A concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull, disrupting normal brain function and leading to temporary chemical and cellular changes. For decades, the common advice after a head injury was to avoid sleep, creating widespread confusion that persists today. Current medical consensus clarifies that sleep is generally safe and beneficial, but this advice comes with important qualifications regarding immediate monitoring and specific danger signs.
The Origin of the Sleep Myth
The historical warning against sleeping was rooted in the fear of severe, life-threatening complications, primarily intracranial hemorrhage (bleeding inside the skull), such as a subdural or epidural hematoma. These bleeds expand slowly, increasing pressure on the brain and leading to a rapid decline in consciousness.
Before advanced diagnostic tools like computed tomography (CT) scans were widely accessible, forced wakefulness served as a crude monitoring method. Caregivers kept the person awake to ensure they did not slip into a coma due to a worsening brain bleed. If a person could not be roused, it signaled a progression of injury requiring immediate intervention.
Modern medicine has largely abandoned this practice because lack of sleep is counterproductive to healing. The danger was never the sleep itself, but the possibility that a worsening, unrecognized internal injury could be masked. Today, improved imaging technology allows doctors to quickly assess the risk of a bleed, making the forced wakefulness rule outdated.
Current Medical Advice on Sleeping
The modern medical consensus is that sleep is not only safe but also an essential component of concussion recovery. Rest, particularly sleep, allows the brain to conserve energy needed to restore the metabolic balance disrupted by the injury. The brain uses sleep to perform restorative functions, including clearing metabolic byproducts and regulating neurotransmitters.
Forcing a person to stay awake can increase stress and fatigue, which may worsen concussion symptoms like headache and confusion. Instead of forced wakefulness, the focus has shifted to structured monitoring during the initial hours after the injury. A responsible adult should check on the person periodically, perhaps every few hours, to ensure they can be easily awakened and are oriented.
If an initial medical evaluation has ruled out a serious bleed, the injured person should be allowed to sleep. Sleep allows the brain to begin the repair process by reducing inflammation and promoting the restoration of damaged neural pathways. Waking someone up only needs to be done a few times for monitoring, not every hour, to avoid excessive sleep disruption.
Urgent Symptoms Requiring Immediate Care
While sleep is generally safe, certain “red flag” symptoms indicate a potentially more severe brain injury, such as a hemorrhage, and require immediate emergency medical attention. These signs suggest increased pressure inside the skull. If a person displays any of these symptoms, they should be taken to the emergency room immediately before being allowed to sleep.
A headache that becomes progressively worse, rather than remaining stable or improving, is a serious warning sign. Repeated or forceful vomiting, especially multiple episodes, also requires immediate care. Any seizure or convulsion that occurs after the injury is a clear indication of a more complex neurological problem.
Other symptoms include significant drowsiness where the person cannot be easily awakened or excessive confusion, restlessness, or agitation. Physical signs such as slurred speech, weakness or numbness in the arms or legs, or any noticeable difference in pupil size also require attention. Clear fluid draining from the ear or nose could indicate a skull fracture and requires urgent care.
Managing Sleep During Early Recovery
Optimizing sleep quality is a practical next step for supporting the brain’s recovery once the immediate danger has passed. The recovery process benefits from a consistent sleep schedule, even on weekends, which helps regulate the body’s sleep-wake cycle, or circadian rhythm. Keeping a consistent bedtime and wake-up time signals to the brain that it is time to rest.
Creating an ideal sleep environment is also helpful, meaning the bedroom should be dark, quiet, and cool. It is advisable to avoid stimulating activities, such as using computers, phones, or television screens, for at least an hour before bedtime. The blue light emitted by these devices can suppress melatonin production, interfering with the process of falling asleep.
Patients should avoid using alcohol, sedatives, or non-prescribed sleep aids, as these substances can interfere with the brain’s healing process or mask deteriorating symptoms. If a person cannot fall asleep within about 20 to 30 minutes, they should get out of bed and do a quiet, relaxing activity until they feel sleepy again. Short, structured naps of 20 to 30 minutes may be appropriate in the first few days if they do not disrupt nighttime sleep.