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.