A concussion, medically classified as a mild traumatic brain injury (mTBI), occurs when a bump, blow, or jolt to the head causes the brain to move rapidly inside the skull, creating temporary functional changes. One of the most frequently reported and distressing consequences of a head injury is post-concussion insomnia (PCI), which involves difficulty falling asleep, staying asleep, or experiencing unrefreshing rest. This sleep disruption is a common experience, affecting between 40% and 65% of individuals following a concussion.
The Neurological Link
A concussion directly impacts the brain’s delicate balance, causing physical and chemical changes that interfere with the body’s sleep-wake cycle. The trauma can disrupt the brain’s internal clock, the circadian rhythm, which regulates sleep timing. This disruption often manifests as a delayed sleep phase.
The injury also affects the production and signaling of key sleep-regulating neurotransmitters. Chemicals like gamma-aminobutyric acid (GABA), which promotes relaxation, and serotonin, a mood and sleep regulator, can be thrown out of balance.
Furthermore, the physical impact can damage structures deep within the brain, such as the brainstem and hypothalamus, which are responsible for maintaining alertness and sleep. Inflammation and metabolic changes occur as the brain reacts to the trauma, which can further impede normal sleep processes. While the primary cause is the brain injury itself, secondary symptoms like persistent headache, neck pain, and heightened anxiety also contribute to sleep fragmentation.
Understanding the Typical Recovery Timeline
The duration of post-concussion insomnia varies considerably among individuals, but for most, it is a temporary issue. Insomnia that appears in the days or weeks immediately following the injury is generally considered acute. For the majority of people, most post-concussion symptoms, including sleep disturbances, begin to resolve within a few weeks, typically within 4 to 6 weeks.
If sleep problems continue past the one-month mark, they are generally classified as prolonged, and if they persist for three months or longer, the insomnia is considered persistent or chronic. Persistent post-concussion symptoms, including insomnia, occur in approximately 10% to 20% of people and warrant specialized medical attention.
Factors influencing the recovery timeline include the severity of the initial injury, the presence of pre-existing sleep disorders, and the person’s age. The presence of sleep disturbances in the first ten days after the injury is also associated with an increased risk of persistent symptoms.
Non-Pharmacological Strategies for Better Sleep
Implementing strong behavioral and environmental strategies, often referred to as sleep hygiene, can immediately support the brain’s attempt to regulate sleep. It is beneficial to establish a consistent sleep schedule by going to bed and waking up at the same time every day, including on weekends.
Managing light exposure is particularly helpful for resetting the disrupted circadian rhythm. The following strategies can help promote the necessary conditions for restful sleep:
- Maintaining a sleep environment that is dark, quiet, and cool.
- Seeking natural light exposure first thing in the morning to help regulate the internal clock.
- Avoiding light-emitting screens, such as phones and tablets, for at least one hour before bedtime, as this light can suppress the production of melatonin.
- Avoiding stimulants like caffeine and nicotine, especially in the late afternoon and evening.
- Avoiding alcohol, as it disrupts sleep architecture even if it initially seems to help with falling asleep.
If unable to sleep, leaving the bedroom after about 20 minutes to engage in a quiet, relaxing activity until sleepy can prevent the association of the bed with wakefulness and frustration.
When to Seek Clinical Intervention
If self-management strategies do not lead to improvement, or if insomnia symptoms persist beyond the three-month mark, professional intervention is recommended. A medical professional, such as a neurologist or a sleep specialist, can conduct a focused sleep assessment to determine if other sleep disorders like sleep apnea or restless legs syndrome are contributing to the problem. These specialists can also investigate if the sleep disturbance is related to underlying issues like anxiety or depression, which frequently occur after a concussion.
The gold-standard, non-drug treatment for persistent insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I). This therapy is a structured program that targets the thoughts and behaviors that interfere with sleep, often requiring six to eight counseling sessions.
In more severe cases, a physician may consider the careful and short-term use of sleep aids, though these medications must be used cautiously in the context of a brain injury. Clear indicators for seeking specialized referral include the worsening of symptoms despite treatment, or if the sleep problem is suspected to be a more complex sleep disorder. A referral to a sleep medicine specialist is warranted if a person is experiencing excessive daytime sleepiness that persists beyond four weeks post-injury.