A concussion occurs when a sudden blow or jolt to the head or body causes the brain to move rapidly inside the skull, leading to temporary chemical and functional changes in the brain cells. This injury disrupts the normal function of the brain’s nerve fibers, which can result in a variety of symptoms. When a head injury occurs, a common concern for patients and caregivers is whether the injured person should be kept awake. Modern medical understanding has clarified the post-injury protocol, shifting the focus from preventing sleep to ensuring safe, monitored recovery.
The Truth About Staying Awake After a Concussion
The belief that a person with a concussion must be kept awake is a common misconception. This outdated advice stemmed from the fear that if a patient fell asleep, a caregiver would not be able to notice the signs of a severe, life-threatening complication, such as a brain bleed. The concern was that sleep would mask the descent into unresponsiveness caused by increasing pressure inside the skull.
However, medical professionals now recognize that forcing wakefulness is counterproductive to the healing process. Sleep is an important component of recovery, as it allows the brain to conserve energy and begin essential repairs. A lack of adequate sleep after a head injury can prolong recovery times. The modern approach emphasizes safe, monitored rest over unnecessary sleep deprivation.
Current Medical Protocol: Rest and Recovery
The current standard of care for concussion management centers on a period of relative rest, particularly within the first 24 to 48 hours following the injury. This approach requires balancing physical rest with cognitive rest, which means avoiding activities that strain the brain. Activities such as reading, using screens, or engaging in mentally demanding tasks should be limited during this acute phase.
Normal, uninterrupted sleep is actively encouraged because it is when the brain performs many restorative functions. During sleep, the brain consolidates and strengthens neural connections, which is necessary for healing. Adequate sleep has also been linked to better management of post-concussion symptoms and a faster overall recovery trajectory. After the initial rest period, a gradual return to light physical and cognitive activities is recommended as tolerated by the patient’s symptoms.
Identifying Red Flag Symptoms (When to Seek Emergency Care)
While most concussions are not life-threatening, the injury mechanism can also cause a more serious brain injury, which is why monitoring is necessary. Certain “red flag” symptoms indicate a potentially severe injury, such as bleeding inside the skull, and require immediate emergency medical attention. These symptoms are distinct from the typical, milder concussion symptoms like light headache or mild dizziness.
If any of the following signs appear, call emergency services immediately:
- Worsening headache: A headache that becomes severe, does not go away, or increases in intensity over time.
- Repeated vomiting: Having multiple episodes of vomiting or nausea that does not resolve.
- Worsening consciousness: Increasing drowsiness, difficulty waking up, or being unable to stay awake.
- Neurological changes: Slurred speech, numbness, or weakness in the limbs, or problems with walking or balance.
- Seizures: Any convulsions or fits.
- Pupil changes: One pupil appearing larger than the other.
- Clear fluid: Clear fluid or blood draining from the nose or ears.
The Initial 24-Hour Monitoring Period
The first 24 hours after a suspected concussion are the most important time for monitoring. If a medical professional has determined that the patient is safe to go home and does not exhibit any immediate red flag symptoms, a caregiver should remain with them. It is acceptable for the person to sleep, but the caregiver should perform periodic checks to ensure their condition is stable.
These checks involve quietly observing the person for signs of distress, such as irregular breathing, and attempting to rouse them every two to three hours. The goal is to confirm that the person is easily awakened and can respond to a simple question. If the person is difficult to wake up, appears unusually confused, or exhibits any of the severe red flag symptoms previously listed, emergency medical help should be sought at once.