A concussion is a mild form of Traumatic Brain Injury (TBI) that temporarily disrupts normal brain function. This injury is extremely common, resulting from a blow to the head or an impulsive force transmitted to the brain. The question of whether to stay awake or allow rest is a primary concern for the injured person and their caregivers. Recognizing signs of a potential complication are essential for a safe recovery process.
Understanding Concussions
A concussion is a brain injury caused by a biomechanical force that results in a transient disturbance of function. The injury is functional, not structural, meaning it does not typically involve a visible bleed on standard imaging. The sudden acceleration or deceleration of the brain triggers an ionic and metabolic cascade within the brain cells, resulting in temporary energy imbalances and impaired cerebral blood flow.
Common symptoms of this functional disruption include headache, dizziness, nausea, and mental fogginess. The person may also experience sensitivity to light or noise, balance problems, or difficulty concentrating. Symptoms can manifest immediately or develop up to 72 hours following the injury. These symptoms are typical for a mild TBI.
The Crucial Question: Should You Sleep?
The belief that a person must be kept awake after a concussion is an outdated medical myth. Sleep is generally safe and beneficial for recovery, provided there are no emergency warning signs present. The brain requires significant energy to heal, and quality sleep is an important part of the recovery program. Studies suggest that people who experience sleep difficulties following a concussion may take longer to recover.
The “stay awake” instruction originated when diagnostic imaging was less accessible, requiring caregivers to monitor for severe brain injuries, such as an intracranial hemorrhage. If an injured person is awake, communicating, and has been medically assessed, they should be permitted to sleep. While a doctor may advise monitoring the patient for changes during the first night, waking the person every hour is unnecessary and disrupts the restorative process of sleep.
Sleeping immediately after an injury can delay medical attention and mask the onset of a more severe condition. If a severe injury is not ruled out, the person’s symptoms cannot be monitored while they are asleep. Therefore, the recommendation is to seek professional medical assessment first to screen for danger signs, and then allow restorative rest.
Recognizing Red Flags and When to Seek Emergency Care
Some symptoms indicate a severe injury, such as a brain bleed, requiring immediate emergency care. These “red flag” symptoms distinguish a typical concussion from a neurological emergency. A severe or worsening headache that does not subside, or repeated vomiting, warrant an immediate trip to the emergency room.
The inability to wake up, increasing drowsiness, or an inability to stay awake are serious warning signs. Seizures must be treated as a medical emergency. Other indicators of severe trauma include slurred speech, weakness, or numbness in the limbs. Unequal pupil size, where one pupil is larger than the other, is a concerning sign of pressure within the skull.
Confusion that rapidly worsens, unusual changes in behavior, or agitation are reasons to seek care immediately. If clear fluid or blood drains from the nose or ears, this may indicate a skull fracture and cerebrospinal fluid leak. Anyone exhibiting these severe symptoms needs immediate medical evaluation.
Initial Steps for Recovery and Management
Management shifts to promoting recovery, focusing on rest during the first 24 to 48 hours. This initial period of “relative rest” involves avoiding activities that significantly worsen symptoms. Physical rest means avoiding strenuous activity, heavy lifting, or actions that risk another head trauma. Cognitive rest requires limiting mentally demanding tasks and excessive screen time.
During this acute phase, the goal is to stabilize the brain’s metabolic state by minimizing exertion. Light activities of daily living, such as walking or preparing a simple meal, are permitted as tolerated, and complete isolation is discouraged. Prioritizing quality sleep, hydration, and regular, balanced meals supports the healing brain. The person should avoid alcohol and non-approved medications, as these can interfere with brain function and recovery.
After the initial 48 hours, management transitions to a gradual return to activity. The return to school, work, or sport should be managed in a step-wise fashion. Activity levels should only increase if symptoms do not significantly worsen. Patients are encouraged to start light aerobic exercise, such as walking, as tolerated, as this can speed recovery. Symptom monitoring should continue, with the understanding that a brief, mild exacerbation of symptoms during activity is sometimes normal.