New Study Shows Cognitive Behavior Therapy Effective Treating Post Concussion Insomnia


Concussion side effects can be debilitating even causing some people to go on long term disability or to stop working altogether. Side effects can be cognitive or emotional. They can include forgetfulness, unpredictable behavior, lack of ability to concentrate or focus, headaches, sensitivity to sound or light, and disruption to sleep patterns. Sleep problems are a major concern as lack of sleep can itself trigger or worsen many of the other problems making recovery very difficult.

It seems that teens are often very susceptible to sleep problems post-concussion, however a new study has found that Cognitive behavioral therapy (CGT) is helping teens with this problem.

Dr. Brian Brooks is a concussion researcher at the Cumming School of Medicine, and he is a neuropsychologist studying the diagnoses and treatment of concussion in youth. Working with a sleep researcher they are investigating the role of insomnia in poor concussion recovery. In their studies they’ve found that 66% of teens who suffer post-concussion symptoms complain that they have serious sleep disorders with insomnia being the most common of them.

Some of the sleep problems are serious enough that they interfere with family life, school and socially. Behavioral problems also ensue from the lack of sleep.

In response to the findings their colleagues at the University of Calgary just published a study in Journal of Head Trauma Rehabilitation that found CBT is effective in teens with post-concussion syndrome and sleep disorders. The improvement was dramatic with almost immediate improvement in sleep health according to Dr. Tomfohr-Madson. The youth were taught about sleep habits, removing digital devices from heir bedrooms, keeping sleep diaries, creating regular sleep schedules and then finally about changing their attitudes to sleep.

Study participants report that they feel better, are doing better in school. Family reports that there is reduced irritability and frustration. Anxiety has also been reduced overall. While more study is definitely required in the area of concussion and insomnia the results reported are promising.

You can read the whole study here, and the abstract is listed for you.

Journal of Head Trauma Rehabilitation. Publish Ahead of Print():, JUNE 25, 2019

DOI: 10.1097/HTR.0000000000000504 PMID: 31246882

Issn Print: 0885-9701

Publication Date: June 25, 2019


A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Insomnia in Adolescents With Persistent Post concussion Symptoms

Lianne Tomfohr-Madsen;Joshua Madsen;Dominique Bonneville;Shane Virani;Vickie Plourde;Karen Barlow;Keith Yeates;Brian Brooks




Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery.

Tertiary pediatric hospital.

Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent post concussion symptoms.

A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion.

Main Measures:
Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory.

Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in post concussion symptoms.

In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent post concussion symptoms. A larger trial is warranted.


Articles by Month of Posting