The Concussion Coach podcast

131. Dysautonomia, Therapies for Sleep, & Concussions in the Elderly: An Interview with Don Watenpaugh, PhD, D, ABSM (Part 3)

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Don Watenpaugh, PhD, D, ABSM, is a scientist, sleep consultant, and data artist. He earned his PhD in Physiology at UC Davis and is board-certified in sleep medicine by the American Board of Sleep Medicine (ABSM). He directed a large urban sleep clinic for 13 years and currently serves as an adjunct faculty member in the Department of Physiology and Anatomy at the University of North Texas Health Science Center and in the Department of Biomedical Engineering at the University of Texas at Arlington.

In this episode, Bethany Lewis welcomes back her uncle, Dr. Don Watenpaugh, for a third deep dive into the science of concussion recovery. The conversation focuses heavily on the physiological underpinnings of common post-concussion symptoms. Dr. Watenpaugh explains the role of the vestibular system (specifically the "rocks in your head" called otoliths) in causing dizziness and vertigo, and how this relates to Dysautonomia (autonomic nervous system imbalance). He also explores cutting-edge therapies for sleep disruption, including neurofeedback and transcranial stimulation. The episode concludes with a critical discussion on the under-recognized risks of concussion in the elderly population and a valuable "internet hack" for finding reliable, peer-reviewed research.


Key Topics & Resources Mentioned

1. Vestibular System & BPPV

  • Concept: The otoliths (calcium carbonate crystals) in the inner ear help the body sense gravity and movement. A concussion can dislodge these "rocks," leading to Benign Paroxysmal Positional Vertigo (BPPV) , dizziness, and disorientation.

  • Impact: Increases fall risk (leading to re-injury), causes sensitivity to movement (e.g., elevators, bending down), and can disrupt sleep by altering spatial awareness.

  • Treatment: Specialized vestibular physical therapists use specific maneuvers (like the Epley maneuver) to reposition the crystals and "re-educate" the system.

2. Dysautonomia (Autonomic Nervous System Imbalance)

  • Concept: The concussion can cause an "adrenergic storm," leading to a dominance of the sympathetic nervous system (fight or flight). This makes it difficult for the body to switch to the parasympathetic state (rest and digest), which is necessary for healing.

  • Symptoms: Random heart rate spikes while resting, profuse sweating, feeling faint upon standing (POTS-like symptoms), and digestive or hormonal issues.

  • Treatment: Sub-threshold exercise (exercising up to the point of symptom onset and then stopping) and High-Intensity Interval Training (HIIT) can help retrain the nervous system's resilience. Listen to The Concussion Coach Podcast episode 37 for more information on how to implement effective HIIT training: 37. Post Concussion Syndrome, Dysautonomia, & Intervals: An Interview with Dr. Mark Allen, PhD

3. Sleep & Advanced Therapies

  • Concept of Brain Fog: Delta waves (slow waves associated with deep sleep) appearing during wakefulness, which is counterproductive to cognitive function.

  • Therapies Discussed:

    • Neurofeedback: Training the brain to reduce inappropriate delta waves during the day to improve wakefulness and potentially improve sleep drive at night.

    • Transcranial Direct Current Stimulation (tDCS): A non-invasive therapy that uses small electrical currents applied to the scalp during sleep to encourage Delta (slow wave) sleep.

    • Transcranial Magnetic Stimulation (TMS): Using magnetic fields to stimulate nerve cells in the brain to treat post-concussion depression and headaches, which indirectly improves sleep.

    • Near-Infrared Light (Red Light Therapy): A therapy mentioned for overall brain recovery (also listen to a previous episode on the Neuronic device: Episode 120: https://youtu.be/Juoz5SApHUg).


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