SUPPORTING A CLIENT TO ACHIEVE A BALANCED SLEEP-WAKE CYCLE

Please note that the names of the clients detailed in this case study have been changed to protect their privacy.

“Anecdotal evidence and the literature identifies that Brain Injured clients self-report significantly higher sleep-related impairment, poorer nightly sleep quality and more frequently met criteria for clinical insomnia. This has a huge bearing on the overall functioning of the brain injured individual and may impact on their ability to progress to their potential. Working in the community we provide care for brain injured individuals with complex health and social care needs at home, the majority of whom present with significant sleep disruption and/or fatigue. This can be one of their most disabling problems which impacts negatively on their overall wellbeing and level of engagement in life and living. One of my clients presented with a disrupted sleep awake cycle and had a range of other complex needs, compromised further by unstable epilepsy. A Sleep Actigraphy assessment was carried out to determine sleep patterns and circadian rhythms for a designated period of time to map sleep and activity over a 24/7 period. The data was used to help the multidisciplinary team to put a sleep management programme in place that avoided the use of medication. This was appealing as it also enabled an objective assessment to be carried out that did not rely solely on carer diaries, as well as relying on the client to recall how many times they woke or how long they slept for during the night. There was also an added benefit of analysing other clinical data such as seizure activity which often has a negative impact on sleep and fatigue during the day. An added benefit was that it could be carried out in the comfort and privacy of the client’s own home enabling sleep data to be more realistic than that of a hospital environment. Over time the multidisciplinary team we able to implement a behavioural programme which established a more effective sleep awake cycle which was scaffolded by the carers as the client was unable to initiate this himself. It increased his periods of wakefulness and interaction with an increasing body of evidence to support his ongoing emergence from a minimally conscious state. The implementation of an effective schedule enabled positive gains in other aspects of his care including pain, seizure activity, mood and grabbing behaviours.”

Neurological Rehabilitation Case Manager & Registered General Nurse