSM.

“However, results from this study provide further evidence that exposure to repetitive head impacts, such as through the routine play of tackle football, plays an important role in the development in these later-life cognitive and emotional problems.”

The researchers point out, however, that one limitation of the research is that researchers didn’t have data on the extent of participants’ injuries.

Last year, BUSM researchers found that longer someone was exposed to tackle football, the higher the risk of developing the degenerative brain disease chronic traumatic encephalopathy.

For every year of exposure to the sport, footballers had a 30 per cent increased chance of having the disease.

Continue Reading

More headlines

City dwellers “more likely to die in hospital” after stroke – US study

Published

on

Compared to those living in urban areas, stroke patients treated at rural hospitals were one third less likely to undergo a procedure to remove a blood clot that caused the stroke and were more likely to die of stroke before leaving the hospital.

Researchers examined national data on almost 800,000 adults hospitalised after a stroke between 2012 and 2017.

In their paper, published in the American Stroke Association’s Stroke journal, the researchers warn that this urban-rural divide may be getting worse. This gap, the paper states, could be caused by the slower take-up of newer treatments and technologies, and because rural hospitals are less well-resourced and have poorer access to specialist care. Rural hospitals may also be more likely to lack specialised clinical support, such as dedicated stroke units.

Other causes for poorer stroke care could be a lack of clinical expertise in urban areas, due to difficulties attracting and retaining experienced staff, and poorer access to emergency services and longer responses to emergency calls due to distance.

“The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications,” said Gmerice Hammond, author of the study and a cardiology fellow at Washington University School of Medicine.

“Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities.”

The study had some limitations, including a lack of data on the severity of patients’ strokes, or factors that would determine whether a patient received advanced therapies, sich as the size of the clot and where it is located.

Karen Joynt Maddox, senior author of the study and assistant professor of medicine at Washington University School of Medicine, calls the differences in care, and the lack of improvement over the five-year period, ‘striking’.

“Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren’t receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren’t eligible by the time they arrived?

“Those questions can’t be answered with administrative data, but they’re very important to look into so that we can develop effective solutions.”

Continue Reading

News

One charity’s challenging move to online group sessions

Since lockdown began in March, many people recovering from brain injuries have had to adapt to remote sessions with health workers.

Published

on

But it’s not just outpatients that have seen a change. One neuropsychologist in York is trying to sustain momentum with her support group, but navigating the new online world with patients has brought its challenges.

Just before lockdown, Diana Toseland, consultant clinical neuropsychologist, was celebrating. Her charity, Café Neuro York, became officially registered. Café Neuro is a social support network that allows people with long term neurological conditions in York to learn new skills, help others and learning to be mindful, after they’re discharged from health services.

Group members were meeting face-to-face for morning and evening meetings, and once a month on Thursday evenings there was an interactive presentation for members to enjoy. When lockdown began, Toseland wanted to continue her twice-weekly sessions online.

But adjusting hasn’t been easy – Toseland had built up a loyal user base, but sessions were very much based offline. Adjusting hasn’t been easy.

“People need this in York. People with a neurological condition need ongoing support,” Toseland says. “People with brain injuries found it helpful to come along to meet people without having to explain – they can just be who they are. It’s about what people can do, not about their condition or disability.

Since lockdown, Toseland has been struggling to know how to support people.

“I’ve got up to speed with Zoom. This week we had six people call in, but their difficulties are quite profound and they’re finding it hard to get onto Zoom. Some call in late because they forget or find it difficult, others call in with help from families.”

Toseland has found there are many technical difficulties to overcome before the sessions can begin.

“You need so many things – good internet connection, distraction-free environment, working microphones and speakers.

“One woman managed to set it up herself, her career before the injury was IT, but then she didn’t have sound. Then she tried headphones, which worked, but then she took them off and couldn’t get the microphone on the computer to work without the headphones – she was the most successful in that meeting.

“Another has poor signal so she has to sit under a tree in her garden, which means she can only do it when the weather’s good.”

Once the call is up and running, Toseland says some members find it difficult to navigate the conversation, which has entirely different unspoken social rules than offline conversations.

“They’ve found it difficult because you can’t have two people having a conversation, it’s got to be one person at a time, which requires intense concentration. People can’t sustain that level of attention long enough to fully participate in the conversation.

“Some go quiet, it leaves people with headaches, it’s fraught with disaster. They might dominate the conversation and not pick up on cues; one finds it’s too much stimulation, so she closes her eyes.”

But Toseland hopes to continue the groups, as when it does work, it works well.

“On the other hand, for those who have joined it, they’ve used it as a bit of a lifeline.”

But Toseland is looking forward to getting meetings back into the real world. She’s been runnin Café Neuro for over a year and a half, and she’s seen more progress in some members than they ever made coming to her clinical practice.

“It’s made a difference in ways I couldn’t have predicted, and an impact wider and quicker than I could’ve possibly hoped for,” she says.

Continue Reading

Trending