For patients with traumatic brain injury (TBI), some of the major challenges involved are sleep disturbances. As a general treatment for such sleep disturbances, one study examined the use of melatonin to enhance sleep quality in TBI patients (Grima et al., 2018). This article will briefly review the procedure followed in this study as well as the results obtained.
Methods
This study examined 33 people who had mild to severe TBI and who reported experiencing sleep disturbances following this injury.
The 10-week study consisted of the following:
- A two-week baseline period
- Four weeks of either melatonin or placebo
- Four weeks of either placebo or melatonin (based on the prior four weeks)
- A 48-hour washout period
Participants were instructed to take their medication daily within two hours prior to falling asleep. They were also instructed to maintain a sleep diary tracking their sleep, specifically in terms of sleep onset, sleep offset, and sleep duration. Participants were sent daily text message reminders to take their medication and fill out their sleep diaries. At the end of each of the three periods, participants were asked about any symptoms they may have experienced.
The following measures were taken at baseline:
- Age
- Body mass index (BMI)
- Employment status
- TBI injury characteristics
- Injury date
- Medications currently taken
Sleep quality was measured at the end of baseline and at the end of each treatment phrase using Pittsburgh Sleep Quality Index (PSQI) global scores, which were recorded with wrist actigraphy. PSQI scores range from 0-21, with higher scores indicating lower quality sleep. Wrist actigraphy data were used to corroborate the sleep diary entries. The following actigraphy data were recorded:
- Sleep-wake behavior
- Sleep onset latency
- Sleep efficiency
The following additional measures were also taken at baseline and at the end of each period:
- The Epworth Sleepiness Scale (ESS), which tracks daytime sleepiness
- The Fatigue Severity Scale (FSS), which tracks subjective fatigue
- The Hospital Anxiety Depression Scale (HADS), which tracks self-reported anxiety and depressive symptoms
- The short-form health survey (SF-36 v1), which tracks eight facets of health-related quality of life
Results
The following results were obtained:
- Melatonin significantly reduced PSQI global scores, reflecting increased quality of sleep.
- Melatonin significantly increased sleep efficiency.
- Melatonin significantly increased self-reported anxiety symptoms, but not self-reported depression symptoms.
- Melatonin significantly reduced subjective fatigue.
- Melatonin significantly enhanced self-reported vitality and mental health.
- There were no serious adverse events, and more symptoms were reported with the placebo treatment than with the melatonin treatment.
Altogether, melatonin had a variety of beneficial effects on sleep in people with TBI, and there were no negative effects.
Wrapping up
These results show that melatonin can substantially enhance sleep quality in people dealing with TBI-induced sleep disturbances. In addition, the beneficial effects of melatonin on sleep also reduced anxiety and fatigue while enhancing certain quality of life factors. This is promising, because melatonin is not harmful and readily available without a prescription. Further research should continue to examine the usefulness of melatonin in people with sleep disturbances.
References
Grima, N.A., Rajaratnam, S.M.W., Mansfield, D., Sletten, T.L., Spitz, G., Ponsford, J.L. (2018). Efficacy of Melatonin for Sleep Disturbance Following Traumatic Brain Injury: A Randomised Controlled Trial. BMC Medicine, 16(1), 8. doi: 10.1186/s12916-017-0995-1.
