Is It True That You Should Keep Someone Awake Who Has Sustained a TBI?

Question: 

I always learned that if someone got “dinged” that he should be kept awake.

How long should someone be observed after receiving a mild brain injury and is there a time frame for the person to stay awake?

Answer: 

There is no benefit to keeping someone awake after a concussion, and it is no longer recommended. In fact, people with a concussion need to sleep to recover. In the days before head CT scanning was widely available, the only way to know if someone had life-threatening brain bleeding (which occurs in less than 0.1 percent of those with concussion) was to observe him for a decrease in his level of alertness that resulted from the blood pressing on vital brain structures. This usually happened within six hours of injury. It was thought that if you could keep someone awake you could prevent him from lapsing into coma, which of course did not work.

Anyone getting very sleepy within six hours of a brain injury should be brought immediately to an emergency department for a head CT scan.

Posted on BrainLine July 12, 2012. Reviewed July 25, 2018.

Comments (42)

I hit my head but it was late at night anyway so I was tired anyway. Is there any other way to know if I’d need to go to the ER? Aside for that, “you should always go to a doctor when sustaining a head injury”. No one can afford that I just want to know if I’m dying.

In case anyone is curious, I survived the 75 foot tree falling and hitting me in the head. :D

Hi
Did you temporarily lose memory? Please tell me details about it my 16 year old son had car accident hit to a tree

Hi I just recently yesterday had received a concussion. I'm confused, seemingly dazed, and am having memory problems. My doctor says this is normal, and that with plenty of rest, and eating well my body will recover and I should get at least get all of my memories before the incident back.
I apologize for any typos I'm still a little out of it.

I just got knocked down by my dog and knocked my head really hard. And messed my back and knee up. Starting to get tired but it is also my normal time to go to bed. Should I stay awake.

I’m having the same issue I hit the top of my head on the wall while doing push-ups and it’s my bed time should I stay awake?

i hit the top of my head against the wall when i feii , i'm putting ice on a goose egg

i was at my track meet and me and a couple friends were racing and we accidentally bumped into each other fast forward i hit my head and it went pitch black then i woke up saying what am i running again

Hi Heavyn,
Please seek medical attention ASAP. "Blacking out" or losing consciousness (even if only briefly) is a symptom of concussion that should prompt an immediate trip to the hospital or emergency room. You can read more here: https://www.brainline.org/qa/when-go-hospital

One of my friends kicked a soccer ball into my face, on accident, straight into the eye from about 10-15 feet away really hard and my vision went completely black for a few seconds. It’s been like 7 hours and I still have a bad headache from it and am a little worried even thought that’s the only symptom I’ve had so far.

I hit my head hard one time when I fell and hit my head against concrete, I woke up and felt dizzy, and I was in pain for a while, and I stayed away for 6 hours or so, I’m doing good now, but I’m still wondering

While closing the car trunk I wasn’t paying attention and my car trunk hit my head. Later on in the day I became really tired (unsure whether it’s the injury or my going to bed late). I have a bump on my upper right temple and cannot sleep on my side because it hurts. Should I go to the ER?

Josephine, you could give your doctor's office a call and see what they advise.

I am 13 years old and this boy accidentally threw the ball at my head and now I'm scared to go to sleep because I don't know if it is serious and my mom tells me to not annoy her and I got really sleepy when I came back home

How ya going now

my little sister (7months) hit her head on the floor while she was sitting. i can't identify if she is sleepy or not. I already applied ice on her head. The redness is gone. I dont think she hurt her head that hard.

You're awesome for paying attention. Continue being a great older brother or sister. Hope all is well.

Let your parents know what happened.

In 2008 I hit my head on the top
Of my car door. I didn’t notice it until 2 weeks after when someone at work asked what happened to your head? I looked in the mirror and noticed a large bump. I left it alone thinking it would go away on its own. I put ice and did all that. Then a few months passed and I started getting headaches. Went to the dr and told him everything that has happened to me. I did a CT and MRI. He said nothing was on there that worried him so he just told me to take 600 mg ibuprofen. I was getting headaches everyday so I start taking ibuprofen everyday.
About a year later my headaches got worse and ibuprofen wasn’t helping. So, I went to the dr and told him ibuprofen wasn’t working anymore maybe my body has become immune to it. I wasn’t sure? He then referred me to a brain and spine specialist. I did the MRI and CT scan. They told me that it seemed like a benign tumor that couldn’t have been from a blunt trauma like hitting my head on the car. Later after 2 or 3 visits or headaches, finally decided with the dr that we should remove the tumor/ I had craniectomy to remove the benign tumor which then thought might have cancer underneath but they couldn’t see it through the MRI or CT scans. After surgery they sent the tumor to pathology and they said it looked to have been formed because of a blunt trauma to the head. Which is exactly what caused it and what I told the dr was the only reason I thought that bump appeared.

Simply AMAZING! Thanx for sharing that story!!

How has your progress been? What did they find? Hope you’re doing ok!

I fell hard last night. Did not hit head as hard as hip and shoulder. slept mostly for14 hours. Hard to stay awake

"very sleepy" is incredibly vague and subjective. What if the person worked long hours the day they bumped their head? Didn't sleep enough the night before...

This is currently my situation. Been fighting to stay asleep after hitting my head after being at work from7:01-9:12

I want to know if a child hit there head and fell asleep half hour after? What does that mean and what do I do.? My child is deaf so waking him up is hard and I don’t want to shake him. Can someone help me.

If you’re still looking for an answer... it may very possibly be a concussion. The easiest way to check that on your own is to flip off the lights in the room and move a flashlight by their eyes. If the pupils still dilate ( get large and then small) they are ok. If there is no dilation, you probably want to get that checked out

I hit my head and I have a knot on my head is it ok for me to lay down after I hit my head

If a 2year old fall off a bench, hitting the back of her head, should she be taken to the doctor are ER?

If you're asking whether or not you should go to the ER, you should probably go to the ER

I believe that the child should because I did that as a kid and it was very painful but it was a good thing that they took me because I could have died.

My 16 mo old just fell out of bed onto hard wood floors at 2 am. he cried inconsolably in my arms for few minutes then drank his milk and fell asleep in my arms .. he was very scared and this may explain his crying more than pain. I checked his hands and arms and legs for reflexes and they are present. He is a deep sleep now and I am so so worried that he sustained a brain injury.

Yes

I went to ER. The only thing they did was address all the cuts on my face! It was weeks before a CT was done! A year later things got very crazy for us when a MRI was done and they could see the damage!! This also was done at another Hospital!! So don't just say "ok" if you feel something is wrong!! If you see changes in the person after the fall keep looking for the "why"!!

It can take time for these things to show up on a CT scan , so doing one right away may not have shown anything anyways. As far as an MRI, this is usually not done right away in the ER unless there are severe concerning neurological symptoms

If someone just wrecked on a bike, fell when they were playing, or just had a big spill and hit their head, it hurts and scares them to the point their adrenaline level spikes very high. I've noticed when someone is scared to the point of crying in a traumatic incident they tend to fall asleep soon after they come down from that adrenaline rush. Couldn't this be the reason why someone might fall asleep soon after they experience a hit to the head during a somewhat traumatic experience and not just the hit to the head?

That's exactly what happened to me. I have really bad anxiety and I hit my head, thinking it was bad I freaked out. My adrenaline kicked and then afterwards I was sleepy. I went to the E.R. and they said I was fine so they didn't run a CT scan. This all happened tonight... Go figure

You obviously won't know if they sustained a "brain injury" as you can't directly see the brain (hopefully!). To state what he said another way, "within six hours of a head injury". The terms head injury and traumatic brain injury are often used interchangeably as somebody who sustains a good-sized head injury will often have a brain injury as well. However, "brain injuries" present on a wide spectrum from "really no injury at all" to "concussions" to "brain bleeds". That being said, not everybody who gets knocked in the noggin needs to be evaluated in an emergency department. Concussions in and of themselves are NOT life-threatening, and no treatment is needed (other than rest). However, one cannot tell if the patient has a more serious brain injury (such as a bleed). This is why it is important to pay attention to symptoms. Somebody who becomes very lethargic, difficult to arouse or awaken, may have a severe concussion, but more seriously, may have a brain bleed. A CAT scan is the only way to tell. Symptoms to worry about: excessive vomiting, significant confusion, lethargy, inability to stay awake or awaken, significant difference in pupil size, numbness/tingling or muscle weakness on one side.

What about dizziness?

Have to agree it is terrible idea keeping someone awake with brain injuries. For some one with brain injury it's not only should they go to bed early but also only watch 3 hours of tv a day. If you go against it it can make the person with brain injury very craby and tiered next day or even worse by having an over load witch is like a adrenaline shot.

Yes. Anyone who has had a tbi should go the the emergency room right away

In your article you said anyone getting very sleepy within six hours of a brain injury should be brought to the hospital for a CAT scan immediately. Maybe I don't understand the term brain injury. How would I determine the person had a brain injury? Shouldn't anyone sustaining a hard blow to the head be checked at a hospital?

Checking dilation of their pupils is how you can tell if they’ve suffered from traumatic brain injuries. Simply turn off the lights, lift a flashlight near their eyes. If their pupils dilate, they’re ok. If they don’t, that’s when they should be checked out at the ER.