Introduction

Many people with brain injury have problems getting started in the morning, just as people without brain injury may have them.
The reverse also occurs.

There are people with brain injury who start the day fresh and cheerful, just as there are people without brain injury who start the day fresh and cheerful.

 

However, people who used to have problems getting started in the morning indicate that these problems have become much worse with the occurance of their brain injury.

 

This can have major consequences. For example, to bring your children to school on time, to arrive at work on time or to be able to attend an appointment.

In addition to the problem of not arriving on time, a person can also function significantly less.

 

A single cause or several causes

There may be a single cause, or a combination of physical, cognitive and emotional causes.

• The brain has to get going. During sleep, all automatic brain functions continue. These functions regulate the bodily functions and keep the person alive. For example, breathing, blood pressure regulation, temperature regulation, etc. The thinking tasks start upon waking. Research has shown that people with brain damage need more energy for thinking tasks than people without brain damage.
• Sleep problems due to brain injury (trouble falling asleep, trouble staying asleep or waking up too early)
• Untreated sleep apnea can cause a person to have too much carbon dioxide in the blood in the morning. That person often has a full, heavy head, headaches and is drowsy.
• The effect of sleeping medication or other medication that has a sedating side effect has not yet been extinguished.
• Physical discomforts such as stiffness, spasms, motor problems, pain, apraxia, bowel problems, balance problems, etc. can cause someone to need more time than others.
• An overstimulated brain from a some time ago, hinders the start-up. Compare being overstimulated to a traffic jam on a country road diversion. The highway is blocked and the cars can only get through in small numbers: one by one. Everything is at a standstill until it is time to be processed. That has a huge impact on process of getting started
• Hormonal factors can be disrupted by the brain injury.
  Normally, the amount of cortisol in the blood drops to its lowest level around midnight. About two to three hours after a person falls asleep, cortisol rises a little. It continues to rise throughout the night and peaks an hour after a person wakes up. Cortisol levels can fluctuate throughout the day in response to what is happening.
  The sleep-promoting hormone melatonin has an opposite timeline. It increases in the evening and night and the amount in the blood drops in the morning. The sleep-wake rhythm (circadian rhythm) or biorhythm can be disrupted by the brain injury.
• The neurofatigue or brain fatigue (the empty battery that has not been recharged during the night)
• Lack of overview, not knowing where and how to start a (daily) task (executive functions of the brain)
• Brain fog
• Depression due to brain injury
• Apathy due to brain injury
• A person with a brain injury needs a single stimulus to start something. Without that command, he or she remains in a state of not really thinking and not functioning. Using a diary may help, and it may also help if someone else reminds you.
  

 

Whether the inability to get started in the morning has a single cause or a combination of causes is not important for the outcome.

It is a serious problem of powerlessness, not of unwillingness.

 

Consequences

The consequences may be immense. The person is sometimes barely able to participate in working or social life.

The person may lose her or his job due to barely or not functioning in the morning. There may be doubts about functioning in the role as a parent of a child. Relationships and friendships can become strained.

 

Not functioning in the morning is a problem that is felt on both sides: by the person concerned and by the environment.

 

Solutions

Because there are so many possible causes, it is impossible to have one solution.
Previously, people just wanted to encourage and have everyone adapt to what was considered 'normal'. Sometimes that was neatly packaged in professional terms such as 'stimulate', 'train' and 'resocialize'.

 

With the insight that the problem has multiple sides, the insight has emerged that the individual person has basic conditions in order to function well.

 

Just as we understand that one person is a real night owl and another a morning person, here too, compromises will have to be made. Discuss with each other what is and what is not possible. Where should help be offered, where not? If there is a medical cause for the problem, a doctor may be able to help think about whether the cause can be cured or reduced. An occupational therapist may be able to help look at the load and load capacity balance. Another professional may be able to help think, especially if it concerns apathy and depression.

 

People with brain injury generally benefit from rest, regularity and structure. A normal night's sleep is often not enough to recover from a normal day.
To recover from extra busyness, worries, sadness, stress or appointments, sufficient rest is essential!
Recovery takes one day for one person, for another person it takes weeks or months, our research showed.

 

Learning to deal with it remains an individual matter. Sometimes there is no solution.

 

Quote

We received the following statement from a reader of our Dutch website:

"I definitely recognize it, for me it has to do with how the days before were. Too much overstimulation causes a bad, restless night's sleep, which results in getting up even worse. I have to turn off the phone on time the night before, not have any more conversations, for example when walking the dogs, or do any household chores such as putting away the laundry. I have to build up the getting up. If I really have to go to an appointment, I go, but rest the rest of the day. If possible, I only plan one appointment per week, but that doesn't always work out. It will be different for everyone, but try to get a clear picture of your triggers, your activities, your overstimulation points so that you learn what works for you".

'Don't judge me till you've walked a mile in my shoes or lived a day in my life'

This proverb is very appropriate.

 

Before you judge someone, try to understand his or her situation. In other words, walk a mile in his or her shoes.

The saying is about being able to empathize with someone’s situation without ever having been in that situation.

Don’t judge someone. You haven’t been in that situation yourself.

 

 

Please also read the topics linked to this page

In the text we have placed links to topics or pages that go deeper into the mentioned problems or solutions and tools.