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Related Concept Videos

Traumatic Brain Injury l: Introduction01:28

Traumatic Brain Injury l: Introduction

DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
Insomnia01:27

Insomnia

Insomnia is a prevalent sleep disorder characterized by difficulty falling asleep, frequent awakenings during the night, and waking up too early without being able to return to sleep. People with insomnia often experience these disruptions at least three nights a week for at least one month. Chronic insomnia, which lasts for at least three months, can lead to increased anxiety, which in turn can worsen sleep difficulties, creating a cycle of sleeplessness and stress.
Multiple factors contribute...

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Related Experiment Video

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Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
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Changes in Subjective-Objective Sleep Discrepancies Among Participants With Post-acute Moderate-to-Severe Traumatic

Daniel J Reis1, Molly J Sullan, Adam R Kinney

  • 1Author Affiliations: VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Reis, Kinney, Stearns-Yoder); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Reis, and Brenner); Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Sullan, Kinney, Mingils, Stearns-Yoder, and Brenner); Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Brenner); VA Brain Health Coordinating Center, Aurora, Colorado (Sullan, Kinney, and Brenner); and VA Eastern Colorado Health Care System Research Service, Aurora, Colorado (Mingils).

The Journal of Head Trauma Rehabilitation
|July 13, 2026
PubMed
Summary

Computerized cognitive behavioral therapy for insomnia (cCBT-I) improved subjective sleep but widened discrepancies with objective measures in veterans with moderate-to-severe traumatic brain injury (TBI). Further research is needed to understand these sleep differences.

Keywords:
actigraphyinsomniasubjective-objective sleep discrepanciestraumatic brain injury

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Area of Science:

  • Neuroscience
  • Sleep Medicine
  • Clinical Psychology

Background:

  • Insomnia is a common and debilitating symptom following moderate-to-severe traumatic brain injury (TBI).
  • Subjective-objective sleep discrepancies are prevalent in TBI populations, complicating treatment assessment.
  • Computerized cognitive behavioral therapy for insomnia (cCBT-I) shows promise for treating insomnia, but its impact on subjective-objective sleep discrepancies in TBI requires investigation.

Purpose of the Study:

  • To evaluate changes in subjective-objective sleep discrepancies after cCBT-I in United States veterans with moderate-to-severe TBI and insomnia.
  • To assess the agreement between subjective (Consensus Sleep Diary) and objective (actigraphy) sleep measures before and after cCBT-I.

Main Methods:

  • Secondary analysis of intervention-arm data from a randomized controlled trial involving 36 veterans with moderate-to-severe TBI and insomnia.
  • Participants completed an online cCBT-I program (SleepEZ).
  • Subjective sleep (total sleep time, sleep onset latency, waking after sleep onset, early morning awakening, sleep efficiency) was measured nightly; objective sleep was measured using actigraphy during initial and final weeks. Discrepancies were analyzed using Bland-Altman plots and multilevel modeling.

Main Results:

  • Poor agreement between subjective and objective sleep measures was observed across all outcomes.
  • At baseline, participants overreported sleep onset latency and early morning awakening, and underreported waking after sleep onset, leading to overestimated total sleep time.
  • Following cCBT-I, subjective overreporting of sleep onset latency decreased, and discrepancies in sleep efficiency widened due to subjective improvements not reflected in objective measures.

Conclusions:

  • Concurrent use of subjective and objective sleep measures is crucial for comprehensive assessment and treatment of insomnia in individuals with moderate-to-severe TBI.
  • Further research is warranted to explore mechanisms underlying subjective-objective sleep discrepancies, such as cognitive impairment or altered sleep homeostasis, to inform targeted post-TBI insomnia treatments.