Brain Injury, November 2011; 25(12): 1256–1265 CASE STUDY Impact of post-traumatic hypersomnia on functional recovery of cognition and communication CATHERINE WISEMAN-HAKES 1 , J. CHARLES VICTOR 2 , CLARE BRANDYS 3,4 ,& BRIAN J. MURRAY 5 1 Graduate Department of Rehabilitation Science, 2 Dalla Lana School of Public Health, 3 Department of Psychiatry, Universityof Toronto, Toronto, Ontario, Canada, 4 Independent Practice in Psychology, Toronto, Ontario, Canada, and 5 Neurology and Sleep Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Received 2 November 2010; revised 25 June 2011; accepted 23 July 2011) Abstract Primary objective: To assess aspects of cognition and communication, in response to the treatment of post-traumatic hypersomnia and mood disturbance. Research design: A single case study; pre–post intervention. Methods and procedures: The participant was a male with severe TBI and cognitive-communication impairments, who subsequently developed sleep and mood disturbance and excessive daytime sleepiness. The Daily Cognitive- Communication and Sleep Profile (D-CCASP), Clinical Interview, Epworth and Stanford Sleepiness Scales and polysomnography assessed sleep and wakefulness. Cognitive-communication was also assessed by the D-CCASP. His sleep, wake and mood difficulties were pharmacologically managed. Main outcomes and results: Baseline polysomnography indicated abnormal sleep. There was a clear positive relationship between quality of sleep, language processing, attention and memory, seen across the phases of the medication intervention (p < 0.01). Conclusions: A comprehensive pharmacological management programme addressing the multi-factorial underlying aetiology was successful in improving sleep, arousal and mood. The D-CCASP was found to be clinically and statistically sensitive to reported changes in cognitive-communication function in relation to improvements in sleep and daytime arousal. These findings suggest that management of sleep/wake disturbances and mood post-traumatic brain injury can potentially facilitate improvements in cognitive-communication function which may, in turn, facilitate participation in rehabilitation and community integration. Keywords: Sleep disturbance, hypersomnia, excessive day-time sleepiness, traumatic brain injury, cognition, cognitive- communication, mood disturbance Introduction Traumatic brain injury (TBI) is the leading cause of death and disability for those under the age of 45 in North America. Given that the peak age of injury occurs between the ages of 15–24 years and the majority are aged 45 and under, this has significant implications to society as these young people are left with chronic residual neuropsychiatric, cognitive and communication disabilities [1]. Impairments in sleep and the development of sleep disorders such as insomnia and excessive day-time sleepiness are among the most commonly reported neuropsychiat- ric sequelae [1]. Studies conducted amongst heterogeneous sam- ples of individuals with TBI report an incidence that varies from 30–70% during the first 3 months post- injury and a prevalence up to 73% long past the injury [2]; 30% meet the DSM-IV criteria for Correspondence: Catherine Wiseman-Hakes, Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Ave., Toronto, Ontario, Canada M5G 1V7. Tel: 416 946-8575. Fax: 416 946-8570. E-mail: catherinew.hakes@utoronto.ca ISSN 0269–9052 print/ISSN 1362–301X online ß 2011 Informa UK Ltd. DOI: 10.3109/02699052.2011.608215