Sleep Following Concussion

Why sleep often changes, how it affects recovery, and what helps

Sleep disturbance is one of the most common and most underestimated effects of concussion. Many people notice changes in sleep even when other symptoms begin to settle—and these changes can quietly drive cognitive fatigue, mood changes, and stalled recovery.

This page explains how concussion affects sleep, why sleep problems can persist, and how improving sleep often plays a key role in overall recovery.

 

Why sleep is so important after concussion

 

Sleep is not just rest. It is when the brain:

  • restores energy balance

  • consolidates memory and learning

  • regulates emotional systems

  • clears metabolic by-products of neural activity

 

After concussion, these processes can become less efficient. Even subtle sleep disruption can have a disproportionate impact on thinking, mood, and resilience.

 

Common sleep changes after concussion

 

People may experience one or more of the following:

  • difficulty falling asleep

  • frequent waking overnight

  • early morning waking

  • unrefreshing sleep

  • increased need for sleep but feeling no better rested

  • excessive daytime sleepiness

  • reversal of sleep–wake patterns

 

Sleep problems may appear immediately after the injury or emerge weeks later as daily demands increase.

 

Why sleep is often disrupted after concussion

 

Sleep changes after concussion are rarely caused by a single factor. Common contributors include:

1. Brain energy disruption

 

Concussion temporarily disrupts how the brain uses and restores energy. This can:

  • alter sleep–wake regulation

  • increase light, noise, and stimulation sensitivity

  • reduce the depth or restorative quality of sleep

 

 

2. Cognitive fatigue and overload

 

Ironically, being cognitively exhausted does not always lead to better sleep.

When mental load is high:

  • the brain can struggle to “switch off”

  • sleep onset may be delayed

  • sleep may be lighter and more fragmented

 

This can create a cycle where fatigue worsens sleep, and poor sleep worsens fatigue.

 

3. Emotional arousal and hypervigilance

 

Anxiety about symptoms, recovery, or performance can increase arousal at night.

Common experiences include:

  • racing thoughts

  • body tension

  • heightened monitoring of symptoms

 

Even low-level, background anxiety can interfere with sleep initiation and maintenance.

 

4. Disrupted routines and pacing

 

After concussion, people often:

  • rest excessively during the day

  • nap irregularly

  • reduce daytime activity

  • spend more time in bed

 

While well-intentioned, these changes can weaken the brain’s sleep drive and disrupt circadian rhythms.

 

5. Pain and physical symptoms

 

Headache, neck pain, dizziness, or sensory sensitivity can:

  • interrupt sleep

  • make certain positions uncomfortable

  • reduce overall sleep quality

 

Addressing physical contributors is often necessary alongside sleep strategies.

 

How sleep problems affect cognitive recovery

 

Poor sleep can significantly amplify post-concussion difficulties, including:

  • slower processing speed

  • reduced attention and concentration

  • increased cognitive fatigue

  • poorer emotional regulation

  • heightened irritability and anxiety

 

When sleep is disrupted, it can appear as though cognition or mood is worsening—even when the underlying brain recovery is progressing.

 

Why “sleep more” doesn’t always help

 

After concussion, people are often told to “get lots of sleep.” While rest is important early on, excessive or poorly structured sleep can:

  • reduce daytime alertness

  • worsen nighttime sleep quality

  • prolong fatigue cycles

 

Recovery usually requires regulated sleep, not simply more time in bed.

 

Typical sleep–fatigue patterns we see

 

Many people describe patterns such as:

  • sleeping long hours but feeling unrefreshed

  • coping well in the morning, then crashing later

  • feeling wired at night despite exhaustion

  • improved sleep on low-demand days but worse sleep after busy days

 

These patterns often reflect difficulty balancing cognitive load and recovery, rather than a primary sleep disorder.

 

When sleep becomes a barrier to recovery

 

Sleep issues can begin to actively slow recovery when they:

  • prevent cognitive stamina from rebuilding

  • intensify emotional reactivity

  • undermine pacing strategies

  • create fear or frustration around sleep itself

 

At this point, addressing sleep becomes a core part of concussion care, not a secondary issue.

 

How sleep recovery typically happens

 

Improving sleep after concussion often involves:

  • understanding how sleep, fatigue, and cognition interact

  • regulating daytime activity and rest

  • addressing unhelpful sleep habits that developed post-injury

  • reducing nighttime cognitive and emotional arousal

  • coordinating care for pain, vestibular, or sensory contributors

 

For some people, targeted interventions such as CBT for insomnia (CBT-I) or medical sleep assessment may be appropriate.

 

The role of assessment

 

Assessment can help to:

  • clarify whether sleep problems are primary or secondary

  • identify patterns linking sleep, fatigue, and cognitive symptoms

  • guide appropriate referral (e.g. sleep psychology, medical sleep services)

  • avoid unnecessary or unhelpful interventions

 

Sleep is best understood in context, alongside cognitive load, mood, and daily functioning.

 

Our approach

 

We address sleep as part of the broader recovery picture by:

  • exploring how sleep interacts with cognitive fatigue and mood

  • providing clear psychoeducation about sleep changes after concussion

  • supporting practical, realistic sleep regulation strategies

  • coordinating with sleep specialists when needed

  • integrating sleep support into cognitive and emotional recovery planning

 

The aim is not perfect sleep—but sleep that supports brain recovery and daily function.

 

If sleep disruption is ongoing after concussion and you’re unsure how much is “normal,” what’s helping or hindering recovery, or whether additional support would be useful, we’re happy to help you think through next steps.