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How long should you stay awake after a mild traumatic brain injury/concussion? — Dr. Mark Heisig
How long do you need to stay awake after a concussion? Should you be woken up throughout the night?
How long should you stay awake after a mild traumatic brain injury/concussion?
How long should you stay awake after a mild traumatic brain injury/concussion? How long do you need to stay awake after a concussion? Should you be woken up throughout the night?
FOR FOLKS IN A PINCH, HERE'S THE QUICK ANSWER:Do not allow the athlete (or concussed individual) to sleep for at least 3 hours after the injury.May not need to wake the athlete throughout the night, but monitoring them throughout the night is prudent.
The 2019 CCMI Clinician Course recommends that the athlete/concussed individual is checked on throughout the night and only woken if there are concerns about breathing or their overall state. They also remind that the athlete will likely be fatigued due to the growing ATP deficit, per normal concussion pathophysiology.
2004 NATA guidelines recommend waking the athlete throughout the night (every 3-4 hours) only if they had experienced a loss of consciousness, had/have prolonged memory loss, or are still experiencing significant symptoms.
In 2006, concussion researchers, Drs. John Leddy and Bary Willer echoed the NATA recommendations from 2004.
Why are there sleep concerns acutely after a concussion?
Ultimately, we don't want to miss a life-threatening issue (e.g., intracranial hemorrhage or cerebral edema) because our athlete slept through it.
Your doctor, athletic trainer, or concussion specialist on the sidelines or in the ER will be considering a set of "rules" to determine if a head CT is needed. These are the Candian CT Head Rule and the New Orlean's Criteria. The Candian CT Head Rule is likely superior and includes:Glasgow Coma Score <15 after 2hrs
Suspected skull facture
Signs of basal skull fracture
Two or more episodes of vomiting65yo or older
Memory loss before the impact by more than 30min
Dangerous injury mechanism
The bolded signs/symptoms are strong predictors of finding anatomical changes on the CT.
Signs of a skull fracture include bruising behind the ears (Battle sign), two black eyes (raccoon eyes), blood behind the eardrum, or clear fluid coming from the nose or ears.A "dangerous mechanism" includes a pedestrian being struck by a vehicle, being ejected from a vehicle, falling from a height of 3ft or more, or falling 5+ stairs.
Everyone made it through the first night. What's next?
It is crucial to be evaluated or re-evaluated by a concussion specialist EARLY after a concussion. For example, the NCAA and professional organizations re-evaluate their athletes within 24-48hrs following concussion to confirm the diagnosis and begin integrative treatments.
A 2020 pediatric concussion study found that the time an individual sees a doctor after a concussion can make a MASSIVE difference in their recovery times. For example, in this study:Normal recovery youths saw their doctors, on average, at day 4 and recovered on day 20.Delayed recovery youths saw their doctors, on average, at day 8 and recovered on day 77.
That's a 57 day (almost two months) recovery delay because of a four-day (less than a business week) delay in seeking medical care.
Seeking a concussion specialist early after your concussion can save you a lot of time, money, and suffering of symptoms.
Sleep after an acute concussion summary.Remember, we're not allowing the athlete (or concussed) individual to sleep for at least 3 hours after their injury. We're looking to be sure that they're not declining in this period, outside of the expected fatigue.There are guidelines for which injured patients are candidates for head and brain imaging, and your doctor, trainer, or concussion specialist should be aware of these.During the night of the concussion, do monitor and check on the injured individual periodically. However, you do not need to wake them unless you're concerned about their breathing or overall state. 2004-2006 guidelines recommend waking every 3-4 hours if there was a loss of consciousness, prolonged amnesia, or significant and sustained symptoms.Following the first night, schedule a visit with a concussion specialist within the next 24-48hrs. This visit is essential for confirming the diagnosis, ruling out more severe problems, and beginning the recovery process ASAP.
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.
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Concussions and Sleep: A Dangerous Mix?
Learn whether or not it's safe to sleep right after a concussion. We'll also go over the ways that a concussion might impact your sleep as you recover.
Sleeping After a Concussion: What You Should Know
Medically reviewed by Heidi Moawad, M.D. — Written by Crystal Raypole on June 14, 2019
If you’ve ever had a head injury or suspected concussion, you may have been warned to stay awake for several hours or to have someone wake you up every hour. This advice stemmed from the belief that falling asleep with a concussion could lead to coma and even death.
Sleeping cannot cause serious problems after a concussion. The danger is that when you are asleep, your family or your doctors are not likely to notice indications of serious brain damage — such as a seizure or weakness of one side of the body.
But is it really necessary to deny yourself sleep following a concussion? In most cases, no. Still, if you have certain symptoms, it’s best to avoid sleeping until you can see a healthcare provider.
Read on to learn more about concussions and sleep, including how to deal with the sleep disturbances that sometimes follow a concussion.
When it’s safe to sleep
You may have a range of symptoms after mild head trauma, but current medical advice supports getting rest and sleep after a concussion as long as:
you can carry on a conversation
you can walk without difficulty
your pupils aren’t dilated
In fact, experts now recognize rest as an essential part of recovering from a mild head injury, especially during the first three to five days.
But if you don’t fit this criteria, see your healthcare provider right away. Even without any symptoms of a serious concussion, it’s best to err on the side of caution. Children in particular should see a doctor within two days of any head injury other than a mild bump.
If you have a more serious concussion, your healthcare provider may recommend having someone wake you up periodically, but this generally only needs to be done a few times — not every hour.
How a concussion might affect your sleep
When you have a concussion, you may feel more tired than usual or need to take brief naps throughout the day. A concussion can also affect your sleep in other ways.
Common sleep issues with concussion include:
trouble falling asleep
trouble staying asleep
feeling tired during the day
These sleep issues generally improve as your injury heals, though this can take up to a few weeks. If you’re still experiencing sleep issues a few weeks after a concussion, talk to your healthcare provider.
To improve your sleep, try these tips:
Keep a regular sleep schedule by going to bed and getting up around the same time each day.
Make sure you’re getting at least the recommended amount of sleep. Keep in mind you might need more sleep while recovering.
Relax before bed with quiet activities, like taking a bath or listening to relaxing music.
Make sure your bedroom is dark and quiet. Keeping your room fairly cool can also promote restful sleep.
Avoid using electronics or bright lights for at least an hour before going to sleep.
Avoid naps if possible, especially in the afternoon.
Other recovery tips
Following a concussion, there are several things you can do to ensure you make a smooth recovery.
Stick to light activity
Walking is generally fine if you feel well enough and it doesn’t make your symptoms worse. But you’ll want to take a break from any activity that raises your heart rate until your healthcare provider approves returning to moderate or intense exercise, such as running or cycling.
You’ll also want to avoid driving for a full day after a concussion. If your symptoms still haven’t improved, you may want to avoid driving even longer. Head injuries can delay your reaction speed, so you may be more likely to have an accident while you are still recovering from a concussion.
You may want to take a day or two off from work or school. If this isn’t possible, consider working shorter days until you begin to recover.
Let your brain rest
School or work tasks that require focus and concentration may be somewhat difficult with a concussion. And trying to work before you’re ready could even make your symptoms worse.
In the first 24 hours after a concussion, you may want to avoid the following activities as much as possible:
television or video games
computer use homework
reading for work or leisure
texting or using a smartphone
If you can’t avoid these activities, taking frequent breaks may help keep you from overstimulating your brain.
Avoid certain medications
If you have significant head pain and are considering taking over-the-counter medication, talk to your healthcare provider first.
Medications containing aspirin, ibuprofen, or naproxen could increase your risk of brain bleeding if you have a more severe concussion. In these cases, acetaminophen (Tylenol) may be a safer option.
If you do take pain relievers, make sure you don’t push yourself too hard. The temporary relief could make you feel good enough that you’ll want to return to your usual activities before you’ve fully recovered.
When to see a doctor
It may take several days before you begin to feel better after a concussion, but it’s never a bad idea to get your healthcare provider’s advice if you have any concerns about your recovery time.
Concussions and Sleep: Is It Safe or Risky?
Is it OK to fall asleep after a concussion? Learn whether it’s safe, how concussions affect sleep, and how to get rest.
BRAIN & NERVOUS SYSTEM HEAD TRAUMA CONCUSSIONS
Is It Safe to Sleep After a Concussion?
By Adrienne Dellwo Published on July 06, 2021
Medically reviewed by Nicholas R. Metrus, MD
Table of Contents VIEW ALL
What Is a Concussion?
When Can You Sleep After a Concussion?
Tips for Getting Rest After a Concussion
When to See a Doctor
It’s common advice that you should not go to sleep if you have had a concussion. You may also have heard that you should wake up someone with a concussion every hour to check on them. But are those things true, or is it OK to sleep with a concussion?
Doctors say not allowing someone to fall asleep after a concussion and needing to wake someone hourly after one are myths. However, surveys have shown that many people still believe you should stay awake for 24 hours after hitting your head.1 In reality, sleep may be the best remedy.
What Is a Concussion?
A concussion is a traumatic brain injury (TBI). When you take a blow to the head—from a fall, a hit, or being whipped back and forth in a car accident—your brain moves suddenly inside your skull, and it can actually twist or bounce around.
That kind of trauma stretches and changes neurons (types of brain cells) and can lead to disruptions in brain chemicals (neurotransmitters) that make it hard for your neurons to communicate with each other.2
The Dangers of Repeat Concussions
A single concussion rarely causes permanent brain damage, but a second one soon after can be disabling, even if it’s not a strong concussion.3
As far as TBI goes, concussions are considered mild. That’s primarily because they’re rarely life-threatening. Even so, they should always be considered a serious medical event because they cause an immediate, but temporary, change in mental status or level of consciousness.3
Common symptoms of a concussion are:4
Headache Nausea or vomiting Confusion
Temporary loss of consciousness
Blurred or double vision
Ringing in the ears (tinnitus)
Noise or light sensitivity
Irritability or anxiety
Feeling “off” or “not right”
Attention or memory problems
Serious Effects of Mild Concussions
When Can You Sleep After a Concussion?
The concern about sleeping after you get a concussion comes from the belief that while you are asleep, you could slip into a coma or die. Sleeping itself can’t cause those things to happen, but it’s also impossible for anyone to notice signs of serious brain damage while you’re asleep.
So, while sleeping isn’t necessarily dangerous, it’s probably best to get medical attention before heading to bed for the night. That way, you’ll know for certain whether you have a concussion or if it could be something more serious.
Some doctors say you can let a potentially concussed person fall sleep if they are awake and able to hold a conversation and are not showing signs of a concussion, such as dilated pupils or trouble walking.5
Others say you should get them checked out before letting them sleep, and some also recommend checking in a few times overnight to see if they’re breathing regularly, which doesn’t require waking them up.6
Concussions can cause some symptoms that are directly related to sleep. It’s common for someone with a concussion to feel tired or have a hard time staying awake within minutes of the injury, and symptoms may linger while they recover.
Other symptoms may take a few days to show up or become apparent. One of those potential symptoms is a change in sleep patterns. Some people, after a concussion, will sleep a lot more than usual, and it may be hard to wake them up. Others may have a hard time falling asleep at all, or they may wake up frequently.7
If you can’t rouse someone from sleep after a head injury, it could be a sign of something serious. Get immediate medical attention.
Tips for Getting Rest After a Concussion
Verywell / Mayya Agapova
Sleep is an important part of the healing process, so you should get plenty of rest after a concussion. However, after headaches, sleep problems are the most commonly reported symptoms of a concussion.
If you have sleep issues that linger after the first few days of healing, you may want to try the following to get better sleep:7
Keep a consistent schedule, even on days off.
Have a bedtime routine that helps you relax.
Set aside at least eight hours to sleep each night.
If you’re not sleepy at bedtime, do something relaxing.
Avoid naps or keep them short and early in the day so they don’t interfere with sleeping that night.
Avoid caffeine, especially late in the day.
Don’t use electronics right before bed or in the bedroom.
If your sleep problems don’t go away within a few weeks of the concussion, be sure to talk to your doctor about it.
When to See a Doctor
After any head injury, especially in a child or someone who’s had prior concussions, it’s a good idea to get checked out by a medical professional. If symptoms are absent or mild, you may want to go to urgent care or see if you can get an appointment with your regular doctor that day. Symptoms that are more serious warrant a trip to the emergency room.