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What is a Concussion? Brief Overview 

A concussion is a mild traumatic brain injury caused by a jolt, bump, or direct blow to the head. It results in changes in brain function. Not everyone who suffers a blow to the head experiences a concussion. Also, some concussions can make you lose consciousness (get knocked out), but most do not. Falls and contact sports are the two most common causes of concussions. Find out How to Know If You Have a Concussion.

Severe vs Mild Traumatic Brain Injury

Doctors classify traumatic brain injuries (TBIs) into mild, moderate, and severe based on the duration of loss of consciousness, amnesia (memory loss), and other factors. If loss of consciousness lasts 30 minutes or less, it is considered to be a mild TBI (concussion). Severe TBIs cause altered consciousness for more than 24 hours and are more likely to have long-term physical and cognitive effects. Fortunately, most traumatic brain injuries are mild. Most people make a full recovery from a concussion.

Concussions are classified into grades 1 through 5 depending on the symptoms:

• Grade 0: Headache and difficulty concentrating.

• Grade 1: Feeling dazed for less than a minute.

• Grade 2: Clouded senses for more than a minute, dizziness, vomiting, confusion, amnesia, ringing in the ears, irritability. 

• Grade 3: Loss of consciousness for less than a minute.

• Grade 4: Loss of consciousness for more than a minute.

The Risks of Sleeping With a Severe Concussion

Can You Sleep After a Concussion? Myths vs. Facts

It is a myth that sleeping after a concussion can lead to coma and death. The fact is that most people do not need to stay awake. You can sleep after a concussion after you have been to the emergency room or your doctor’s office. In fact, getting a good night’s sleep is vital to help your brain heal during recovery from a concussion. 

Why Sleep Can Be Dangerous After a Concussion

Sleep may be dangerous after a concussion because it can be more difficult to notice worsening symptoms while a concussed person is asleep. The head trauma that caused the concussion can damage brain cells and cause life-threatening complications due to a brain bleed or swelling. 

Therefore, healthcare professionals sometimes advise family members to awaken a person who has suffered a concussion every few hours for the first few nights. This allows family members to monitor the person by: 

• Asking simple questions

• Checking if their pupils are responsive and the same size

• Watching for any behavioral changes

Awakening the person every few hours alerts family members of any worrisome symptoms so they can report them to the health care provider. 

Note: Doctors don’t always recommend waking up concussion patients. This can disrupt sleep, and staying asleep with good sleep quality is important for concussion recovery. Therefore, depending on the severity of the concussion, the doctor may advise a family member to stay with the person while they sleep without waking them up every few hours.

Can You Sleep With a Grade 3 Concussion? 

Only a doctor can tell you whether you can safely sleep with a grade 3 concussion. Sleep is important for recovery, but you may need to have someone stay with you for 1-2 days and monitor your symptoms.

Concussion Protocols and Safe Sleep

What is the Concussion Protocol for Sleeping?

The concussion protocol for sleeping is to: 

• Have someone stay with you for the first 12 to 24 hours. 

• Maintain your regular sleep schedule and take extra naps during the day to help your body recover.

• Maybe have someone wake you up every few hours for 1-2 nights to monitor you for worsening symptoms if this is recommended by your healthcare professional.

When and How to Safely Fall Asleep

Depending on the severity of your concussion, your doctor may recommend that someone wake you up every few hours and ask you simple questions, such as your name, check your pupils, and watch for any changes in behavior. If you can hold a conversation while awake and have not developed any other symptoms, such as dilated pupils, your companion can let you safely fall back asleep.

When to Seek Medical Attention

Immediate Steps to Take After Suspecting a Concussion

• See a healthcare professional as soon as possible after suffering a blow to the head, even if you don’t have any symptoms and don’t require emergency care.

• Do not return to the activity that caused a concussion or other vigorous mental or physical activities. Athletes should not return to play immediately after a concussion. Your healthcare professional will supervise a gradual return to activities.

Common Symptoms of a Concussion

The various physical, cognitive, emotional, and behavioral symptoms that occur after a concussion are together called post-concussion syndrome.

Physical Symptoms of a Concussion:

• Headache

• Dizziness

• Seeing stars or appearing dazed

• Drowsiness

• Nausea

• Vomiting

• Tinnitus (ringing in the ears)

• Blurred vision

• Slurred speech

• Balance problems

• Fatigue or feeling tired

Mental Symptoms of a Concussion:

• Confusion or mental fog

• Amnesia (memory loss) about events surrounding the injury

• Forgetfulness

• Slow response to questions

• Temporary loss of consciousness (getting knocked out)

Long-Term Concussion Symptoms:

• Trouble with memory and concentration

• Personality changes such as irritability and mood swings

• Light and noise sensitivity

• Changes in taste and smell

• Trouble sleeping

• Anxiety and depression 

Sleep Problems Related to Concussions:

• Drowsiness immediately following the injury

• Sleep difficulties or insomnia for a few weeks

• Hypersomnia (excessive sleepiness) 

• Excessive daytime sleepiness

• Sleep apnea (temporary stopping of breathing during sleep)

When to Seek Emergency Care After a Head Injury

All head injuries should be evaluated by a healthcare professional. The following signs and symptoms warrant immediate attention:

• Bleeding that won’t stop

• Large bumps or bruises

• Loss of consciousness (being knocked out) for more than 30 seconds

• Repeated vomiting

• Persistent or worsening dizziness

• Severe headache or worsening headache

• Bleeding or drainage of fluid from the nose or ears

• Vision changes or changes in pupil size

• Persistent ringing in the ears

• Slurred speech

• Weakness in the limbs

• Behavioral changes

• Disorientation, confusion, or changes in mental function

• Stumbling, clumsiness, or poor balance and coordination

• Convulsions or seizures 

How Long Do Concussion Symptoms Last?

The majority of concussion symptoms are temporary and typically resolve within 10 to 14 days. However, some symptoms, such as difficulty falling asleep, can linger for weeks. It is called a persistent post-concussive syndrome when symptoms last for more than 3 months. This is more likely to occur after multiple concussions. Check out our blog to find out “How Long Does a Concussion Last?”

What is the 3 Concussion Rule?

The three-concussion rule, also called the three-strike rule, refers to a rule where an athlete who experienced three concussions in a season was out for the season. This rule was based on experience rather than scientific evidence and was followed by coaches for years.

Recent guidelines recommend complete physical and cognitive rest after a head injury. Returning to physical activities or activities that require mental effort too soon can cause worsening of symptoms and delay in concussion recovery. For athletes, return to play is recommended in a stepwise manner. If post-concussion symptoms occur, the athlete should go back to the previous level of activity and try again in 24 hours.

Post-Concussion Tips to Support Recovery and Safe Sleep 

Sleep disturbances are common after a concussion. You may feel sleepy more than usual or experience sleep problems such as insomnia. Yet, sleep is essential to support recovery from a brain injury. The following sleeping habits can promote better sleep at night and help you recover faster from a concussion:

• Maintain your usual sleeping pattern. A healthy sleep schedule involves going to bed and waking up at the same time every day.

• Sleep in a cool, dark, and quiet room.

• Develop a relaxing bedtime routine, such as a warm bath, light music, or reading.

• Limit screen time and bright lights before bedtime. Keep electronic devices such as cell phones, tablets, and other distractions out of reach.

• Avoid caffeine, alcohol, and nicotine.

• If you do not fall asleep within 20 minutes of going to bed, get out of bed and do a light, calming activity until you feel sleepy.

• Take frequent naps during the day, but make sure they don’t interfere with nighttime sleepiness.

• Talk to your healthcare provider about when it is safe to start light exercise, such as walking, which can help improve sleep after a concussion.

References:

1. https://www.sleepfoundation.org/physical-health/concussion-sleep

2. https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594#:

3. https://www.ncbi.nlm.nih.gov/books/NBK98986/table/introduction.t1/

4. https://www3.uwsp.edu/stuhealth/Documents/Other/Head%20Injury%20-%20Concussion.pdf

5. https://www.ncbi.nlm.nih.gov/books/NBK534786/#

6. https://jamanetwork.com/journals/jamaneurology/fullarticle/796113