A concussion is a mild traumatic brain injury that happens when the brain gets shaken inside the skull. This could be from a hard blow or jolt to the head, neck, or body or when the head moves rapidly back and forth. With so much information available, much of it outdated or inaccurate, it can be confusing to know what to do next if you think you might have a head injury. In addition to not knowing how to recognize a concussion, many people are unclear on how to manage them. One common question people ask is if it is okay to sleep after a concussion or how long to stay awake. In this article, we will explore the answers to these questions and provide useful information on managing a concussion.
Every concussion is different, and each person’s symptoms vary. They may not appear immediately and can develop several hours to days after the injury. Less than 10% of concussions result in loss of consciousness; most will show a combination of the following common signs and symptoms:
Physical: headache, dizziness, nausea, pressure in your head
Mental: confusion, trouble with memory, difficulty concentrating, feeling slowed down
Mood: irritable, sad, anxious, more emotional than usual
Most concussions are not medical emergencies. However, the same mechanism that can cause a concussion can also cause more serious brain injuries, such as bleeding inside the brain, brain swelling, or skull fracture. There are warning signs of more serious head injuries that require immediate medical care. [1]
Seek emergency care for an adult or child who experiences a blow to the head, neck, or body and any of these symptoms appear:
A traumatic brain injury that is more serious than a concussion will need to be diagnosed in the emergency department, usually by using imaging such as a CT scan, MRI, or X-ray. Concussion by itself does not show up on standard imaging, so even if the scans do not show bleeding, swelling, or structural injury (such as a fracture of the skull), a concussion can still be present. If a more serious brain injury is identified, the person will need to stay in the hospital for treatment and possible surgery. If not, they are typically released with instructions to follow up with their healthcare provider.
It was previously believed that individuals with head injuries should stay awake and that sleeping after a concussion was dangerous. This misinformation stems from the notion that if a person has a serious injury such as a brain bleed or hematoma, sleeping could lead to a rare and potentially fatal complication. However, brain bleeding is rarely associated with concussions. In fact, there is no scientific evidence to support this practice. Sleeping after a concussion doesn’t actually increase the risk of a coma. [2]
The most important thing is to ensure that the individual has been evaluated and cleared of any serious brain injury by a healthcare professional before sleeping. Many experts recommend allowing someone with a mild concussion to sleep as long as they are easily awakened.
If the person has been cleared of brain bleeds and acute trauma by a medical professional, restful sleep is safe and crucial for recovery. There’s no evidence to support the idea that waking someone up or preventing them from sleeping is necessary or helpful for their recovery. Letting them sleep for a full eight hours is actually more beneficial than interrupting their rest to check on them. “Sleeping through the night is okay once you’ve been evaluated by a medical professional,” says Michael “Micky” Collins, PhD, an internationally renowned expert in concussion and the director of the UPMC Sports Medicine Concussion Program.
Checking in a few times to see if the sleeping person with a concussion is breathing regularly is fine and doesn’t require waking them up. [3] During the first 3 hours after the injury, someone with a concussion should not be left alone. They should be monitored closely and checked frequently. If you notice that they aren’t breathing normally, wake them immediately and seek medical attention. If you cannot wake them, call emergency medical services.
The first 24-48 hours after injury are especially critical. The newest sports-related concussion guidelines recommend “relative” (not strict) rest, including activities of daily living, reduced screen time, light, and symptom-limited physical activity. [4] This also means no sports or working out to avoid the risk of further injury or delayed recovery. After this 2-3 day period, slowly returning to normal activities (as long as it does not cause symptoms to come back) will help speed recovery. [5]
After being diagnosed with a concussion, it’s important to stick to a regular sleep schedule. A good night’s sleep helps the brain repair and recover from the damage caused by the injury. Additionally, the hormones your body produces to promote sleep can help alleviate concussion symptoms such as headaches, fatigue, and memory problems. [6] It’s also important to avoid anything stimulating the brain, such as loud noises or bright lights. Screens (TV, phone, tablet, computer) should be avoided before bed (30-90 minutes) to prevent disrupted sleep.
Everyday activities can be more tiring when recovering from a concussion, which is another reason why sleep is so important. However, it is important to note that too much sleep can also be harmful. [7] Oversleeping can lead to fatigue and difficulty falling asleep at night. Aim for 8-10 hours of sleep per night but listen to your body and adjust accordingly. It’s also essential to avoid caffeine, alcohol, and any medications that may interfere with sleep.
During the recovery process, some patients mention having trouble falling asleep, staying asleep, and/or not getting enough sleep. In addition to affecting the healing process, these sleep problems can cause issues in mental function and an increase in concussion symptoms, memory problems, feeling tired during the day, and emotional health.
If you have trouble sleeping after a concussion, talk to your doctor about the best course of action for you.
In the meantime, here are some suggestions for healthy sleep habits to get higher quality sleep:
It’s best to avoid taking sleeping pills or other medications that induce sleep. They can mask symptoms, making it difficult to monitor progress, and can cause additional damage to your head and/or health. Also, avoid drinking alcohol and using nicotine since these substances can slow down the healing process and interfere with normal sleep cycles.
The hormone melatonin regulates the sleep-wake cycle and is often considered a potential aid for poor sleep after a concussion. The body naturally produces it as light levels decrease in the evening. Some studies suggest that melatonin can help improve sleep quality, reduce the time it takes to fall asleep and increase overall sleep duration. However, the use of melatonin after a concussion should be approached with caution. The effect of melatonin can vary depending on the individual and the specific circumstances, and there may be potential interactions with other medications.
Be sure to consult a healthcare professional before taking any supplements, as they may have side effects or interactions with other medications. The best way to improve sleep quality is by following the tips mentioned above, getting regular check-ups, and monitoring progress with your doctor or healthcare provider.
In managing a concussion, sleep and rest play a vital role in recovery. After a concussion is diagnosed, maintaining a regular sleep schedule and ensuring adequate rest is of utmost importance as it aids the brain recovery process. The first 24-48 hours after the injury are especially critical, and patients should rest their bodies and minds. The myth of staying awake after a concussion has been thoroughly debunked. It is okay to check on the concussed person for abnormal breathing without waking them. Irregular breathing, or the inability to wake the person up, requires immediate emergency care.
Adhering to a consistent sleep schedule and creating healthy sleep habits, including regular physical activity, can significantly enhance the quality of sleep, which is essential for recovery. While medications and supplements like melatonin may be considered to aid sleep, they should be used under the guidance of a healthcare professional to avoid potential interactions with other medications.
Gradual return to exercise, sports, school, and work, based on symptom limits, paired with quality nutrition and sleep habits, will lead to a quicker and more complete recovery after a mild traumatic brain injury. Remember to listen to your body and seek medical advice if you experience any concerning symptoms. Rest up, recover well, and take care of yourself!
Check out our other blog post about concussions and sleep to learn more.
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