A concussion is a type of traumatic brain injury that results from a bump, blow, or jolt to the head, or a hit to the body that causes the head and brain to move rapidly. This sudden movement can temporarily alter normal brain function. For a long time, a common piece of advice circulating after someone experienced a concussion was the instruction to keep them awake.
The Historical Basis of the Advice
The advice to keep a person awake after a head injury originated from significant concerns about potential severe, undiagnosed brain damage. In earlier times, medical professionals and caregivers feared that if someone with a concussion fell asleep, they might slip into a coma or that signs of a rapidly worsening condition would be missed. This rationale was primarily driven by the possibility of an intracranial hemorrhage, which could expand and exert pressure on the brain. Without advanced diagnostic tools readily available, observing changes in consciousness was a primary method for detecting such life-threatening complications. The concern was that sleep would obscure these important indicators, delaying urgent medical intervention.
Current Medical Understanding and Risks
Current medical understanding largely indicates that keeping someone awake after a concussion is not necessary and may even hinder recovery. Rest, including sleep, is now recognized as beneficial and often a core part of the healing process for a concussed brain. Rather than sleep itself, the primary concern for medical professionals revolves around serious complications such as an expanding intracranial hematoma or increased intracranial pressure.
These conditions require immediate medical attention. Signs of serious complications are distinct from typical concussion symptoms and warrant close monitoring. For instance, an intracranial hematoma might manifest as a headache that progressively worsens, repeated vomiting, or a gradual loss of consciousness. Other indicators include confusion, pupils of different sizes, slurred speech, or weakness or paralysis on one side of the body. Increased intracranial pressure, another serious concern, can cause symptoms such as a severe headache that is worse when lying down, persistent nausea and vomiting, changes in mental status ranging from drowsiness to coma, or vision disturbances like blurred or double vision. Other concerning signs include difficulty staying awake, extreme drowsiness, or inability to be roused, numbness, decreased coordination or balance problems, seizures, or pupils of unequal size or changes in vision. The risk is not in sleeping, but in failing to recognize these dangerous signs of a worsening condition.
What to Do After a Concussion
After a suspected concussion, seeking medical evaluation is an important first step. A healthcare provider can properly diagnose the injury and rule out any more serious underlying conditions. Following a medical assessment, rest is considered paramount for recovery, especially within the first 24 to 48 hours. This typically involves “relative rest,” which means avoiding activities that significantly worsen symptoms, rather than complete isolation in a dark room.
Limiting strenuous physical activity and cognitive exertion, such as extensive screen time, demanding reading, or complex tasks, allows the brain to heal. Sleep is encouraged as it plays a restorative role in brain function and aids in the recovery process. However, if any “red flag” symptoms (as described in the previous section) appear, immediate medical attention is necessary. As symptoms improve, a gradual return to normal activities is typically recommended.