Risk Factors For Post
On a , Dr. Bert Vargas, Director of Sports Neurology and Concussion Program at UT Southwestern Medical Center, shared that over 90% of individuals experience a headache after a traumatic brain injury. Fortunately, that doesnt mean that everyone will experience post-traumatic headache, or a headache that develops within seven days of an injury or after regaining consciousness, after an injury. Risk factors, such as being female, having pre-existing migraine or a family history of migraine, make an individual more susceptible to developing post-traumatic headache.
Sleep Issues After Concussion
A concussion can change how well you sleep.
You might find that it is hard to get a good nights sleep. You might have trouble falling asleep or staying asleep. Sleeping for too long during the day might be a problem.
Other factors such as pain, worrying, medications, mood or other medical conditions can also affect sleep.
It is important to try and get a good nights sleep after a concussion. Sleep helps the brain recover and helps you feel well when you wake up. A good routine for sleep, or what is called Sleep Hygiene, can be very helpful.
Is It Safe To Sleep With A Concussion
Although sleeping after a concussion is considered safe, it is more difficult to assess a persons symptoms when they are asleep. For the first few nights, healthcare professionals may advise family members to wake up the concussed person every few hours. They can conduct simple tests by asking easy questions, watching for unusual behavior, and shining a light to see if the pupils are the same size and responsive to light. These tests are designed to alert caregivers of any worrying developments.
However, waking someone up every few hours can disrupt sleep, and sleep is extremely important while recovering from a concussion. Depending on the severity of your concussion, your doctor may advise an adult family member to stay with you while you sleep, but not wake you up.
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Concussions: Can They Lead To Sleep Disorders
They may not even mention head injuries to the doctors they visit regarding their sleep problems. And doctors may not take into account previous head injuries when interviewing them regarding their current sleep issues.
However, research continues to draw linkages between brain injuries and sleep disorders.
Food Activities And Lifestyle
- Do not drink caffeine or alcohol or eat heavy meals 4-6 hours before bedtime. It can make it hard to fall asleep or wake you up in the middle of the night. Eating a small bedtime snack with protein before you go to bed can help.
- Make sure you have enough vitamins and minerals in your diet.
- Get enough natural light during the day.
- Try to exercise 30-60 minutes a day if you feel well enough. Do not exercise right before bedtime. Talk to your doctor or health care provider before starting to exercise.
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Can Someone Recover From A Brain Bleed
Dr. Wiles: Recovery is very dependent on location of the bleeding within the brain, the size of the bleeding and the general health of the patient prior to the stroke. Some recovery can be a matter of a few days, and others can take months. In general, healing of the complex function of the brain can be a slow process.
The Link Between Insomnia And Concussions
Insomnia is one of the most commonly reported symptoms after a concussion. Approximately 30-70% of concussed individuals report sleep disturbances following an injury. These sleep disturbances are often categorized as either excessive sleepiness during the day, insomnia, or feeling unrefreshed when waking up in the morning. Overall, 40-65% of the individuals who have sustained concussion are experiencing insomnia.
What Is Insomnia?
Those who are suffering from insomnia, tend to experience one or several of the following symptoms: poor sleep quantity or quality, delayed sleep onset, nocturnal awakening, early rising, or failing to feel rested regardless of having a full night of sleep. In order to receive a diagnosis of insomnia, the individual must be experiencing these symptoms to such an extent that it is causing distress or impairment during waking and sleeping hours.
Is Insomnia Experienced Immediately or Gradually?
Researchers have noted that there is often a gradual shift from hypersomnia to insomnia. Shortly after sustaining a concussion, individuals report feeling overly sleepy and requiring naps throughout the day. However, 2-3 weeks following the head trauma, they report experiences that are more characteristic of insomnia: having trouble sleeping and waking up earlier than desired. Interestingly, despite persistent reports of sleep disturbances following a concussion, changes in sleep behaviour are often overlooked in the concussion recovery process.
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Why Sleep Problems Can Occur After A Brain Injury
A Brain Injury causes dysregulation within the brain, resulting in sleep disturbance. You may feel extraordinarily tired if your brain injury affects your ability to fall asleep or disrupts your customary sleep/wake cycle. This is a common complaint, because sleep patterns are fragile and can easily be affected by injury to the brain. You may notice that in the first four to six weeks following injury, pain and other symptoms may play havoc with two key facets of sleep: sleep initiation and sleep maintenance . Often, people with a traumatic brain injury awaken several times each night for no apparent reason. Their sleep patterns may appear inverted, because they sleep more during the day and less at night.
Common Sleep Syndromes Include:
- Restless Leg Syndrome : Urge to move the legs because they feel uncomfortable, especially at night or when lying down.
- Bruxism: Grinding or clenching teeth.
- Sleep Apnea: Brief pauses in breathing during sleep, resulting in reduced oxygen flow to the brain and causing loud snoring and frequent awakening.
- Periodic limb movement disorder : Involuntary movement of legs and arms during sleep.
- Sleepwalking: Walking or performing other activities while sleeping and not being aware of it.
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What Is Brain Injury
For me, prior to my first concussion, I slept soundly for six hours a night and had great dreams. I never woke up during that time and always awakened alert and refreshed. After my first brain injury, a concussion, I would sleep for 19 hours and wake up groggy and disoriented. It would take me almost an hour to get focused. With the use of neurofeedback, cranial electro stimulation , and changes to my diet, my sleep cycle once again provided restorative sleep. That is until I had a subsequent concussion. Each new concussion threw off my sleep cycle again, but I am now able to go to bed at 1:00 a.m. and wake up refreshed at 8:00 a.m. My mother, who sustained three concussions, used to be up all night and sleep all day. However, after I introduced her to a cranial electro stimulation, through use of a CES device, she was able to re-regulate her brain and resume a normal sleep schedule. So too for my middle son, who sustained a brain injury from an auto accident. He too had awful sleep problems until I introduced him to both neurofeedback and a CES device.
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Conventional Treatments For Sleep Problems
There are two conventional medical avenues to treat sleep disturbances. The first is behavioral and/or environmental intervention, which includes the following:
- Chronotherapy, or stabilized time of waking. It is important to go to bed and wake up at the same time each day.
- Reduction of or avoidance of caffeine and alcohol.
- Elimination of tobacco.
- Eating a higher protein diet while eliminating sugar, artificial sweeteners, and processed foods.
- Environmental controls such as turning off lights and minimizing background noises.
- Regular exercise however, do not work out within four hours of your bedtime.
- Limited time in bed by not watching TV in the bedroom.
- Napping, or not napping. Recent research shows that a 90-minute nap during the day promotes restorative sleep at night. It is recommended that you discuss this with your doctor.
- Selection of the proper bed, pillow, and mattress for the promotion of restorative sleep.
- Psychotherapy specifically, Cognitive Behavioral Therapy to learn new cognitive approaches to sleeping and daily living and/or Trauma Therapy to minimize the effect of PTSD.
The second conventional approach to correcting sleep disturbances is pharmacological treatment. The following substances can help if taken on a limited, short-term basis and under your doctors supervision:
Clinical Features & Diagnosis
Sleep disturbance is a common complaint following head injury, with milder injuries more likely to disrupt sleep than more severe head trauma. Mahmood et al postulate that this may be due to multiple factors such that those with more severe head injuries are less aware of their deficits and may underreport sleep issues. In addition, those with mild TBI may over-endorse sleep complaints or may have greater pressures to reintegrate into their daily life more quickly leading to increased stress and sleep issues. Lastly, neurobiological differences between mild and severe injuries may lead to more sleep complaints in mild TBI. A common pattern following TBI includes difficulties initiating and maintaining sleep, with or without concomitant daytime sleepiness. A large epidemiological study showed that up to half of those suffering TBI endorsed insomnia symptoms of some type. Causation can be due to diverse clinical and other factors such as: pain, injury to sleep/wake regulatory nuclei and pathways in the brain , post-traumatic stress disorder, maladaptive behaviors or other factors preventing the occurrence of sleep.
Head trauma occasionally triggers parasomnias, including sleepwalking, sleep terrors, REM sleep behavior disorder and dissociative disorders. These studies indicate that TBI can precipitate almost every sleep disorder, which emphasizes the importance of careful history taking and physical examination when diagnosing sleep disturbance in this patient population.
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When To See A Doctor
It may take several days before you begin to feel better after a concussion, but its never a bad idea to get your healthcare providers advice if you have any concerns about your recovery time.
Symptoms that linger for more than a few weeks can indicate post-concussion syndrome. This is rare if youve never had a concussion before, but youll want to see your provider for symptoms that persist for more than a week.
Concussions are typically mild, but they can occasionally cause more serious complications. Its important to monitor signs and symptoms for the first day or two after a head injury.
What Are The Chances Of Surviving A Brain Bleed
About 30% to 60% of people with an intracerebral hemorrhage die. In those who survive long enough to reach an emergency room, bleeding usually has stopped by the time they are seen by a doctor. Many people with ruptured aneurysms or subarachnoid hemorrhages also do not survive long enough to reach a hospital.
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Signs You May Have A Concussion
Concussion symptoms vary, and you can have a concussion even if you do not lose consciousness. Common symptoms of a concussion include:
- Mood swings
Concussion symptoms specific to sleep include:
- Feeling sleepy during the day
- Trouble falling asleep at night
- Not sleeping as much as usual
- Sleeping more than you usually do
These symptoms might not show up right away. If you suspect you might have a concussion, it is very important to seek medical help, rest, and avoid activities that could cause another concussion before you are healed. People with more serious symptoms, such as seizures, vomiting, trouble staying conscious, a severe headache, an unusually aggressive attitude, or tingling sensations or weakness in the limbs, should visit the emergency room.
Veterans & Service Members
Clinical trial for veterans and active-duty military members with insomnia
Military service members and veterans sometimes struggle with insomnia after coming home. Luckily, cognitive behavioral therapy is a common treatment that can help. But in-person sessions arent always feasible, especially now with COVID-19 restrictions. The Center for Neuroscience and Regenerative Medicine is testing a CBT-I app that was made specifically for military personnel with a history of head injury. This online study is open for enrollment and needs volunteers. Interested? Contact us at or call/text 301-456-5474. For more information, see our blog post about this study.
New Concussion Alliance resource, Sleep and Sleep Problems after concussion
To learn why sleep is challenging after a concussion, and why it is crucial for concussion recovery, see our new resource page Sleep and Sleep Problems. The page covers:
the role of sleep in maintaining health
causes of sleep disturbances after concussion
concussion-related sleep disorders
how sleep difficulties can influence the number of days to concussion recovery
sleep hygiene tips
when to see a specialist, and how to find a sleep specialist
Persistent post-concussion symptoms, TBI history predictive of intimate partner violence perpetration among veterans
See our blog post to read this synopsis.
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Considerations In Using Traditional And Novel Sleep Technologies In Clinical Settings
In answering the question regarding the types of sleep measures available to neurologists, there exist a number of both of low-tech and high-tech options. Traditional pencil-and-paper sleep measures provide several benefits to clinicians. Although the majority of standard sleep measures do not provide continuous monitoring of sleep behavior, the measures described above can provide a good overview of clinical sleep symptoms and can alert clinicians to any serious sleep disturbances at an initial intake appointment. If a clinician sees a patient on several occasions, most measures, such as the ESS and ISI, can be readministered to track symptoms or posttreatment outcomes over time. Moreover, for those who wish to address sleep specifically but are new to sleep assessment, most of the previously mentioned traditional sleep measures are user-friendly and easy to obtain from the publisher’s Web site at little to no cost. Finally, for those who have concerns regarding the burden of administering self-report questionnaires to a concussed population, most pencil-and-paper questionnaires are short and quick to complete. As an added benefit to the clinician, these assessments are equally as simple to score and scores are often easy to interpret in terms of assessing clinical severity of symptoms.
Which Measures To Use
In conducting a sleep evaluation, neurologists might ask themselves the following questions: What types of sleep issues is the individual reporting? How long has he or she been reporting sleep issues? Have the reported symptoms changed over the course of treatment? Would it be useful or feasible to monitor this individual’s sleep habits over time? For example, if a person responds to I’m sleeping more than usual on the ImPACT, a follow-up with assessment of daytime sleepiness as well as nighttime patterns would be indicated. Alternatively, if a person indicates that he or she has difficulty falling asleep at night but takes many naps throughout the day, a clinician may choose to implement a sleep and rest diary or daytime activity monitoring to measure daytime vs nighttime sleep behavior.
In addition to a patient’s reported sleep symptoms, neurologists may also take practical considerations into account when choosing how to monitor sleep behavior: Will you see the patient once or will he or she return for follow-up appointments? How much time will you have to assess sleep during each individual appointment? How much time will you or an additional clinician have to score or interpret sleep data? Are free or low-cost measures preferred or are more expensive, high-tech options available to you or the patient?
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Sensitivity To Light And Noise
Another common symptom is sensitivity to light and noise. Painful light sensitivity, otherwise known as photophobia, may present in up to forty-three percent of patients after a traumatic brain injury. If individuals have other risk factors, their rate of photophobia might be higher. Individuals at risk include patients who participate in high-contact sports, activities, and professions. The risk may also increase for those who have had multiple head injuries. The most notable statistic is that between sixty and seventy-five percent of soldiers who had blast-related concussions report light sensitivity. This indicates veterans have one of the highest risks of light sensitivity after a concussion. Noise sensitivity is common following a concussion, but it’s unusual for the sensitivity to last for a prolonged period. Sensitivity to noise is often paired with tinnitus.
Continue to reveal more post-concussion syndrome symptoms now.
Tips For Better Sleep After A Concussion
The following recommendations are intended to help your child sleep once they are past the first few days or weeks after a concussion. If your childs healthcare provider has recommended cognitive rest immediately after injury, please discuss how you should manage their sleep during that time. Discuss the following tips with your child:
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Warning Signs Of Post
Post-concussion syndrome occurs when an individual has symptoms for a significant period, such as weeks or months, after a concussion-causing injury. A concussion is the mildest form of traumatic brain injury. It might also occur when an individual shakes their head violently. There doesn’t appear to be a correlation between the injury’s severity and the risk of post-concussion syndrome. This means individuals can still get post-concussion syndrome even if they didn’t lose consciousness due to the injury. The symptoms tend to start seven to ten days after the injury, and they subside within three months. There are rare cases where symptoms persist for more than a year.
Get the details on the major symptoms of post-concussion syndrome now.