A concussion is a mild traumatic brain injury (TBI) that occurs following a blow, bump, or jolt to the head or body, causing the brain to move quickly within the skull. This rapid movement triggers temporary chemical changes within brain cells, which can affect a person’s cognitive function, emotions, and sleep patterns. Understanding the difference between a typical concussion and a more severe brain injury is necessary for safely managing the initial recovery period. This guidance is essential for appropriate sleep management immediately following a suspected concussion.
The Myth of Staying Awake
The belief that someone must be kept awake after a concussion is a long-standing piece of advice that is now considered outdated. This misconception stemmed from a historical fear that a sleeping person with a brain bleed might slip into an irreversible coma unnoticed. Current medical consensus finds that internal bleeding is rarely associated with a typical concussion. For a person who has sustained a mild injury and does not exhibit severe symptoms, sleep is not only safe but is highly beneficial for recovery.
The brain needs rest to heal the temporary damage caused by the injury. Sleep allows the brain to perform cellular repair processes and conserve energy otherwise consumed by cognitive demands during wakefulness. Uninterrupted rest is important for recovery, especially within the first 24 to 48 hours after the injury. Waking a person repeatedly throughout the night can disrupt this restorative process, potentially hindering healing. Once a medical professional has ruled out more serious conditions, rest is considered one of the best tools for recovery.
Emergency Warning Signs
While rest is encouraged for a mild concussion, certain symptoms indicate the injury is more severe and require immediate emergency medical attention. These signs suggest a potential complication, such as severe brain swelling or an intracranial hemorrhage. If any of these severe symptoms are present, the person should not be allowed to sleep, and emergency services should be contacted immediately.
Warning signs that require immediate medical attention include:
- A headache that becomes progressively worse and does not improve with pain relief medication.
- Repeated vomiting, particularly three or more times.
- Increasing confusion, slurred speech, or significant difficulty in being awakened.
- Physical symptoms like weakness or numbness in the arms or legs, or a seizure.
- Unequal pupil sizes, which can signal increased pressure inside the skull.
Monitoring During Rest
For an individual resting at home without displaying emergency signs, monitoring is necessary, particularly during the first 24 to 48 hours post-injury. The person should not be left alone during the initial 24 hours after the head injury. This observation period ensures that no severe symptoms develop after the onset of sleep.
Checking on the resting person does not require full arousal every few hours. The goal is to confirm the individual can be easily awakened and is responsive. A caregiver should gently rouse the person enough for them to open their eyes, respond to their name, and briefly acknowledge their surroundings. If there is any difficulty in waking the person, or if they seem excessively drowsy or confused upon waking, emergency medical help should be sought immediately.
Managing Recovery Sleep Issues
Beyond the immediate post-injury period, many individuals experience sleep disturbances during the subsequent weeks of recovery. The trauma can affect the brain’s neural networks that regulate sleep, leading to issues like insomnia (difficulty falling or staying asleep) or hypersomnia (excessive daytime sleepiness). These sleep problems may be related to changes in the brain’s chemistry or function. Maintaining a consistent sleep schedule is important, even if the person feels overly tired.
Good sleep hygiene practices support the brain’s efforts to re-establish a regular sleep-wake cycle. This involves maintaining a quiet, cool, and dark bedroom environment. Limiting screen time before bed and avoiding long naps during the day can help consolidate better nighttime sleep. If sleep issues persist for several weeks or severely interfere with daily function, consult a doctor, as persistent sleep problems can worsen other concussion symptoms.