How long should you stay awake after a mild traumatic brain injury/concussion?
How long do you need to stay awake after a concussion? Should you be woken up throughout the night?
Other common questions:
Do you have to avoid coffee and caffeine after a concussion?
How long after a concussion can you drink alcohol?
Can you take Ibuprofen for a concussion?
FOR FOLKS IN A PINCH, HERE'S THE QUICK ANSWER:
Do not allow the athlete (or concussed individual) to sleep for at least 3 hours after the injury.
May not need to wake the athlete throughout the night, but monitoring them throughout the night is prudent.
The 2019 CCMI Clinician Course recommends that the athlete/concussed individual is checked on throughout the night and only woken if there are concerns about breathing or their overall state. They also remind that the athlete will likely be fatigued due to the growing ATP deficit, per normal concussion pathophysiology.
2004 NATA guidelines recommend waking the athlete throughout the night (every 3-4 hours) only if they have experienced a loss of consciousness, had/have prolonged memory loss, or are still experiencing significant symptoms.
In 2006, concussion researchers, Drs. John Leddy and Bary Willer echoed the NATA recommendations from 2004.
Why are there sleep concerns acutely after a concussion?
Ultimately, we don't want to miss a life-threatening issue (e.g., intracranial hemorrhage or cerebral edema) because our athlete slept through it.
Your doctor, athletic trainer, or concussion specialist on the sidelines or in the ER will consider a set of "rules" to determine if a head CT is needed. These are the Canadian CT Head Rule and the New Orlean's Criteria. The Candian CT Head Rule is likely superior and includes:
Glasgow Coma Score <15 after 2hrs
Suspected skull fracture
Signs of basal skull fracture
Two or more episodes of vomiting
65yo or older
Memory loss before the impact by more than 30min
Dangerous injury mechanism
The bolded signs/symptoms are strong predictors of finding anatomical changes on the CT.
CLARIFICATION:
Signs of a skull fracture include bruising behind the ears (Battle sign), two black eyes (raccoon eyes), blood behind the eardrum, or clear fluid coming from the nose or ears.
A "dangerous mechanism" includes a pedestrian being struck by a vehicle, being ejected from a vehicle, falling from a height of 3ft or more, or falling 5+ stairs.
Everyone made it through the first night. What's next?
It is crucial to be evaluated or re-evaluated by a concussion specialist EARLY after a concussion. For example, the NCAA and professional organizations re-evaluate their athletes within 24-48hrs following concussion to confirm the diagnosis and begin integrative treatments.
Sleep after an acute concussion summary.
Remember, we're not allowing the athlete (or concussed) individual to sleep for at least 3 hours after their injury. We're looking to be sure that they're not declining in this period, outside of the expected fatigue.
There are guidelines for which injured patients are candidates for head and brain imaging, and your doctor, trainer, or concussion specialist should be aware of these.
During the night of the concussion, do monitor and check on the injured individual periodically. However, you do not need to wake them unless you're concerned about their breathing or overall state. 2004-2006 guidelines recommend waking every 3-4 hours if there was a loss of consciousness, prolonged amnesia, or significant and sustained symptoms.
Following the first night, schedule a visit with a concussion specialist within the next 24-48hrs. This visit is essential for confirming the diagnosis, ruling out more severe problems, and beginning the recovery process ASAP.