From the Guidelines
After a concussion, it is generally safe to allow a person to sleep, as sleep is beneficial for recovery and helps the brain heal. The outdated belief that patients must be kept awake is no longer supported by current evidence 1. However, during the first 24 hours after injury, it's advisable to check on the person periodically if they're sleeping to ensure they can be awakened normally and aren't showing signs of a more serious brain injury. These concerning signs include:
- Difficulty waking up
- Confusion upon waking
- Worsening headache
- Repeated vomiting
- Slurred speech
- Seizures
- Weakness or numbness in limbs
- Dilated pupils If the person lives alone, having someone stay with them for the first night is recommended. The recommendation to allow sleep reflects our current understanding that rest, including adequate sleep, is a cornerstone of concussion recovery. The brain needs time to heal, and forcing someone to stay awake can actually impede recovery by increasing symptoms and prolonging healing time. If you're concerned about the severity of the injury, seek medical attention before allowing the person to sleep. According to the most recent and highest quality study, sleep is actually beneficial for recovery from a concussion 1.
The provided evidence from the American Academy of Pediatrics 1 focuses on cognitive rest, which is also an important aspect of concussion recovery, but it does not directly address the question of sleep. However, the more recent studies 1 provide a clearer understanding of the role of sleep in concussion recovery, and they all support the idea that sleep is beneficial. Therefore, based on the most recent and highest quality evidence, allowing a person to sleep after a concussion is the recommended course of action.
From the Research
Sleep Post Concussion
- There is limited direct evidence on whether to keep a patient awake or let them sleep post concussion.
- A study on concussion evaluation and management 2 mentions sleep disturbance as a common symptom, but does not provide guidance on sleep post concussion.
- Another study on cognitive behavioral therapy for insomnia in individuals with concussion 3 suggests that improving sleep outcomes can be beneficial for reducing postconcussion symptoms, but does not address the immediate post concussion period.
- A review of cognitive rest versus rehabilitation after sports concussion 4 recommends cognitive rest for patients with acute sports concussion, but does not provide specific guidance on sleep.
- A study on clinical guidelines and the certainty of evidence 5 discusses the importance of evidence-based recommendations, but does not provide direct evidence on sleep post concussion.
- A study on pharmacotherapy for treatment of cognitive and neuropsychiatric symptoms after mild TBI 6 does not address sleep post concussion directly, but highlights the need for more research on treatment options for mild TBI.
Cognitive Rest and Rehabilitation
- The study on return to learn 4 suggests that the optimal cognitive load for patients after sports concussion is yet to be determined, and additional controlled trials of cognitive rehabilitation are needed.
- The study on cognitive behavioral therapy for insomnia 3 provides some evidence for the benefits of cognitive behavioral therapy in improving sleep outcomes and reducing postconcussion symptoms.
Treatment of Postconcussion Symptoms
- The study on pharmacotherapy for treatment of cognitive and neuropsychiatric symptoms after mild TBI 6 provides some evidence for the safety and possible efficacy of pharmacotherapies, such as methylphenidate and sertraline, in treating mild TBI-related cognitive dysfunction and postinjury depression.
- The study on concussion evaluation and management 2 outlines the common symptoms of concussion, including headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues, but does not provide specific guidance on treatment.