Sleep is the "top of the cascade" for recovery - the most important factor, as sleep has neuroprotective and neurorecuperative effects on the brain. In the early stages of a concussion (typically the first week) concussion patients may sleep more than usual and may need daytime naps, and it's important to allow for this. After this early stage, concussion patients can often have trouble falling asleep or staying asleep. Research shows that from 30% to 70% of concussion patients have sleep-wake problems. Additionally, 43% to 73% have symptoms of fatigue.
Concussion patients are usually asked just one or two questions about sleep when they are evaluated. If you are having serious problems with sleep after a concussion, you may want to see a sleep specialist.
Ways to promote sleep
“Melatonin levels rise about two hours before bedtime," according to an article John Hopkins Medicine. Create optimal conditions for melatonin to do its job by keeping the lights low before bed. Stop using your computer, smartphone or tablet—the blue and green light from these devices can neutralize melatonin’s effects. If you watch television, be sure you’re at least six feet away from the screen. Turn off bright overhead lights too. Meanwhile you can help program your body to produce melatonin for sleep at the right time of day by getting exposure to daylight during the morning and afternoon. Take a walk outside or sit beside a sunny window."
Reduce screen blue light
Alcohol, meals, and sleep
Research is indicating that drinking alcohol up to one hour before bedtime can reduce the body's own melatonin production by up to 19%. What you eat, and when you eat, also affects your sleep.
Consider asking your doctor for a short-term prescription of a nonaddictive sleep aid, such as Trazadone. If your sleep problems continue, you may want to ask for a referral to a sleep specialist.
Research also indicates that CBD (cannabidiol) helps with sleep, see our section on CBD. You can get CBD from hemp, commonly referred to as CBD oil, or high CBD/low THC marijuana products, where legal.
Cognitive Behavioral Therapy, and CBT apps
Cognitive Behavioral Therapy (CBT) is considered to be the most effective treatment for insomnia and it has shown to be successful with concussion and TBI patients. Typically a patient sees a CBT therapist once a week for six to eight weeks.
Cognitive Behavioral Therapy apps were found to be effective in combatting insomnia in a 2017 research study. The study also concluded the CBT apps have “likely benefits beyond sleep to mental health and well-being.” NPR has an excellent article (Oct 8, 2018) about CBT apps for insomnia. In the article, several sleep counselors recommend the FREE app developed by the Veterans Administration, called CBT-i Coach.
Sleepio and SHUTi are additional Cognitive Behavioral Therapy programs which have proven effective and are recommended by Dr. Charles Czeisler, Professor of Sleep Medicine at Harvard Medical School. Both Sleepio and SHUTi are subscription-based online programs, SHUTi is $149 for a 26-week program, for example.
The newest concussion guidelines recommend that after a concussion the patient should rest for for 24 to 48 hours and then start light activity. Recommended activities are use of a stationary bicycle, or walking for short distances if the concussion has not compromised balance. The patient should gradually become more active, staying below the activity level that makes cognitive or physical symptoms worse.
Studies are showing that the brain "recovers faster with physical activity" after concussion and that "prolonged rest time may even delay healing and recovery."
Athletes should refrain from vigorous exertion until cleared by their doctors; these new recommendations are NOT about returning to the soccer field or football practice.
Free yoga classes and yoga videos for people with TBI (including a concussion)
The nonprofit organization LoveYourBrain.com provides a free, FUNdamental 6-week series of yoga classes for people with TBI and concussions. Classes are available in most US states and Canada.
Gentle yoga to improve strength and balance
Meditation practices to reduce stress
Class themes to foster resilience and compassion
Facilitated group conversation to build community
Free yoga and meditation videos for people with a concussion will allow you to do yoga at home, or help you decide if you want to take their classes.
Consider your food choices and whether foods are inflammatory or anti-inflammatory. For instance, sugar, red meat, and a lot of simple starches are fairly inflammatory while high water vegetables (greens, etc), chicken and fish, and healthy fats like coconut oil work well to reduce inflammation. We've also found that ginger or ginger-turmeric tea is helpful - it is highly anti-inflammatory and soothing psychologically.
There is research linking gut health with brain health, and some concussion patients have found it useful to drink fermented beverages with probiotics, such as kombucha.
Hydration is an important piece of managing concussion symptoms - be sure to drink plenty of water. Many in our community always carry a large water bottle with them.
Help with Sound Sensitivity
Sound sensitivity is a common symptom of a concussion and post-concussion syndrome. It can be hard to avoid loud sounds such as city streets and sirens, malls, and school hallways. Going to the movies can be difficult due to the high volume of cinema sound systems. We've found that a high-performing pair of earplugs can make all these activities more doable for someone with sound sensitivity.
We highly recommend Ear Peace earplugs. They are high fidelity, meaning that they reduce the volume without reducing sound quality. Equally helpful, they come in a small tube with a keychain clip. Men can clip it to a belt loop, and women can clip it to a loop in their purse, so you always have it handy.
When you purchase the Ear Peace earplugs through our links on this page, Amazon gives Concussion Alliance a small commission (at no cost to you) that helps support our mission of helping people recover from concussions.
Apps to help manage your stress and recovery
Apps to help you stay on track with your self-care
One of our closed Facebook group members recommends the app Productive, which has helped her manage her recovery. You can use the app to help remember when to take medications and other self-care essentials that can be hard to juggle when dealing with concussion symptoms.
SuperBetter is an app that increases resilience and your ability to “stay strong, motivated, and optimistic even in the face of difficult obstacles.” A research study conducted by the University of Pennsylvania found that “Playing SuperBetter for 30 days improves mood, reduces symptoms of anxiety and depression and increases belief in the ability to successfully achieve goals.”
Meditation, and Deep Breathing
Headspace app aims to helps you meditate, reduce stress, focus, and sleep better. Several people in our community have found the app very useful in starting and maintaining a meditation practice that has improved their well being.
Oak is a free app which was named a "2018 New Apps We Love" by Apple and is only available iOS (Apple) devices. "We have guided meditations starting at just 5-minutes in length. If you're on the go, decompress with breathing exercises that can be practiced anywhere. For those with trouble sleeping, fall asleep to our background sounds like distant rain, crackling fire, white noise and many more."
Do NOT avoid all screens and digital media
Medical advice has changed regarding this issue. The newest recommendations do say to avoid screens during the first few days after a concussion if they are making symptoms worse. However, once symptoms have lessened, it's important to get back to normal activities. Phones are an important element of staying connected socially and maintaining a sense of identity, as are video games for some people. Taking away these digital devices can promote depression and anxiety which can prolong recovery from a concussion.
Computers are an integral part of school and work-life, so the use of screens needs to be included in the recovery process. The visual strain of screens can be reduced with apps and devices, see the section below. Prolonged sensitivity to screens may indicate that the concussion has created a vision problem, see our section on Vision Therapy.
Apps that reduce the visual strain of screens
Light sensitivity is a common symptom of concussions and post-concussion syndrome. Screens present a strain on the eyes that can be reduced with apps that automatically adjust the color of the display.
f.lux is a free software download recommended by vision therapists for people with concussions and resulting vision problems. The f.lux app makes the screen color match the room, so it looks like the sun during the day, and like your indoor lights (a warm color) at night, getting rid of the blue night-time glow. Daytime brightness and warmth are adjustable. It's available for Mac, Windows, and Linux, downloadable from the f.lux website. It is not available in the Apple App store or on the iPhone.
iPhone Night Shift mode
Turn on Night Shift on your iPhone or iPad. The Night Shift mode adjusts the colors of your iPhone screen to the warmer end of the color spectrum, which is easier on your eyes. The default setting for Night Shift is to automatically turn on after dark and turn off at sunrise.
You may want to customize the settings so that Night Shift is always on, in order to reduce symptoms of visual strain. A 24/7 setting can be created by turning Night Shift on at 7 am, and off at 6:59 am, for example.
There are two ways to turn Night Shift on and off:
Open Control Center from your Home screen. Firmly press the Brightness control icon, then tap to turn Night Shift on or off.
Go to Settings > Display & Brightness > Night Shift.2On the same screen, you can schedule a time for Night Shift to turn on automatically and adjust color temperature.
Android App: Irlen digital colored overlays for your phone
Specialized vision optometrists recommend the Irlen colored overlays for screens, and Irlen has created an Android app for phone and tablet. The app gives you 10 color choices or you can create a custom color; this color is then set as an automatic overlay on your screen, reducing eye strain. Available for $1.99 at Google Play or at Irlen.
Reduce visual strain: colored overlays for computer, phone screens, and books
The Irlen company makes acetate sheets (overlays) of different colors and sizes to lay on top of screens or the pages of a book. The different color overlays filter out different wavelengths of light which may be creating problems with visual processing. It's important to select the color that reduces strain for you. You can purchase a sample pack of colors which comes with instructions on how to determine which color helps you. If you get an exam by an optometrist specializing in vision development (see Vision Therapy), the optometrist may go through the Irlen overlay samples with you to determine which color sheet(s) you should use.
When you purchase the Irlen Colored Overlays for Reading through our links on this page, Amazon gives Concussion Alliance a small commission (at no cost to you) that helps support our mission of helping people recover from concussions.
Reduce visual strain: Slant Board to reduce the strain of reading
The Slant Board by Visual Edge, recommended by optometrists specializing in vision development, has a 22-degree angle - the optimum angle for visual processing based on research. It's light and folds flat, making it easily portable. The surface also works as a dry erase whiteboard.
When you purchase the Slant Board by Visual Edge through our links on this page, Amazon gives Concussion Alliance a small commission (at no cost to you) that helps support our mission of helping people recover from concussions.