Effective Pharmacological and Non-pharmacological Treatments for Sleep Disturbances and Fatigue in Patients Who Have Experienced a Mild to Severe Traumatic Brain Injury

Background: In the United States alone, an estimated 1.5 million people sustain a head injury every year.1 With improved recognition of traumatic brain injuries by healthcare providers, the number of patients diagnosed with a traumatic brain injury (TBI) is only increasing. Unfortunately, many patients who sustain a TBI, regardless of the severity, experience sleep disturbances, insomnia, fatigue, and daytime sleepiness. Purpose: For the purposes of this systematic review, the focus will be primarily on the comparison of nonpharmacological treatments of sleep disturbances or fatigue secondary to a TBI. In addition, the focus will include recent studies on pharmacological treatments of post-TBI fatigue and insomnia. Methods: A literature review was conducted to critique current evidence on nonpharmacological and pharmacological interventions for the treatment of sleep disturbances, insomnia, and fatigue in adults following a traumatic brain injury. Searches were performed for articles published between 2015-2022, using PubMed, UpToDate, Academic Search Ultimate, APA Psycinfo, and Google Scholar. Conclusions: As a result of the nuanced pathophysiological processes behind TBIs and subsequent insomnia, a multifaceted, holistic approach to care is the most effective. Many of the included studies are pilot trials or preliminary studies– further research with larger participant quantity is warranted to determine or elaborate specific treatment efficacy. Given the most recent research, providers should consider cognitive behavioral therapy, bright light therapy, sleep hygiene, and melatonin as first-line treatments for sleep disturbances, insomnia, and fatigue after a traumatic brain injury