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JANUARY IS NATIONAL WINTER SPORTS TRAUMATIC BRAIN INJURY AWARENESS MONTH. For many people, winter means participating in winter sports such as snowboarding, skiing, figure skating, and ice hockey. Accidents such as falling onto ice or hitting objects at high speed can set the stage for a concussion, which is a type of traumatic brain injury.
A concussion occurs when the brain is jarred and twists within the skull because of a direct blow to the head or because of a blow to the body that causes the head to jerk back and forth rapidly (e.g., whiplash). The twisting of the brain within the skull can stretch and damage brain cells.
Symptoms of a concussion can be the following:
• Headache
• Ringing in the ears
• Memory changes such as amnesia for the accident that caused the concussion, trouble remembering new information, trouble concentrating or thinking, and confusion
• Mood changes such as irritability, depression, and anxiety
• Blurred vision
• Dizziness
• Nausea and vomiting
• Sensitivity to light or noise
• Feeling fatigued or exhausted
• Sleep changes such as insomnia (i.e., trouble falling asleep or remaining asleep) or sleeping too much. A concussion does not always involve the loss of consciousness, and symptoms usually resolve within 7-10 days. However, 10%-25% of people do not fully recover within this period and several months later may still be experiencing symptoms—a phenomenon called “post-concussion syndrome.”
After a concussion, some people develop obstructive sleep apnea (OSA), a sleep disorder that involves intermittent periods of stopping breathing (i.e., apnea). OSA occurs because muscles supporting tissues such as the tonsils or adenoids relax too much, which allows the structures to collapse into the upper airway, thereby blocking (i.e., obstructing) airflow. With airflow blocked, the blood oxygen level decreases during sleep, which ultimately causes a person to awaken briefly to take some deep breaths to restore the blood oxygen level. During this arousal, loud snoring can occur. The fall and rise of blood oxygen during sleep and frequent arousals during sleep in people with OSA may impact the brain’s ability to heal after a concussion.
Exactly why some people develop OSA after a concussion is unclear. One possibility is that certain medications (e.g., sedatives, hypnotics) used to treat concussion symptoms such as insomnia contribute to OSA.
A common but erroneous belief is that people with signs of a concussion should not be allowed to sleep because “they may never wake up” and that they should be awakened every few hours to keep them from “sleeping too much.” However, research indicates that frequently interrupting sleep may actually worsen or prolong the symptoms of concussion. Thus, people with a concussion should be allowed to sleep.
If you have had a concussion and notice that symptoms are persisting, undergoing a sleep study to rule out OSA or another sleep disorder may be helpful, especially if you note that your sleep is nonrestorative (i.e., feeling unrefreshed after sleeping), you awaken with headaches, and/or you have difficulty going to sleep or you sleep too much. You may also want to consider a sleep study if people report that you stop breathing during sleep, you have loud snoring, and you awaken with a sense of being choked. Treating OSA may aid (although not necessarily hasten) healing from a concussion.
Regina Patrick, RPSGT, RST, is a freelance writer/editor and a registered sleep technologist. She has been involved in the sleep field for more than 30 years. ✲
