The Relationship Between Sleep Issues and Sports-Related Concussions
This article is based on the content provided in the Using Baseline Symptoms of Athlete Sleep to Help Interpret Post-Concussion Recovery presentation provided by Brendan Duffy, RPSGT, RST, CCSH.
As sleep is essential for the brain and body, it is surely essential for athletic performance and recovery. Sleep restriction and sleep loss have been shown to impair cognition, learning and memory consolidation; disrupt growth and cell repair; and increase pain perception. A lack of sleep may have an array of negative effects on an athlete’s performance and, more importantly, their overall health.
Insufficient sleep affects athletes of all ages and experience levels. A 2019 study by Reardon et al. found that 49% of Olympic athletes classified as poor sleepers (Pittsburgh Sleep Quality Index [PSQI] score of less than 5) with 64% reporting insomnia. More than half of college athletes reported getting insufficient sleep, with 79% getting less than eight hours per night. In a 2019 GOALS study, student athletes reported sleeping an average of six hours and 15 minutes, which is 14 minutes less than what student athletes reported in 2010. Football players in particular recorded a weekly average of only 5.85 hours per night.
Concussions and Sleep
Poor sleep impacts many aspects of an athlete’s performance, wellbeing and recovery. Inadequate sleep delays response time, and increases fatigue and poor decision making.
Sleep issues and sports-related concussions (SRCs) have a bidirectional relationship meaning that (1) concussions impact how a concussed individual sleeps and (2) research suggests that, how much someone sleeps may affect their likelihood of having an SRC. The individual’s baseline sleep quality may also affect their recovery from the concussion.
Getting Proper Sleep During Recovery From a Concussion
The impact of concussions on sleep is the more well-known side of the bidirectional concussion—relationship. Sleep emanates from structures in the deeper areas of the brain and concussions can often damage these areas. Unsurprisingly, 30%-80% of concussed individuals will experience sleep disturbances. In the acute stages post-concussion, athletes often experience excessive sleepiness and increased sleep, both healing mechanisms, as most of the brain’s restoration occurs during sleep. Adequate sleep is essential to recovery because sleep restores the brain’s electrochemical balance, decreasing the chances of the athlete experiencing prolonged symptoms. Concussed athletes also complain of variable sleep with sleep deficits and “catch up” nights.
In the past, common advice given immediately following a head injury or an SRC was to keep the injured athlete awake for several hours or have someone wake them up every hour. The notion was that those caring for the injured athlete (doctors, coaches, parents, teammates, etc.) would miss signs of serious brain damage in the athlete such as seizures or loss of consciousness. This advice, however, is a myth. Concussed players should be watched over for three to six hours, but be allowed to sleep; and, if their symptoms are aggravated, they should be sent to the emergency room. Getting adequate sleep can improve a concussed athlete’s recovery time and should be a priority.
Post-Concussion Syndrome Impact on Sleep
Sleep issues often arise in post-concussion syndrome (PCS) including hypersomnia, insomnia, narcolepsy, restless legs syndrome and sleep apnea. Insomnia is reported in 30% of SRC cases, and weeks to months later, 36% of people experience circadian rhythm shifts. Many others report sleep disruption and continued fatigue. PCS issues should be managed on an ongoing basis as the sleep complaints may change.
Poor Sleep and the Risk of Having a Sports-Related Concussion
A more recent focus of the concussion–sleep relationship is the impact poor sleep has on the risk of athletes getting a concussion. Studies are inconclusive on a lack of sleep causing concussions, but the research is suggestive of this relationship. A study on NCAA Division 1 athletes who completed sleep surveys found that individuals with both insomnia and excessive daytime sleepiness had a 14.6 times higher risk of getting an SRC than those who were well rested. Those that only experienced moderate-to-severe insomnia had a three times higher risk of having a concussion, and athletes that experienced daytime sleepiness were twice as likely to have a concussion.
The bidirectional relationship between SRCs and sleep is important for athletes and coaches to understand as it affects recovery and prevention. Sleep problems beget higher rates of post-concussion symptoms and concussions beget increased sleep problems. Insomnia and daytime sleepiness are independently associated with SRC risk, however additional research is needed to better understand the relationship.
There is a growing knowledge of the effects sleep has on athletes, and many sports teams have increased their recognition of how sleep impacts both performance and recovery. While more research and testing is needed to show the correlation between lack of sleep and concussions, baseline concussion tests on athletes can help identify the effects of post-concussion syndrome and sleep disturbances. It is important that sleep complaints be addressed by the team’s doctors or a qualified sleep physician. Both post-concussion health and any sleep complaints must be taken seriously for the long-term health and recovery of concussed athletes.