Abstract Introduction Over 18% of American adults report prior traumatic brain injury (TBI), with the CDC reporting over 586 TBI-related hospitalizations per day. Research suggests that more than half of these patients experience sleep dysfunction, which jeopardizes their long term outcomes by limiting post-acute recovery. Treatment modalities such as CBT-I and melatonin are routinely employed for post-TBI sleep dysfunction, but compliance, patient preferences, and variation in the underlying cause of sleep dysfunction create a prominent risk for treatment failure. To alleviate this risk, we propose the use of a multimodal treatment plan that incorporates various well-tolerated treatment modalities along with acupuncture. We present a patient with post-TBI sleep dysfunction, successfully treated with a multimodal insomnia treatment plan. Report of case(s) A 33-year-old female one month post-rehabilitation for moderate TBI presented to an outpatient PM&R clinic with insomnia, difficulty initiating and maintaining sleep, nocturnal awakenings, and daytime fatigue. Treatment was initiated with an individualized multimodal plan including cognitive behavior therapy for insomnia (CBT-I), acupuncture, melatonin, light therapy, and structured sleep hygiene. CBT-I included in-person and online sessions. Acupuncture was used for sleep and mood support, while morning bright light, blue-wavelength light therapy, and melatonin (2-10 mg nightly for 4 weeks) were used to address circadian rhythm disruption. Sleep hygiene education included sleep-wake schedules, minimizing naps, and optimizing sleep environment. Following these interventions, the patient showed improvements in sleep quality, insomnia severity, daytime alertness, and rehabilitation engagement. Her spouse reported improvements in her activities of daily living and sleep continuity. Conclusion After inpatient care ends, patients return home and frequently develop sleep dysfunction in the less-supervised outpatient setting, jeopardizing their recovery. The first months following TBI represent a critical window to restore sleep function, with research indicating that this opportunity closes soon after discharge. During a period of recovery when sleep quality must urgently be restored, treatment failure means inadequate post-acute recovery and permanent detriment to the patient. This case demonstrates the clinical effectiveness of a multimodal approach that incorporates acupuncture to produce observable clinical benefits in post-acute TBI care and its potential to become a standard option for sleep dysfunction in this population. Support (if any)
Potratz et al. (Fri,) studied this question.