Bradley, Joanne and Simpson, Jane and Eccles, Fiona (2015) Sleep disturbances following traumatic brain injury : lived experiences and the use of psychological interventions. PhD thesis, Lancaster University.
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Abstract
Sleep disturbances are common following traumatic brain injury (TBI). Biological, psychological and social aetiological factors have been identified, with consequences of sleep disturbances including mood disturbances and exacerbation of cognitive difficulties, with potential impacts on rehabilitation outcomes. Therefore, gaining a better understanding of sleep disturbances post-TBI is necessary to inform appropriate interventions and evaluate their efficacy. There is limited research into the efficacy of interventions for sleep disturbances post-TBI. However, the use of medications can be problematic due to their impacts on cognitive functioning, thus alternatives should be considered. The first section of this work presents a narrative review which outlines the biological, psychological and social factors which influence the development and maintenance of sleep disturbance post-TBI and justifying the use of cognitive behavioural therapy for insomnia (CBT-I) in the management of sleep disturbances post-TBI. Limited but promising research exploring the efficacy of CBT-I post-TBI is reviewed, with therapy adaptations outlined and limitations of CBT-I post-TBI discussed. Given the potential consequences of disrupted sleep for the individual, there is a lack of research on individual experiences of sleep post-TBI. Consequently, individuals’ experiences of sleep disturbance post-TBI were explored. Interpretative phenomenological analysis was used to analyse data gathered from semi-structured interviews with nine participants. Three themes resulted: (1) "Why is that happening?": Making sense of sleep changes; (2) "Don't worry because it makes it worse": Finding a way to manage; (3) "Everyone's different": A unique and personal experience. Potential clinical implications of the findings are highlighted, with discussion of limitations and areas for future research. The critical appraisal explores several considerations for conducting qualitative research with individuals post-TBI and provides further reflections on the research process.