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CU College of Nursing - Research Stories

College of Nursing

Understanding sleep disturbances in veterans with traumatic brain injury

Study contributes to health outcomes of veterans with TBI

two veterans at the park

​When Ellyn Matthews, RN, PHD, was an oncology nurse in a cancer center back east in the late 90s, she noticed how many patients were suffering from sleep disturbances. “What really floated up was that even before cancer, they had serious sleep problems,” she says. “Literature was emerging, and there were so many avenues to study. It was an underappreciated problem.”


Since then, Matthews has devoted much of her research to understanding how sleep problems affect various populations, including breast cancer survivors. In 2013, she was certified in Behavioral Sleep Medicine by the American Academy of Sleep Medicine—a certification held by only handful of nurses.


Most recently, though, Matthews is the principal investigator collaborating with Lisa Brenner, PhD, director of the Denver VA Hospital’s Mental Illness Research, Education, Clinical Center (MIRECC), and Gina Signoracci, PhD, also of the MIRECC, in a study titled “Sleep Disturbances in Veterans with Moderate to Severe Traumatic Brain Injury.” Matthews initiated the study through an interprofessional agreement between the VA and the College of Nursing while working with Brenner and Signoracci to develop the study protocol.

Traumatic brain injury, or TBI, is a leading cause of death and disability in the United States, especially in the veteran population, according to the U.S. Department of Veterans Affairs.
The goal of the collaborative TBI sleep study is to assess the feasibility of collecting qualitative and quantitative sleep data in veterans with moderate or severe TBI. “Severe” and “moderate” are determined in a number of ways, but generally the injuries are defined by the length of time the person is unconscious immediately after the injury, Matthews explains. Longer than 30 minutes is moderate; 24 hours or longer is severe. Traumatic brain injuries are so variable, Matthews recalls the comment of her MIRECC colleague, Dr. Signoracci: “When you’ve seen one TBI, you’ve seen one TBI.” She adds that sleep problems are very common in those with TBI and “come in a variety of flavors.”

Participants in the study range in age from 18–60, but the aver- age age of the 11 participants enrolled in the study thus far is mid-fifties. The study will enroll at least 20 male veterans and consists of two visits with the participants. The first visit/ interview entails an assessment using a tool developed by Ohio State University (OSU). After eligibility is established based on history of TBI on the OSU scale, Matthews and her colleagues conduct quantitative and qualitative assessments using a variety of measures; review the medical records; and interview the participants about their sleep environments, their psychological history, their level of fatigue, mood and depression; and whether they are a suicide risk.

The second interview is even more in-depth, Matthews says. “We ask about what impacts their sleep quality, and I ask about acceptability of interventions [to address the sleep problems], such as with groups, online or phone calls.”

The participants wear an Acti-watch® on their non-dominant wrist that uses algorithms to measure activity levels, rest and sleep periods over 24 hours. They’re also asked to keep a sleep dairy for seven days, recording how many times they woke up and how they were feeling on awakening. “Self- reporting is very important,” Matthews says, and thus far, participants are fully engaged in doing so.

“Ellyn brings an amazing perspective that facilitates the research,” says Brenner, whose research interest is TBI, co-morbid psychiatric disorders and negative psychiatric outcomes, including suicide. “Sleep is such a huge part of this work, so to have someone like Ellyn, who focuses on the long-term effects of poor sleep, is novel.”

Although Brenner and Signoracci are Matthews’ main collaborators, others in the MIRECC lab are named on the study. “The work at this center is very collaborative; everyone is involved in some way on every- one else’s research—to facilitate the work,” Matthews says.

Findings from the study will address gaps in the current literature about sleep-wake disturbances and ultimately the health outcomes of veterans with TBI.

And that, says Matthews, will support the mission of the VA to honor America’s veterans by providing exceptional health care that improves their health and well-being.