As published on PsychologyToday.com, April 4, 2016.
Old school of thought once suggested to keep a person with a concussion awake, fearing the brain may just decide to quit during the slumber. But in fact, it’s quite the opposite.
Researchers from the University of Maryland School of Medicine believe to have found ways to develop sleep-related treatments to improve the outcome of mild traumatic brain injury (TBI). The recommendations appear online in the journal Neurotherapeutics, and point to my single best piece of advice for anyone who gets a concussion.
Sleep, or what I call “relative rest.”
Typically, half of concussed individuals will struggle with sleep disruption due to the injury, so it’s a common symptom that doesn’t get enough air time in the media. Also it is worth mentioning that insomnia can be a consequence of concussion. This may need a doctor’s intervention, which is better than using over-the-counter remedies which may worsen brain fog.
So, here’s what you need to know about sleep during the concussion recovery time period.
First, we can dispel the myth about keeping a concussed individual awake. In fact, the best and first thing to do is give the concussed brain rest. Sleep is one attribute, along with other mental rest to include in the recovery protocol. Minimize mental, and physical stimulation until the athlete is symptom free. The concept is relative rest, meaning the avoidance of any mental or physical activity that provokes the athlete’s concussion-related symptoms. Once the injured player is free of symptoms at rest, I have included a “5-Step Progressive Exertion Recovery Guide” built into my protocol that monitors symptoms, and guides the timeline for a return to practice or even classroom activities.
However, I highly recommend monitoring the first 24 hours of sleep. Watch for worsening symptoms such as breathing disruption, vomiting, and prolonged confusion and amnesia. These could signs of something other than the concussion alone. Tools like these help track the symptoms, automatically reporting them to the right medical personnel if there is cause for alarm.
The only time to wake a concussed patient is if the injury caused a loss of consciousness. In this case, wake up the individual during the night to check for signs of deteriorating mental status such as prolonged amnesia, presence of headaches, and obvious emotional changes.
Insomnia is a common post injury symptom. I recommend a temporary sleep aid. Over the counter remedies are usually made of antihistamines which are sedating for most people and help improve sleep quality. However, it is not uncommon for some people to become more alert with antihistamines worsening the insomnia. Short-term use of traditional sleep aids is appropriate in this setting. A doctor may even recommend taking imipramine, a tricyclic antidepressant, which not only helps with sleep but also can help protect against headaches and improve cognitive performance.
Post-Concussion Recovery Tips
Post-concussion symptoms typically last about 7 to 10 days, depending on how severe the concussion is and other factors. Most people get better within a week, however, that varies based on how well they adhere to the recovery protocol.
Keep these guidelines for recovering from concussion, much of which I pulled from the book “Concussion-ology” and are based the concussion management system XLNTbrain.com.
Sleep: Try to get at least 7 to 8 hours of sleep per night within the first week of sustaining a concussion.
Mental Rest: The brain needs to rest while recovering. Avoid strenuous mental activities during the first few days after sustaining a concussion to avoid provoking symptoms. Limit reading, writing, texting, using computer, and playing video games. Also avoid other visual and auditory stimulus like bright lights and loud music.
Physical Rest: Engage in no physical exercise until symptom free. Exercise adds strain on the brain, delaying the healing process.
Eat Healthy: The brain needs a nutritional diet and perhaps some nutritional supplements, such as Omega 3 fatty acids, Vitamin B Complex, Vitamin E, CoQ10, and other brain healthy supplements to enhance the healing process.
Drink Water: The brain needs water to facilitate returning to proper balance. Stay well-hydrated throughout the day.
Avoid Toxins: Drinking alcohol, and smoking never help the situation, but in this case they can really delay the healing process, even if it feels relaxing.
Unfortunately, when the brain is injured, the injury causes malfunction, with lots of possible repercussions. While concussions are a milder form of brain injury, a number of factors influence how well the brain heals and what functions may be altered. As the brain grapples to return to normalcy, it often builds alternate paths for the neural signaling to occur. Further concussion injuries would only exacerbate the problem.
Therefore, the importance of getting enough “relative rest” is key to recovery. Without rest, the brain’s overall health may be compromised, placing it at a higher risk of further concussion injuries and post-concussion related symptoms. Other factors affect how fast someone recovers, and how vulnerable they are to further complications.
Five Factors Affecting Concussion Risk and Recovery
Heredity: Genetic history of neurological disorders can be passed down. Although these genetic profiles do not automatically guarantee a future of disorder, they can have an influence. Heredity can also influence the vulnerability or susceptibility to develop neurological conditions.
Gender: A number of studies have identified that women are more vulnerable to concussion injury than men. In any sport (such as soccer) where women compete with the same rules as men, the incidence of concussion injury is greater. A variety of factors have been postulated as contributors to this phenomenon. Women have smaller neck sizes, making the head more likely to “whiplash.” About 20 percent of women suffer from migraines. And women are more likely to express concerns about their health than men.
Pre-Morbid Brain Function: Conditions such as cerebral palsy, ADD, learning disability, developmental delay or previous head trauma affect the risk and recovery time period.
History of Migraines: Individuals with a history of migraines are more vulnerable to post-concussion symptoms than those without.
Lifestyle: Brain health is also highly influenced by the individual’s present lifestyle habits. This includes nutrition, exercise, sleep, alcohol and drug and smoking, even environmental toxins from the air, water.
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Harry Kerasidis, M.D. is the founder and medical director for the sports concussion management platform XLNTbrain, LLC, based in Maryland. He is also the founder of Chesapeake Neurology Associates in Prince Frederick, Maryland and serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital.