Factors associated with the remission of insomnia after traumatic brain injury: a traumatic brain injury model systems study.

Only 40 people were analysed, and they were 17% of the 237 screened with two interview waves, which is much smaller than insomnia rates reported in the literature. All participants had moderate or severe TBI and received acute hospitalization plus inpatient rehabilitation at specialized centers, so findings may not apply to milder TBI or people without that care. Sleep, fatigue, depression, and participation were measured by self-report and retrospective interview, so recall and self-awareness could affect the results. Two different follow-up intervals were combined, so remission that happened between years 2 and 5 was not captured, and separate cohort analyses were not possible. Medication and non-medication treatment questions were missing for 6 participants, and treatment use was not assigned, so the study cannot show what caused remission. Sleep apnea was self-reported in 10% of the sample, but may be under-detected; untreated sleep apnea could masquerade as insomnia and reduce benefit from behavioral sleep treatment.

The study used a National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems database, and the authors declared no conflicts of interest.

Do not conclude that insomnia medication caused remission or better sleep, fatigue, mood, or participation. The study did not assign treatment, medication use was similar between groups, and authors said reported medication effectiveness could reflect attribution bias.