Sleep After Concussion: Why You're Tired and What Can Help
I can't fall asleep. I can't stay asleep. I'm so tired all the time. I feel like a zombie.
If this sounds familiar, you're not alone. Sleep disturbances are among the most common issues reported after concussion.
Sleep problems can include:
Difficulty falling asleep
Difficulty staying asleep
Sleeping less than usual
Sleeping more than usual
Excessive daytime fatigue
Research suggests that sleep problems following brain injury may be associated with poorer recovery, cognitive difficulties, and reduced productivity.
Why Does Concussion Affect Sleep?
One factor that influences our sleep-wake cycle is melatonin, a hormone produced by the brain that normally increases during the evening and overnight.
Melatonin helps regulate sleep onset and supports healthy sleep patterns, including REM sleep.
Light and Melatonin
Melatonin production is inhibited by light. This includes both:
Natural light
Artificial indoor lighting
Blue light from phones, computers, and other electronics
Research has found that people following traumatic brain injury may have lower evening melatonin production compared with people of the same age without a brain injury. Lower melatonin production has also been associated with reduced REM sleep.
How Can I Improve My Sleep After a Concussion?
Because sleep disturbances are common following concussion—and adequate sleep is important for recovery—creating healthy sleep habits can be an important part of your recovery.
Sleep Hygiene Tips
Give yourself enough time to sleep.
Allow adequate time for sleep rather than consistently cutting your sleep window short.
Create a wind-down routine.
Set aside approximately an hour before bed for quiet, relaxing activities.
Limit naps.
If you need to nap during the day, keep naps relatively short—around 30 minutes.
Limit caffeine to the morning.
Avoid alcohol.
Alcohol can interfere with your ability to stay asleep.
Avoid large meals close to bedtime.
Get natural daylight during the day.
Regular exposure to natural daylight helps your body distinguish between daytime and nighttime.
Stay physically active as appropriate for your recovery.
Regular exercise can support healthy sleep, but activity should be appropriate for your individual concussion recovery plan.
Reduce screen exposure before bed.
Try limiting phones, television, computers, and other bright screens during the hour before bedtime.
Stay hydrated.
Keep your bedroom cool and dark.
Consider white noise if background noise makes it difficult to sleep.
If you can't sleep, get up.
Try a quiet, relaxing activity and return to bed when you feel sleepy. Keep lighting low and avoid stimulating screens.
When Should I Talk to a Concussion Specialist About Sleep?
Persistent sleep problems can affect energy, concentration, mood, and overall recovery. If sleep difficulties continue after a concussion or are interfering with your daily life, talk with your healthcare provider about your symptoms.
At Colorado Concussion Clinic, sleep concerns can be considered as part of a comprehensive evaluation of persistent concussion symptoms.
References:
Grima NA, Rajaratnam SM, Mansfield D, et al. Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomized controlled trial. BMC Med. 2018;16:8.
Kostyun RO, Milewski MD, Hafeez I. Sleep Disturbance and Neurocognitive Function During the Recovery From a Sport-Related Concussion in Adolescents. The American Journal of Sports Medicine. 2014;43(3):633-640.
Shekleton JA, Parcell DL, Redman JR, et al. Sleep disturbance and melatonin levels following traumatic brain injury. Neurology. 2010;74:1732-1738.
Medical Disclaimer: This content is intended for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Concussion recovery is highly individualized. Please consult a qualified healthcare professional about your specific symptoms and treatment needs.