How Sleep Affects Concussions and Overall Brain Wellness
Get a good night’s sleep. Don’t lose sleep over it. Did you sleep well? Sweet dreams! The many idioms and expressions about sleep in our culture indicate the significance of this basic, yet highly essential, function when it comes to our health. Indeed, the National Sleep Foundation explains how sleep works, why it’s fundamental to our well-being, and why sleep is critical for our physical and mental development. All this being said, it makes sense that our brain injury specialists often get asked the question: “Does a concussion affect sleep?”
Concussions: To Sleep or Not to Sleep?
It once was thought that it was critical to keep an individual awake after a head injury, in case they wouldn’t wake up after a concussion. But today that isn’t a steadfast practice. Concussions aren’t normally physical damage. They are functional injuries caused by blows or jolts to the head, and one of the main treatments is indeed cognitive rest, i.e., sleep. Provided an individual is communicating, doesn’t have dilated pupils or problems walking, sleep is fine. In fact, sleep is generally considered beneficial for healing after a concussion.
The rule still stands that within 24 hours of head injury, patients are instructed to not sleep for 6-8 hours continuously without someone waking them up, checking pupils, asking a simple question every 2-3 hours, and letting them go back to sleep. This is still the rule in case a slow bleed develops in those first 24 hours from the forces of the head injury possibly tearing a blood vessel in the brain. These 2-3 hours “neuro-checks” allow detection of a change in status that may require a trip to the ER for a CT scan of the head. A CT scan of the head does not rule out a concussion, just a bleed. This is an important fact because only a bleed can be deadly and needs immediate attention to possibly drain the bleed to avoid brain injury or death. So, if on the every 2-3 hour “neruo-checks” within 24 hours of acute head injury, the pupils are different in size, dilated, or the patient is unable to be aroused, confused, vomiting or having a severe headache, then the family is instructed to take them immediately to the local ER to get a CT scan of the head to rule out a brain bleed.
Concussions: After 24 hours
It’s thought that damage to various regions of the brain after a concussion can disrupt the sleep process, so sleep disturbances are common. Variations in sleep disturbances during the post-concussion recovery period can include someone who feels very sleepy during the first week following concussion, followed by reports of insomnia. As an example, a study of Individuals with severe traumatic brain injury published in Neurology showed an increase in sleep needs and daytime sleepiness.
Types of sleep disturbances can include:
- Hypersomnia: a condition that makes you feel excessively sleepy during the day, even after long stretches of sleep. This is also called excessive daytime sleepiness (EDS)
- Insomnia: a disorder that makes you have trouble falling or staying asleep.
- Narcolepsy: a condition where you are overwhelmed by daytime sleepiness and sudden fall asleep. It makes it difficult to stay awake for long periods of time, regardless of the circumstances.
- Sleep apnea: a disorder where breathing stops and starts repeatedly as you sleep. It can be potentially serious, and is often characterized by loud snoring and feel tired even after a full night’s sleep.
In addition, neuro-trauma can disrupt production of neurotransmitters melatonin and serotonin which can result in depression and anxiety, affecting concentration and memory.
Sleep is Critical for Brain Health and Overall Wellness
Every living creature sleeps. The Sleep Foundation says that “the ramifications of sleep deprivation offer strong support to the view that sleep doesn’t have just one biological purpose but in fact, through its complexity, is an important contributor to the proper functioning of nearly all the systems of the body.” Simply put, sleep helps us stay healthy.
Sleep Duration and Quality Impact the Brain
A fascinating recent video from Boston University lets us watch what takes place in the brain while we sleep. Following research in 2013 on how sleep helps us maintain “clean” brains by taking out neurotoxins associated with disease, the Boston University researchers took the concept a step further. They monitored the brain waves of 13 healthy individuals while they slept via encephalography and images of cleansing cerebrospinal fluid (CSF). In this video, we see how brain waves during REM and non-REM sleep triggers this incredible cleansing function.
Is There a Sleep-Dementia Link?
We all need sleep, with a basic consensus of opinion recommending between 7-9 hours a night.
A recent study by Peking University Clinical Research Institute points to an association between both too much (more than 10 hours) and too little (less than four hours) sleep and cognitive decline. Inflammation was related to excess sleep, with lack of sleep related to increased cerebrospinal fluid (CBF) levels which are associated with Alzheimer’s disease. While more research is needed to help determine the exact relationship, the study offers one more reason to take sleep seriously.
Addressing Sleep Difficulties with Better Habits
Sleep is an important part of the post-concussion recovery program, and any difficulties or changes in your sleep should be discussed with your concussion specialist, neurologist or medical provider. Even if you are not recovering from a concussion, healthy sleeping habits are important for brain wellness.
Some tips to help you sleep:
- Establish consistent bedtime and rising schedules.
- Create calming bedtime routines (listening to music, stretching, meditating).
- Avoid caffeinated beverages or heavy meals within 4-6 hours before bedtime.
- Limit naps to only once a day, if that, and making sure you take the nap before 3 p.m. and do not nap more than 30 minutes at a time.
- Aim for a dark, cool room and turning off all electronic devices. (That includes cell phones, folks!)
- Do not use tobacco in any form.
- Consume foods that help with sleep, like those with tryptophan (turkey), high in complex carbohydrates (whole grains) and contributing significant levels of vitamin B6 (milk, cheese, leafy greens and more).
- Exercise during the day.
Mac Alliance recommends various post-concussion treatments based on an individualized program, based on the patient’s diagnosis, health and medical needs. But brain rest protocol is a key factor. If you have received treatment post-concussion and are still experiencing sleep difficulties, contact your Mac Alliance provider. Our growing network of certified concussion specialists located throughout Delaware, Maryland, New Jersey, New York, Pennsylvania and Virginia are here to help.
