When someone sustains a concussion, there are many key considerations on their path to healing.

Proper nutrition, metabolic recovery, and of course, sleep. But exactly what effect does a concussion have on a person’s quality of sleep and how can they get more restorative rest?

These questions and more will be answered in today’s blog, so let’s dive in!

What is the Function of Sleep?

In short, the answer to this question is that we don’t totally know. What we do know is that physically, mentally and emotionally things can go wrong when people don’t get enough sleep. Sleep is not just a downtime of “nonexistence.” There are actually many important physiological things that happen during this period.

Here’s What Happens to Your Body During Sleep

Slow wave sleep is a time for the brain to clean and renew itself. It actually flushes out toxins and proteins that don’t need to be – and shouldn’t be – in there. In fact, with excessive buildup of some of these components, we see the typical pattern of an Alzheimer’s brain.

While we don’t know for certain the exact link between a lack of restorative sleep and neurodegenerative conditions like Parkinson’s and Alzheimer’s (it’s a bit of a ‘chicken and egg’ scenario), we do see unique patterns of sleep abnormalities years before the onset of certain conditions.

For example, people that develop Parkinson’s Disease can be seen with REM sleep behavior disorder 10 years prior to any clinical symptoms of the disease process. Despite this, discussion remains as to whether sleep disturbances contribute to the illness or the reverse, if the process that caused the disease is impacting parts of the brain that control sleep. This currently remains unclear.

In addition, we know that heart rate and blood pressure should decrease somewhat during the stages of sleep. But if sleep is disturbed we often see a persistence in daytime elevated heart rate and blood pressure, which can lead to cardiovascular disease.

Proper sleep is necessary for the production and release of important hormones, including Human Growth Hormone (HGH). Proper regulation of this hormone is particularly important for children to progress through puberty, though it is also important for adults throughout life to maintain homeostasis in terms of muscle and bone.

And finally, good rhythmic breathing patterns are important during sleep because when we have drops in oxygen levels, as happens with sleep apnea, it is a trigger for inflammation. And as we are now learning, chronic inflammation is the root cause of most modern disease.

So, the reality is that sleep, along with diet and exercise, is an overarching element that impacts your health and well-being.

Proper Cognitive Function Requires Sleep

We know that behaviorally and cognitively, if you don’t sleep enough, you’re more emotionally unstable. So, your boss and kids and commuter traffic are going to annoy you that much more. You also don’t have the same attention span, you don’t have the ability to multitask, and even your reflexes are affected.

You can take an otherwise healthy young person and deprive them completely of sleep for just a few nights and in some more extreme cases, cause psychotic breaks. In a lesser degree this can contribute to car accidents and lots of learning difficulties. So while many students think pulling all-nighters studying is the right way to go, they’re actually shooting themselves in the foot as proper sleep is required for memory consolidation and the ability to learn the next day.

Sleep or lack thereof affects everything; cardiovascular health, brain health, next day brain function, and emotional function to name a few. When you sleep poorly, it also impacts how you eat the next day, your food choices, hormone production and ultimately your microbiome and general gut health. It is all tied into a regular and cyclical pattern of wakefulness and rest.

How Concussion Disrupts a Healthy Sleep Pattern.

So we’ve just seen how important sleep is for our mental and physical health. Now let’s take a look at how a concussion can disrupt a person’s sleep patterns. Later, we’ll talk about how concussion patients can maintain proper sleep hygiene for better health outcomes.

What typically happens to someone who has sustained a concussion is they are told by well-meaning doctors to go home, sit in a dark room for X number of days, and not do anything. And so this person very suddenly changes their schedule and begins “free sleeping” so to speak. They no longer set an alarm to get up for school or work and they nap throughout the day because, they no longer have anywhere to be, what else are they going to do? In short, their sleep schedule gets completely out-of-whack.

They also can’t really continue their exercise program, or don’t feel well enough to eat well or shop, perhaps they start eating more comfort foods. Body pains or medications used can disrupt the ability to maintain deep, restorative sleep at night. And, all these major changes can cause depressive symptoms, and we know mood can impact sleep as well.

In addition, the brain has experienced a trauma and so there may be a disruption in hormone production and even a breakdown in the blood-brain barrier. Now things are leaking into the brain that shouldn’t be, which triggers an inflammatory response. Even though a concussion does not present as a structural change on an MRI, you still get changes in how the neurons function chemically and hormonally due to this perpetuating inflammation.

Many concussion patients also develop a disruption in their breathing patterns, breathing shallow and more rapidly. And as we saw, this impacts sleep and your body’s ability to clear inflammation.

One of the big reasons so many concussion patients have trouble sleeping is because the concussion causes them to be more sensitive to light. So they tend to avoid light by either drawing the curtains in their home or wearing sunglasses all day.  But it is this exposure to light that helps the body to maintain its circadian rhythm.

The human body functions on a 24-hour pattern. This is why it has been said that we each have an internal clock. When you are exposed to sunlight in the early morning hours, it sets your internal clock by saying “My day begins NOW.” Your clock then programs itself from that initial start time and says, “In about 12 to 16 hours, we’re going to start feeling sleepy.” This internal conversation works in conjunction with adenosine buildup and melatonin secretion.

The problem is that historically, concussion patients have been told to avoid bright lights and wear sunglasses, for fear light would provoke unpleasant symptoms. This results in the patient not getting the proper exposure to light in the morning to regulate their sleep/wake cycle.

Admittedly, it’s a bit of a catch 22. If a patient exposes themselves to blue light, it may indeed provoke symptoms. But if they don’t expose themselves to blue light, they are messing with their natural circadian rhythm and sleep cycle and their ability to clear inflammation. And the more inflammation they have, the more sleep issues they will develop, and on and on. It is for this reason that we ultimately tell our patients to get as much exposure to light as they can at the same time each morning, without causing themselves pain or triggering symptoms.

Concussion and Sleep Apnea

New data suggests there is an increased rate of sleep apnea among people who have sustained a concussion. The interesting thing is that in these cases we are dealing with obstructive, not central sleep apnea.

Central apnea is where the brain does not send the signal to the body to take a breath. Whereas in obstructive apnea, the brain sends the signal, but the airway has collapsed and has closed and therefore you cannot draw down air in an effective manner.

We don’t necessarily have a good explanation why an obstructive mechanism would be more prevalent in concussion patients. Having said that, some of the risk factors that go along with developing obstructive sleep apnea tend to occur. For example, gaining weight is a risk factor for obstructive sleep apnea. In concussion patients, a lack of exercise and eating more can lead to sudden weight gain.

At the end of the day, it’s still neural pathways that control the pattern of breathing, and the maintenance of tone in muscles. So, have we disrupted that pathway in some way, whether directly through impact or the subsequent inflammation that is happening in the brain? More studies will need to be conducted for us to have any solid understanding of the mechanisms that may be occurring here.

How Concussion Patients Can Optimize Sleep.

The following are the go-to strategies we share with our clients to help them get the restorative sleep they need to heal.

Get Up at the Same Time Each Morning

While this is a good tip for the general population, it is of particular importance to concussion patients. As mentioned earlier, patients don’t have to keep to any specific schedule while they are healing. At least, this is what they think. In reality, they absolutely should keep to the same schedule in an effort to maintain their sleep schedule. If you start getting up at 11am instead of 7am, your body clock uses 11am as the “start time”. That means you won’t begin to get remotely sleepy until well after midnight. And now your clock is all out of whack.

So, if you were getting up at 7am or 8am for school or work, ideally you would keep getting up at that hour. And be sure to get outside for some early morning daylight exposure, ideally within the first half hour from waking for a good half hour minimum. As an added bonus, being out in nature will also aid to downregulate your stress response. If the weather refuses to cooperate, then use a 10,000 Lux minimum happy lamp.

Avoid Caffeine

Many coffee lovers follow the general rule that says have your coffee in the morning and early afternoon, but stop drinking it after 12pm. This would seem practical advice as it gives your body enough time to break down the caffeine. Caffeine, after all, suppresses your brain’s recognition of sleep signals and your ability to stay in deep, restorative sleep.

The thing is, caffeine also raises your body’s stress response. If you drink enough of it in the morning and early afternoon, your stress response will be through the roof. And it should be noted that your stress threshold can be a lot higher after a concussion, so even a little bit of caffeine may push you too far. And this could be still greatly impacting you at bedtime and throughout the night. We typically advise our clients to forgo caffeine during their recovery.

Exercise in the Morning

If you’re able to exercise in general, we say good, do whatever you can manage. But ideally you would exercise in the morning. One of the results of exercise is a raised core body temperature. Exercising too late in the day or early evening raises your core temperature and also raises your stress response. You don’t want these responses happening in the hours before bed.

Room Temperature Matters

As we just saw, you don’t want to exercise in the evening because you want your body temperature to be cool at night. To that end, you also want to keep your bedroom temperature nice and cool. Don’t cover yourself up with heavy clothing or blankets to allow your core temperature to come down a bit. If you’re too warm, you’ll eventually wake up.

Eating can also have an impact here. We should mention that one of the reasons it’s never a good idea to eat right before bed is because digestion also causes your core temperature to rise through the shunting of blood to your core, so you will be more likely to wake or have interrupted sleep. So be sure not eat for 2-3 hours before bedtime.

Napping is Not the Best Idea

Depending on where you are on your recovery journey and how much energy you have, napping can be counterproductive and should be avoided. If you can’t help but sleep, then you should nap. But if you’re napping because you’re bored, find something else to do.

The problem with indiscriminate napping is that it dissipates the chemical signals that tell your brain to be tired and go to bed later that night. Basically, that’s the adenosine that builds up throughout the day. The longer you’ve been awake, the higher the level goes, and then it becomes a stronger pressure to go to sleep. So, if you have a nap during the afternoon, you kind of let off that pressure.

No Bright Lights at Night

While you want plenty of light exposure in the morning and some throughout the afternoon, you DON’T want to expose yourself to high levels of blue light at night. It’s the blue light that tells the body to “wake up” and “start the day.”

Our ancestors didn’t have electronics or lightbulbs. When the sun rose, they rose. When dusk set in, they started to get sleepy and ready for bed. When the sun fully set, their day ended. No streaming Netflix or watching funny cat videos on their phone for hours.

It is this natural light exposure that results in melatonin release at dusk. This natural trigger and buildup of melatonin is what tells the brain that in about 3-5 hours is when you are going to want to go to sleep.

It’s in the evening that we tell clients to reduce the amount of light in their home, and to feel free to go ahead and wear the blue light filtered glasses – the orange ones – while watching TV or using any electronic gadgets. But even better is to get out of the habit of using any electronics after 8pm, as they are an intense, direct source of blue light to your eyes. Also to note is that any kind of ‘work’ at this time is simply too stimulating for the time of night.

Hit the Carbohydrate Sweet Spot

In addition to avoiding raised body temperature, another reasons to avoid eating right before bed is to avoid fluctuations in blood sugar. This causes changes in your insulin levels that can cause you to awaken during the night.

Now there’s a little bit of nuance here, as not everyone is the same, and women in particular can have a need for some glucose at night. So we tend to do some biohacking with our clients to find that carbohydrate sweet spot. You don’t want to be hungry when you go to bed, but you also don’t want to experience crashes during the night. The general rule of thumb here is not to eat within 3 hours of your bedtime.

If You Can’t Sleep – Get Up and Do Something

Most people, when they’re having trouble sleeping, will lie there and toss and turn in agony and frustration for hours. But this is a really bad idea as you’re training yourself to think of your bedroom as a place of not sleeping and frustration.

The better thing to do is get up, leave your bedroom, go into another dark or very dimly lit room, and listen to a podcast or an audio book. When you feel sleepy again, return to your bedroom and give it another try. If you don’t fall asleep within 10-15 minutes, get up and start again.

Melatonin (as a supplement)

Melatonin is a complicated topic, and we usually only recommend it to patients as a last resort after we’ve worked on all the lifestyle factors first.

When it comes to melatonin, where it has been most shown to help is in setting your clock of when to go to sleep (ie. the jetlag effect).  A low dose of a high quality supplement three to five hours before bed can help your body to reset this natural physiologic effect and your internal clock. But again, there is no point in taking melatonin if you are not going to get up in the morning, nap all day, use caffeine and be on your phone for hours at night. Only use it after you have tried everything else.

Other Helpful Supplements

Some common supplements that can help with sleep issues are magnesium glycinate, L-theanine, 5 HTP and GABA. There certainly isn’t one go to, and we recommend working with your practitioner and always buy from a reputable store or website.

Sleep and Concussion Recap.

Sleep is incredibly important for everyone’s physical, mental and emotional health. This is particularly true for those recovering from concussion.

Unfortunately, as we’ve seen, a concussion injury can in and of itself impact our quality of sleep. But we can combat this impact by following some proper sleep hygiene rules, namely waking early and at the same time each day, avoiding caffeine and napping during the day, exercising in the morning, avoiding food or alcohol right before bed, keeping our bedrooms nice and cool, and staying off those electronic gadgets prior to bed as well.

By following these simple guidelines, concussion patients can get the restorative sleep they need so they can recover and get back to their life as quickly as possible.


Blog content adapted from ACD Podcast Episode 129 with Dr Adit Margaliot (Neurologist) – to listen to the full podcast click (here)

Doctor Margaliot is a Canadian trained neurologist with a fellowship in neuromuscular disorders and further specialization in sleep medicine.

She has practiced in both hospital and community settings. She now also practices Functional Medicine, an approach to treating individuals as a whole and addressing root causes of chronic illness.

She views sleep as a very important component of an individual’s care and also recognizes the impact that other health issues have on sleep.

She presently practices in Toronto, and is pleased to sit on the board of Complete Concussions.