Concussion and Insomnia: Understanding and Managing Sleep After Head Injury

Explore the vital connection between concussion recovery and sleep, including causes, symptoms, and effective strategies for managing insomnia.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 25, 2025

Explore the vital connection between concussion recovery and sleep, including causes, symptoms, and effective strategies for managing insomnia.

Sleep disturbances are among the most reported and impactful symptoms following a concussion. Whether you experience trouble falling asleep, staying asleep, or an overall change in sleep patterns, insomnia after a concussion is both common and disruptive. This comprehensive guide explores how a concussion affects sleep, why sleep is critical for recovery, and practical steps for managing insomnia and other sleep issues after a head injury.

What Is Concussion-Related Insomnia?

A concussion is a type of mild traumatic brain injury (mTBI) usually resulting from a blow, jolt, or bump to the head. Insomnia following a concussion typically means trouble falling or staying asleep, awakening frequently in the night, or waking up too early and struggling to return to sleep.

Insomnia is reported in up to 80% of people after concussion.
Symptoms can last weeks, months, or occasionally longer.
Children, adolescents, and adults are all at risk, though patterns may differ across age groups.

Why Are Sleep Problems So Common After a Concussion?

Research shows that a concussion can physically alter brain structures and disrupt regulatory systems:

Damage to neurons and pathways that govern sleep-wake cycles
Impaired production of sleep hormones such as melatonin
Inflammation and metabolic changes in brain tissue

This disruption can cause a cascade of issues, including delayed sleep onset, night awakenings, and disturbed sleep cycles. These issues not only prolong concussion symptoms but also complicate recovery.

Common Types of Sleep Disturbances After Concussion

Insomnia – trouble falling or staying asleep
Hypersomnia – unusual sleepiness or excessive sleeping in early days post-injury
Circadian rhythm disorders – irregular sleep-wake patterns
Sleep apnea and restless legs may also be triggered or worsened

How a Concussion Impacts Sleep: Stages and Symptoms

Immediate Response: First Few Days After Injury

Following a concussion, people are often extremely tired and may nap more frequently. It was once thought unsafe to allow prolonged sleep after a concussion, but current guidelines do not generally recommend waking patients through the night unless there are warning signs of more severe brain injury.

Sleep helps repair damaged white matter in the brain.
Brief rest in a calm, dim environment is recommended, but complete isolation (the “cocoon” method) is now discouraged.

Acute Phase: One Week and Beyond

Almost everyone feels unusually fatigued during the first week, but as days progress, persistent sleep problems may appear, including:

Difficulties falling and staying asleep at night
Napping during the day but still waking up feeling unrested
Fragmented or light sleep, especially if pain, headaches, or sensitivity to light/sound are present

Persistent and Chronic Symptoms

For some people, sleep issues linger well after other concussion symptoms fade, sometimes lasting 12 months or more:

Chronic insomnia
Cognitive and emotional symptoms—brain fog, irritability, low mood—made worse by poor sleep
Increased risk for depression or anxiety

Why Is Sleep Essential for Concussion Recovery?

Sleep is a critical time for the brain’s healing and repair mechanisms to activate. Adequate sleep:

Promotes restoration and clearing of brain waste products
Regulates inflammation and hormone production
Enhances cognitive function, mood, and pain tolerance

Studies show people who sleep poorly after a concussion often experience:

Longer lasting symptoms—including headaches and neurocognitive issues
Slower return to school, work, or sports
Greater risk of prolonged post-concussion syndrome

In children, poor sleep can mean a significantly longer recovery period and worse symptom severity compared to those who sleep well after injury.

Causes of Insomnia and Sleep Problems Post-Concussion

The causes of sleep disturbances after concussion are often multifactorial, including:

Neurological Changes: Physical injury to the brain that disrupts normal sleep regulation and melatonin production.
Mental Health Effects: Concussions can worsen or trigger anxiety, depression, or stress, each of which is closely linked to insomnia.
Physical Symptoms: Headache, neck pain, dizziness, nausea, light/sound sensitivity all can make comfortable sleep difficult.
Medication Side Effects: Some painkillers or traditional sleep medications can disturb sleep cycles.
Disruption to Routine: Time off work or school, less daytime activity, and irregular sleep schedules contribute to sleep problems.

Risk Factors for Post-Concussion Sleep Issues

History of previous concussion(s)
Existing sleep disorders prior to injury
Pre-existing mental health conditions (anxiety, depression, bipolar disorder, etc.)
Younger age (children and adolescents at higher risk of both insomnia and protracted recovery)
Environmental and socioeconomic factors

How to Recognize Insomnia After a Concussion

Symptoms of concussion-related insomnia may be subtle or obvious. Be alert to:

Difficulty falling asleep, even when tired
Frequently waking up during the night
Waking up much earlier than usual or before feeling rested
Excessive daytime tiredness, despite more or less total sleep
Feeling “half-awake” or unrested even after a full night’s sleep
Changes in mood, memory, concentration, or performance

When to Seek Medical Attention

Not all sleep difficulties after concussion require formal medical care. However, consult a healthcare professional or concussion specialist if:

Sleep problems persist more than two weeks
Insomnia is severe or worsening
You experience breathing disruptions (possible sleep apnea), limb movements, or vivid nightmares
Fatigue is overwhelming, prevents normal activity, or is accompanied by worsening headaches, confusion, slurred speech, or new neurological symptoms

Diagnosis: Assessing Insomnia in Concussion Patients

Healthcare providers evaluate insomnia after concussion using a detailed medical and sleep history, sometimes including:

Patient sleep diaries
Interviews about symptoms, previous concussions, and mental health
Screening for related disorders (anxiety, mood disorders, apnea, etc.)
In rare or severe cases, a sleep study (polysomnography)

Managing and Treating Insomnia After Concussion

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Research consistently demonstrates that CBT-I is the most effective first-line treatment for insomnia after a concussion. CBT-I helps by:

Limiting negative sleep thoughts and reducing nighttime anxiety
Identifying and correcting unhelpful sleep habits
Improving sleep hygiene and promoting a regular sleep-wake schedule
Teaching relaxation techniques

CBT-I’s benefits are:

Long-lasting improvements (>70% respond with lasting benefit)
No medication side effects
Effective even for persistent and chronic insomnia

Other Professional Treatments

Short-term Melatonin: Occasionally useful for short-term sleep promotion, particularly if circadian rhythms are off. Only to be used under medical direction.
Medications: Rarely prescribed for post-concussion insomnia unless symptoms are very severe or persist despite behavioral treatment. OTC and prescription sleep aids can carry risks, including worsening symptoms.
Treatment of Emotional or Physical Symptoms: Managing headaches, pain, anxiety, and depression is often critical to restoring sleep.

Self-Care and Sleep Hygiene for Concussion Recovery

Simple lifestyle and behavioral changes can make a major difference in sleep quality post-concussion.

Consistent bedtime and wake-up: Set regular sleeping and rising times, even on weekends.
Wind-down routine: Read, listen to soft music, or do gentle stretches before bed. Avoid screens at least 1 hour before bedtime.
Bedroom environment: Use blackout curtains, keep the room cool and dark, and minimize noise. Reserve the bed for sleep only.
Limit naps: If napping, keep naps under 30 minutes and avoid late afternoon naps so as not to disrupt your night sleep.
Avoid caffeine and stimulants: Stop consuming caffeine, nicotine, and even chocolate by early afternoon.
Daily activity: Gentle physical activity and light exposure during the day helps reset circadian rhythms and improve sleep drive.
Eat and hydrate: Try not to eat a large meal or drink excessive fluids right before bed.

Frequently Asked Questions About Concussion and Insomnia

How long does insomnia last after a concussion?

The majority of people improve within a few weeks, but insomnia can last for months, sometimes a year or longer if not properly addressed. Early intervention with behavioral strategies is strongly advised.

Is it safe to sleep after a concussion?

Yes, it is generally safe to sleep after a concussion. Unlike older advice, current recommendations do not support waking a person every few hours unless there are warning signs of worsening injury (persistent vomiting, confusion, or movement difficulties).

What should I do if I can’t sleep after a concussion?

Start by improving sleep hygiene and routines. If trouble persists, seek professional help—CBT-I is the best-established therapy. Report severe or worsening symptoms to your doctor immediately.

Does poor sleep after concussion make recovery take longer?

Yes. Research shows poor post-concussion sleep prolongs symptom duration, increases the risk of complications, and is linked to worse cognitive and emotional outcomes, especially in children and teens.

Tips for Supporting Someone With Post-Concussion Insomnia

Help maintain a peaceful sleep environment—quiet, dark, and comfortable
Remind them to establish a wind-down bedtime routine
Provide reassurance while also monitoring for new or worsening symptoms
Support gradual return to normal activity, as tolerated
Encourage them to seek professional support if sleep does not improve

Key Takeaways

Insomnia and other sleep issues are extremely common after concussion and can significantly slow recovery.
Symptoms may arise from a combination of neurological damage, emotional distress, pain, and lifestyle disruption.
Good sleep hygiene and behavioral therapies—especially Cognitive Behavioral Therapy for Insomnia—are safe, effective first-line treatments.
Check with a healthcare provider if symptoms last more than two weeks, are severe, or are accompanied by unusual changes in mood, cognition, or breathing.
With correct support, almost everyone can regain normal sleep and speed up their concussion recovery.

Frequently Asked Questions (FAQs)

Can insomnia from a concussion become permanent?

Most cases of post-concussion insomnia resolve within a year, especially with proper treatment. Persistent insomnia may require extended behavioral therapy and ongoing medical support.

How soon should I treat post-concussion insomnia?

Early self-care and behavioral intervention can speed recovery and prevent chronic sleep deprivation. Don’t wait longer than 2-3 weeks if you’re unable to sleep well.

Should I avoid screens/devices after a concussion?

Yes—especially in the evenings. Light from screens disrupts melatonin and can worsen insomnia after brain injury.

Does melatonin work after a concussion?

Short-term, low-dose melatonin may help some people, but only under medical supervision. Long-term use and high doses should be avoided unless directed by a specialist.

Can treating anxiety or depression help my sleep after a concussion?

Absolutely. Addressing mental health, pain, and stress is often critical for improving sleep outcomes after head injury.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete