Can you sleep with a concussion? Sleep, screens and flying after a head injury

Many people grew up hearing that you must keep someone awake after a bang to the head. Current UK guidance is calmer than that, and more useful. This guide covers sleep, screens, flying and the other everyday decisions that come up in the first days and weeks after a concussion.

It assumes the injury has been assessed, or that none of the NHS warning signs apply. If someone is getting more drowsy, cannot stay awake, has a seizure, keeps vomiting, has new weakness or is becoming confused, call 999.

Can you sleep with a concussion?

Usually, yes. The NHS advice for a minor head injury is to rest and avoid stress, and it says plainly that you do not need to stay awake if you are tired.

What the guidance does ask for is company. The NHS says an adult should stay with you for at least the first 24 hours. NICE's written advice for adults leaving hospital says not to stay at home alone for the first 24 hours, and to stay near a telephone for the first 24 to 48 hours. NHS inform in Scotland suggests a responsible adult monitors someone with a suspected concussion for 72 hours. If a hospital gave you written advice, follow that.

The line between ordinary tiredness and a warning sign is how hard it is to stay awake. The NHS lists being unable to stay awake or keep your eyes open as a reason to call 999. NICE's discharge advice tells people to go back to the emergency department for drowsiness that lasts longer than 1 hour when they would normally be wide awake.

A few practical points:

• Avoid sleeping pills. The NHS says not to take them while recovering unless a doctor advises you to. NICE extends that to sedatives and tranquilisers unless they have been prescribed.
• Skip alcohol. The NHS, NICE and Headway all advise avoiding it while you recover.
• Expect some disruption. NICE lists problems sleeping among the symptoms that are common after a head injury and should disappear within 2 weeks.

Should you avoid screens after a concussion?

For the first day or two, it makes sense to cut right back. NHS inform's graduated return plan recommends 24 to 48 hours of relative rest, keeping time spent looking at TVs, computers and phones to a minimum. After that, screen time, reading and games can be built back up gradually.

There is some trial evidence behind this. A randomised trial in JAMA Pediatrics enrolled 125 people aged 12 to 25 who attended an emergency department with concussion. Those asked to avoid screens for 48 hours took a median of 3.5 days for symptoms to settle, against 8 days for those allowed screens. It was a single-centre study that relied on self-reported screen use, and it did not include older adults, so treat it as supportive rather than definitive.

In practice, that might mean:

• phone calls instead of scrolling
• larger text and lower brightness when you do need a screen
• short blocks with breaks, rather than an afternoon at a laptop
• stopping to rest if a headache or dizziness builds

Can you fly with concussion?

There is no single rule, and UK organisations say so. Headway's travel guidance says it cannot advise on the safety of flying after brain injury, because there is no set rule and it depends on personal circumstances. It suggests checking with your GP or neurologist.

A travel leaflet from the Scottish Trauma Network in NHS Highland explains why caution makes sense. Cabin pressure changes, engine noise and turbulence can intensify concussion symptoms. It advises always seeking medical advice before flying, especially after seizures, bleeding within the brain or a skull fracture. For a mild concussion, it suggests considering a wait of 24 to 48 hours after symptoms have gone before flying, and longer after more significant injuries.

Two other points are worth knowing:

• Surgery changes things. The UK Civil Aviation Authority notes that neurosurgery may leave gas trapped within the skull, and advises avoiding air travel for approximately 7 days afterwards. It also says passengers with traumatic injuries in the 7 days before travel should contact their airline.
• Research on mild cases is reassuring, with caveats. A cohort study of US college athletes and military cadets compared 92 people who flew within 72 hours of a concussion with 1,383 who did not, and found no link between flying and slower symptom recovery. Participants were young athletes and cadets, so the result may not apply to everyone.

If you do fly, the NHS Highland leaflet suggests short direct flights, avoiding overnight flights, an eye mask, noise-cancelling headphones, staying hydrated and moving around when it is safe. Headway recommends checking that your travel insurance covers your brain injury.

What should you do in the first two weeks?

Most guidance follows the same shape: brief rest, then a gradual return.

1. Rest for 2 to 3 days. NICE advises this, then gradually returning to normal activities, guided by symptoms. If they get worse, go back to a level of activity that was manageable. NHS inform adds that light activity has been shown to be more beneficial than complete rest.
2. Go back to work in steps. NHS inform's plan moves from gentle daily activity to tasks that take more mental effort, such as working from home with breaks, before a full return.
3. Do not drive until you feel fully recovered. After a serious head injury, GOV.UK says you must tell the DVLA. Ask your doctor if you are not sure.
4. Keep away from contact sport. The NHS says at least 3 weeks. NHS inform's plan takes a minimum of 21 days, with no return to competitive sport until there have been no symptoms for 14 days.
5. Use paracetamol for headaches, and avoid alcohol and sleeping tablets.

What if you are still struggling after two weeks?

See a GP if symptoms last more than 2 weeks, or if you are unsure about driving, work or sport. NHS inform calls symptoms lasting more than 28 days post-concussion syndrome.

For symptoms that have gone on for months, some people ask about hyperbaric oxygen therapy. It is not aftercare for a recent injury. The most relevant recent trial, in Scientific Reports, involved 47 adults injured between 6 months and 10 years earlier, 40 sessions at 1.5 ATA and a sham comparison. It reported a larger improvement with HBOT, but it was small, it stopped early and both groups improved. Our head injury evidence page sets out what it can and cannot tell you, and what happens in an HBOT session describes the practical side. If that is a step you want to take, you can see available times.