How to Improve Sleep After a Concussion: Causes, Symptoms & What Helps
Sleep problems are extremely common after a concussion.
You may have trouble falling asleep, wake up repeatedly during the night, wake much earlier than usual, sleep far more than you used to, or wake up after a full night of sleep and still feel exhausted.
For some people, sleep problems improve as the other effects of the concussion improve. For others, sleep becomes one of the symptoms that continues long after the initial injury.
Sleep is not simply something to address after everything else gets better.
Sleep and concussion recovery are closely connected. Poor sleep can make headaches, fatigue, concentration problems, irritability, and other concussion symptoms harder to manage. At the same time, concussion symptoms can make it much harder to sleep.
That means sleep should be addressed as part of concussion recovery—not treated as an unrelated problem.
What Happens to Sleep After a Concussion?
A concussion can disrupt the systems responsible for regulating your sleep-wake cycle.
You may notice changes such as:
Difficulty falling asleep
Waking up frequently during the night
Waking much earlier than usual
Sleeping for unusually long periods
Excessive daytime sleepiness
Feeling exhausted despite getting enough hours of sleep
Sleeping at unusual times
Feeling like your sleep is not restorative
A major change in your normal sleep schedule
Research suggests that sleep disturbance is common following mild traumatic brain injury. A large systematic review and meta-analysis found that insomnia symptoms were particularly common after mild TBI, although estimates varied substantially between studies.
Sleep disturbance is also important because it can become part of a cycle:
Concussion symptoms → poor sleep → increased fatigue and symptom sensitivity → greater difficulty functioning → more difficulty sleeping.
Breaking that cycle can be an important part of recovery.
Why Can't I Sleep After a Concussion?
There isn't one explanation for every person.
Sleep problems after concussion can be influenced by several factors, including changes in sleep-wake regulation, pain, headaches, autonomic regulation, changes in activity levels, stress, medications, changes in routine, and other sleep disorders. Clinical Recommendations for Sleep After Concussion/mTBI
Autonomic Nervous System Changes
The autonomic nervous system helps regulate many automatic processes in your body, including heart rate, blood pressure, and the body's response to stress.
Changes in autonomic regulation can contribute to difficulty transitioning between states of activity and rest in some people after concussion.
This is particularly relevant if you also experience:
A racing heart
Difficulty relaxing
Dizziness when standing
Exercise intolerance
Feeling unusually "wired" or restless
Symptoms that increase with physical or mental exertion
Autonomic dysfunction is not the explanation for every sleep problem after concussion, but it can be one piece of the picture.
You can read more about this in:
Post-Concussion Autonomic Dysfunction: Symptoms, Causes & Treatment
Headaches, Neck Pain and Dizziness Can Disrupt Sleep
Sometimes the problem isn't that your brain simply "won't sleep."
You may be trying to sleep while dealing with:
Headaches
Neck pain
Dizziness
Nausea
Light sensitivity
Anxiety about your symptoms
Muscle tension
Difficulty finding a comfortable position
If these problems are keeping you awake, improving sleep may require addressing the underlying problem rather than focusing exclusively on bedtime habits.
For example, someone whose sleep is repeatedly disrupted by a cervicogenic headache may need treatment directed at the neck and headache rather than simply being told to practice better sleep hygiene.
This is one reason concussion rehabilitation should look at the whole picture.
Why Is Sleep So Important After a Concussion?
Sleep is important for normal brain function, learning, memory, emotional regulation, and physical recovery.
When sleep is disrupted, you may notice that other concussion symptoms become harder to tolerate.
Poor sleep can contribute to:
Fatigue
Difficulty concentrating
Brain fog
Irritability
Headaches
Reduced exercise tolerance
Increased sensitivity to stress
Difficulty managing normal daily activities
Sleep disturbance following concussion has also been associated with a greater risk of prolonged symptoms. Current concussion consensus specifically notes that sleep disturbance in the early period following concussion is associated with an increased risk of persisting symptoms and may warrant evaluation and treatment.
What Can You Do to Improve Sleep After a Concussion?
There is no single sleep strategy that works for everyone, but several basic changes can help support a healthier sleep-wake pattern.
1. Keep a Consistent Sleep Schedule
Try to maintain a relatively consistent:
Wake-up time
Bedtime
Morning routine
Your circadian system responds to regular timing.
Sleeping until noon after a poor night and then trying to go to bed extremely early that evening can make it harder to establish a consistent rhythm.
If you are sleeping excessively during the day, discuss this with your healthcare provider rather than assuming that more sleep is always better.
2. Get Light During the Day
Light is one of the strongest signals that helps regulate your circadian rhythm.
Getting natural outdoor light earlier in the day can help reinforce your body's normal day-night cycle.
This can be as simple as spending time outside in the morning or taking a walk, assuming your symptoms allow it.
This is different from completely avoiding light because you have a concussion.
You do not need to sit in a dark room all day.
Gradually returning to normal light exposure is generally part of recovery rather than something to avoid indefinitely.
3. Be Physically Active During the Day
Physical activity can support both concussion recovery and sleep.
If you are able to tolerate it, regular daytime activity can help reinforce the distinction between being awake and being asleep.
However, this does not mean doing an intense workout late in the day or pushing through significant symptoms.
After concussion, exercise should be appropriately dosed and progressed.
Current concussion guidance supports prescribed, symptom-limited aerobic exercise rather than prolonged strict rest.
If exercise consistently causes a major increase in your symptoms, that is useful information—not a reason to abandon exercise altogether. Your starting intensity or type of exercise may need to be adjusted.
4. Don't Spend the Entire Day in Bed
If you're exhausted after a concussion, it can be tempting to spend most of the day lying down.
But excessive daytime inactivity can make it harder to establish a consistent sleep-wake cycle.
Your goal is to gradually return to normal daytime activity while allowing appropriate recovery periods.
That might include:
Walking
Light household activities
Work or school as tolerated
Social activities
Exercise appropriate to your current level of recovery
The right amount depends on your symptoms and current tolerance.
5. Create a Bedroom That Supports Sleep
Your bedroom should be:
Cool
Dark
Quiet
Comfortable
If headaches, neck pain, or other physical symptoms make it difficult to find a comfortable sleeping position, that problem should also be addressed.
Your sleep environment matters, but sleep hygiene alone isn't always enough to fix persistent insomnia.
What About Screens Before Bed?
You do not need to completely avoid screens because you have a concussion.
However, if your phone, computer, or television is keeping you mentally engaged late at night—or if the visual stimulation is increasing your symptoms—it may be helpful to reduce screen use before bed.
You can experiment with:
Reducing screen use in the hour before bed
Lowering brightness
Using a warmer display setting
Choosing less stimulating content
Taking breaks if screens increase symptoms
The goal is not to create a rigid list of things you are "not allowed" to do.
It is to identify what helps your particular sleep and symptom pattern.
What If I Am Exhausted but Still Can't Fall Asleep?
This is a common and particularly frustrating pattern.
You may feel completely exhausted during the day but become wide awake when you finally get into bed.
If this continues, don't assume that you simply need more willpower or that you aren't tired enough.
Persistent insomnia deserves to be evaluated.
For chronic insomnia in adults, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line behavioral treatment in major sleep-medicine guidelines.
Sleep problems after concussion may also require evaluation for other sleep disorders, particularly when symptoms suggest something beyond insomnia.
Could I Have Sleep Apnea After a Concussion?
Not every sleep problem after concussion is caused by the concussion itself.
Sleep apnea, restless legs syndrome, circadian rhythm disorders, medication effects, and other sleep disorders can also cause poor-quality sleep.
Consider discussing a sleep evaluation with your healthcare provider if you experience:
Loud snoring
Gasping or choking during sleep
Witnessed pauses in breathing
Significant daytime sleepiness
Morning headaches
Waking repeatedly without knowing why
Persistent unrefreshing sleep
Identifying a separate sleep disorder can be important because treating that condition may improve both sleep and daytime functioning.
What About Melatonin After a Concussion?
Melatonin is frequently discussed as a potential treatment for sleep problems after concussion, but it should not automatically be treated as a universal solution.
Research on melatonin specifically after concussion is still developing, and the appropriate dose and timing can depend on the individual and the type of sleep problem.
If you are considering melatonin or another sleep supplement, discuss it with your physician or pharmacist—particularly if you take other medications.
When Should You Get Help for Sleep Problems After a Concussion?
You don't need to wait months before addressing significant sleep problems.
Consider getting evaluated if:
Your sleep changed substantially after your concussion
You consistently have difficulty falling or staying asleep
You are sleeping excessively
You wake up feeling exhausted despite adequate time in bed
Poor sleep is worsening your other concussion symptoms
Sleep problems are interfering with school, work, exercise, or daily life
You suspect you may have a sleep disorder
The 2024 clinical recommendations for sleep disturbances associated with concussion/mild TBI specifically emphasize addressing sleep early rather than allowing sleep problems to become chronic.
How Can Concussion Rehabilitation Help With Sleep?
Sleep problems don't always require a treatment that happens at bedtime.
If headaches, neck dysfunction, dizziness, exercise intolerance, autonomic dysfunction, visual problems, or difficulty regulating physical and cognitive activity are contributing to poor sleep, addressing those factors may be an important part of improving sleep.
For example, someone who becomes significantly symptomatic after physical activity may have difficulty sleeping because their overall activity level and exercise tolerance have changed.
Someone with neck pain may be unable to find a comfortable sleeping position.
Someone with autonomic dysfunction may experience changes in heart rate or other symptoms that interfere with settling down at night.
Someone with vestibular dysfunction may become more symptomatic with movement or changes in position.
The goal is to understand what is contributing to the sleep problem rather than treating sleep as an isolated symptom.
The Connection Between Sleep and Concussion Recovery
Sleep and concussion recovery can influence one another in both directions.
Poor sleep can make it harder to manage headaches, fatigue, cognitive demands, and physical activity.
At the same time, concussion-related symptoms can make it harder to sleep.
That is why improving sleep should be considered part of a broader concussion recovery plan.
You don't necessarily need to find one magic sleep remedy.
You need to identify what is disrupting your sleep and what your brain and body currently need to rebuild a normal sleep-wake pattern.
Want a Structured Plan for Concussion Recovery?
If you're struggling to figure out what exercises to do, how much activity is appropriate, or how to address the different factors contributing to persistent concussion symptoms, The Concussion Solution was created to give you that structure.
It's a step-by-step online concussion recovery program that addresses the interconnected systems involved in recovery, including exercise tolerance, autonomic regulation, vestibular function, vision, the neck, headaches, sleep, and pacing.
Learn More About The Concussion Solution
Related Articles
What is a Concussion? Understanding What Happens to Your Brain
Post-Concussion Autonomic Dysfunction: Symptoms, Causes & Treatment
Safe Exercise After a Concussion: How Movement Supports Recovery
Ready for a Structured Approach to Concussion Recovery?
Understanding what happens after a concussion is important, but knowing what to do next is what helps turn that information into a recovery plan. The Concussion Solution provides a structured, step-by-step approach to addressing the different systems that can contribute to persistent concussion symptoms—including exercise tolerance, autonomic regulation, vestibular function, vision, the neck, headaches, sleep, and pacing.
