Sleep problems after a concussion: what to discuss with your care team
Track your nights for two weeks and bring clear questions about sleep care
Imagine a 44 year old dental hygienist who was hit by a car while walking through a store parking lot. Three months later, she lies awake until 2 a.m. most nights and drags herself through work. At her last checkup, she said, “I’m not sleeping well.” She left with a sheet of sleep tips and no plan.
Many people sleep poorly after a concussion, and a short visit leaves little time to describe it. This guide helps you bring the details: a two week sleep diary, a plain way to explain how poor sleep affects your days, and questions about care.
A sister page, sleep and memory after concussion, looks at how sleep affects memory and at treatment options in depth. This one is a toolkit for the conversation with your care team.
Why sleep deserves a spot on your visit list
Sleep trouble after a head injury is very common. A 2012 review pooled 21 studies of people with brain injuries of all levels [1]. Half had some form of sleep disturbance, and 25% to 29% had a diagnosed sleep disorder, such as insomnia or sleep apnea [1]. Those rates were far higher than in the general population [1].
A Canadian guideline for adults, the Living Concussion Guidelines, puts the share of concussion patients with sleep problems above 50% [2]. It says insomnia symptoms show up in roughly 70% [2]. The patient version describes insomnia as trouble falling or staying asleep, or sleep that does not feel restful [3]. It adds that sleep problems are very common when the injury also causes pain [3].
Sleep matters for the rest of your recovery too. The guideline notes that poor sleep may make headaches, fatigue and mood problems worse [2]. That is why it asks care teams to screen every patient for sleep problems and to make sleep care a priority [2].
The same guideline says most sleep problems after a concussion clear up on their own with time [2]. A U.S. military and veterans guideline adds that these problems are checked and treated much as they are in anyone else [5]. Standard sleep care applies to you.
Keep a two week sleep diary
A sleep diary needs only paper, a pen and a few minutes each day. Sleep researchers call a nightly diary the “gold standard” for tracking sleep as you experience it [4]. A group of experts built a standard version, the Consensus Sleep Diary, so that everyone records the same core facts [4].
The guideline’s patient pages suggest keeping a diary for 1 to 2 weeks [3]. Fill in the morning part within an hour of getting out of bed, and fill it in every day [4]. Include workdays and days off. Clinicians often ask about your sleep times on both [10].
The tables below follow the core items of the consensus diary for mornings [4]. The evening items come from the sleep diary attached to the Canadian guideline [11]. Print one copy of each for every week.
Worksheet from Safety Behind the Wheel Foundation
Morning sleep diary (fill in within an hour of waking)
| Night of | Got into bed; tried to sleep | Time to fall asleep; times awake and for how long | Final wake time; out of bed; sleep quality 1 to 5 |
|---|---|---|---|
| Sun (example) | 10:30 p.m.; 11 p.m. | About 90 min; woke twice, 40 min total | 5:45 a.m.; 6:15 a.m.; 2 |
| Mon | |||
| Tue | |||
| Wed | |||
| Thu | |||
| Fri | |||
| Sat | |||
| Sun |
Columns follow the core items of the Consensus Sleep Diary [4]. Use your best guess for times. You do not need to check the clock at night.
Worksheet from Safety Behind the Wheel Foundation
Evening day log (fill in before bed)
| Day | Naps: when and how long | Caffeine, alcohol, medicines: what time | Dozing, mood, and what poor sleep cost you today |
|---|---|---|---|
| Mon (example) | 3 p.m., 45 min on couch | Coffee 2 p.m.; wine 8 p.m. | Nodded off at desk; snapped at son; cut work short |
| Mon | |||
| Tue | |||
| Wed | |||
| Thu | |||
| Fri | |||
| Sat | |||
| Sun |
Items adapted from the sleep diary attached to the Living Concussion Guidelines [11] and from NHLBI guidance [10]. In your own copy, write the name of each medicine and the time you took it.
Tips that make the diary easier
Keep the pages and a pen by your bed. Set one alarm in the morning and one at night as reminders. A bed partner can help here. Ask them to note any loud snoring, gasping or pauses in breathing they hear. A U.S. federal health agency, the National Heart, Lung, and Blood Institute (NHLBI), lists loud snoring and waking up gasping among the things a clinician may ask about [10].
Read your diary before the visit
At the end of two weeks, spend ten minutes looking for patterns. Count the nights it took you a long time to fall asleep. Add up nap time. Note the days you dozed off when you did not mean to.
Then match what you see to the table below. The table cannot diagnose you, but it can help you pick the right questions.
Comparison compiled by Safety Behind the Wheel Foundation
What your diary may show and what to ask
| Pattern in your diary | What it may point to | Question to bring |
|---|---|---|
| Long time to fall asleep or long stretches awake, most nights | Insomnia | Is CBT for insomnia right for me, and who offers it? |
| Loud snoring, gasping, morning headaches, sleepy all day | Possible sleep apnea | Should I be screened or have a sleep study? |
| Dozing while reading, watching TV or riding in a car | Too much daytime sleepiness | Should I see a sleep specialist, and is it safe to drive? |
| Sleep times 2 or more hours later than your day requires | A delayed body clock | Should I keep a longer diary or wear an activity tracker? |
| Poor nights after pain or headache | Pain that disturbs sleep | Can we treat the pain that keeps me awake? |
Sources: Living Concussion Guidelines [2, 3]; TBI Model Systems sleep apnea factsheet [7]; TBICoE guidance [8]; NHLBI [12]. Only a clinician can diagnose a sleep disorder.
For body clock problems, military guidance for primary care calls for a sleep diary over 7 to 14 days that covers work and free days [8]. It may also use a wrist worn monitor that records movement day and night [8].
Explain how poor sleep affects your days
Saying you are tired rarely tells your clinician enough. Specific examples of what you could not do after a bad night give them more to work with.
The NHLBI says that too little sleep can make it harder to learn, focus and react quickly [12]. Decisions, problem solving and memory may suffer too [12]. Work, school, driving and social life can all take a hit [12]. The Canadian patient guide notes that poor sleep can affect how you get along with others [3].
Cover these areas
Use the last column of your evening log to fill in one or two lines for each area:
- Work or school: tasks you slowed down on, mistakes, hours cut.
- Memory and focus: things you forgot or had to reread.
- Mood: short temper, worry, low days.
- Headaches and pain: whether they were worse after a bad night.
- Driving: any time you felt drowsy at the wheel.
- Home and family: chores or plans you skipped.
Your care team may hand you short forms. Military guidance lists two common forms: the Insomnia Severity Index, plus the Epworth Sleepiness Scale when staying awake is a concern [8]. The NHLBI says you may be short on sleep if you often feel you could doze off while reading, watching TV or riding in a car for an hour [12].
A short script
Practice saying something like this at the start of the visit:
- I have kept a sleep diary for two weeks.
- Most nights I lie awake more than an hour before I drift off, then wake twice.
- On the worst days, I cut work short and nodded off at my desk twice.
- I want to know what is causing this and what treatment you suggest.
Ask about CBT for insomnia
If insomnia shows up in your diary, ask about cognitive behavioral therapy for insomnia, or CBT for insomnia. It is a structured talk therapy for sleep. It pairs ways of changing unhelpful thoughts about sleep with teaching about how sleep is regulated [13]. It also uses steps that change sleep habits, such as stimulus control and limiting time in bed [13].
Several guidelines agree on putting it first:
- The Canadian guideline says to refer people who have insomnia after a concussion for this therapy [2].
- The VA/DoD guideline says care without medicine should be considered a first line treatment for chronic insomnia [5].
- Military guidance for primary care prefers CBT for insomnia or a shorter brief behavioral treatment [8].
- The American Academy of Sleep Medicine gives CBT for insomnia a strong recommendation in its guideline for all adults with chronic insomnia [6].
Treatment often takes four to eight sessions [13]. If a therapist is hard to find, the Canadian guideline asks primary care to at least share sleep habit advice and self help tools [2]. The VA and the Defense Health Agency offer free apps, including one built around CBT for insomnia [8].
Good sleep habits help, but on their own they are not a treatment for a sleep disorder [8]. The academy suggests against using sleep habit advice as the only treatment for chronic insomnia [6].
If sleep medicine comes up
The Canadian guideline says medicines could be considered when care without medicine has not worked [2]. It favors short use and avoiding medicines that can cause dependence [2]. If you are prescribed a sleep medicine, the patient guide says to avoid both driving and alcohol while you are taking it [3]. Never start, stop or change a sleep medicine on your own.
Ask about sleep apnea
In obstructive sleep apnea, soft tissue in the throat gets in the way of air moving to the lungs during sleep [7]. It turns up often after brain injuries of every severity [7]. Watch for snoring that is loud or frequent, choking sounds at night, headaches on waking, trouble paying attention, and fighting sleep during the day [7].
Clinicians often start with a short yes or no questionnaire [7, 8]. In military guidance, a score in the middle range on one such screen calls for a referral to sleep medicine [8]. You may take the sleep test in your own bed at home or spend a night in a sleep lab [7]. Treatment may include a bedside machine that blows moist air to hold the airway open during sleep, or a mouth device for mild to moderate cases [7].
Untreated sleep apnea can raise the risk of accidents [7]. A 2013 CDC report on survey data from 19 states and Washington, D.C., found that snoring and sleeping 6 hours or less were each linked to drowsy driving [14].
Drowsy driving: protect yourself and others
Federal road safety figures show that drowsy driving crashes took 644 lives in 2024 [9]. That count comes from NHTSA, the National Highway Traffic Safety Administration [9]. It estimates that 91,000 police reported crashes in 2017 involved drowsy drivers, and it notes wide agreement that this figure understates the problem [9]. The NHLBI says lack of sleep can harm driving as much as being drunk, or more [12].
Military guidance lists trouble staying awake or feeling sleepy while driving as a red flag that calls for an immediate sleep medicine referral [8]. Tell your care team right away if this happens to you.
Warning signs on the road
A CDC training page on fatigue lists these signs [15]:
- Heavy eyelids, frequent blinking, or trouble focusing.
- Yawning again and again, or rubbing your eyes.
- Not remembering the last few miles, or missing an exit or sign.
- Drifting out of your lane or hitting a rumble strip.
- Feeling restless and cranky.
If you notice any of them, get off the road. NHTSA advises finding a safe spot, such as a well lit rest stop, and pulling over for a short nap [9]. Coffee by itself may not be enough, and the boost wears off quickly [9]. Alcohol adds to sleepiness and makes impairment worse [9]. Some medicines can cause drowsiness too, so NHTSA advises checking the labels on prescription and store bought medicines [9].
Before you drive
Checklist from Safety Behind the Wheel Foundation
- I slept about as long as my diary says is normal for me.
- I have not had alcohol today.
- I checked my medicine labels for drowsiness warnings.
- The trip is short, or someone can share the driving.
- I know where I can pull over safely.
- I will stop at the first warning sign.
For more on driving after a concussion, see the article on returning to driving in this section and the live page on drowsy driving.
Signs that need emergency care
After a recent head injury, sleepiness can be a danger sign. Dial 911 or get emergency care at once if the injured person [16]:
- Is very hard to wake, cannot be woken, or blacks out.
- Has head pain that worsens and stays.
- Has new weakness or numbness, clumsy movements, or a seizure.
- Throws up several times.
- Slurs words or behaves strangely.
- Has pupils that do not match in size.
- Seems confused, agitated or restless, or fails to recognize people and places they know.
Questions to ask your care team
About my sleep
Question checklist from Safety Behind the Wheel Foundation
- Based on my diary, what kind of sleep problem do you think I have?
- Would a sleep questionnaire help, or should I track my sleep for longer?
- Could my snoring or daytime sleepiness mean sleep apnea, and do I need a sleep study?
- Could pain, headaches, worry or any of my medicines be keeping me awake?
About my care
Question checklist from Safety Behind the Wheel Foundation
- Who near me offers CBT for insomnia, and can I do it by video or through an app?
- How many sessions should I expect, and will my health plan cover them?
- What should I try at home while I wait for treatment?
- If my sleep does not improve, when should I see a sleep specialist?
About safety
Question checklist from Safety Behind the Wheel Foundation
- Am I safe to drive at this point, and which signs mean I should stop?
- Do any of my medicines make drowsy driving more likely?
Frequently asked questions
Do I need a sleep tracker or app?
A paper diary is enough to start. The Canadian guideline mentions monitoring devices as one way to track long lasting insomnia [2]. Ask your clinician before you buy one.
Will my sleep go back to normal?
For most people, sleep problems after a concussion improve with time [2]. If they last, effective treatments exist, so keep raising sleep at your visits.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Poor sleep after a concussion is common, and many people improve with time [1, 2]. You can help your care team by bringing a two week sleep diary, a few lines on how poor sleep affects your days, and grouped questions.
Ask about CBT for insomnia and, if you snore or feel sleepy all day, about a sleep apnea screen [2, 7]. Do not drive when you feel drowsy [9]. Check with your own health plan about coverage for sleep studies and therapy, and talk with your care team before changing any medicine.
Sources and further reading
- 1Mathias JL, Alvaro PK. Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis. Sleep Medicine. 2012;13(7):898-905. doi.org/10.1016/j.sleep.2012.04.006
- 2Living Concussion Guidelines. Section 7: Sleep-wake disturbances. Updated May 2023. concussionsontario.org/…/sleep-wake-disturbances
- 3Living Concussion Guidelines. Sleep-wake problems (patient version). Updated July 2025. concussionsontario.org/…/sleep-wake_problems
- 4Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35(2):287-302. doi.org/10.5665/sleep.1642
- 5Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury, version 3.0. Provider summary. June 2021. healthquality.va.gov/…/VADoDmTBICPGProviderSummaryFinal508.pdf
- 6Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255-262. doi.org/10.5664/jcsm.8986
- 7Bell K, Greenwald BD, Nakase-Richardson R. Obstructive sleep apnea after traumatic brain injury. Model Systems Knowledge Translation Center. 2022. msktc.org/…/obstructive-sleep-apnea-after-tbi
- 8Traumatic Brain Injury Center of Excellence. Assessment and management of sleep disturbances following concussion/mild traumatic brain injury: guidance for the primary care manager. Defense Health Agency. September 2024. health.mil/…/Management-of-Sleep-Disturbances-Following-ConcussionmTBI-Clinical-Recommendation
- 9National Highway Traffic Safety Administration. Drowsy driving: avoid falling asleep behind the wheel. Accessed October 2026. nhtsa.gov/risky-driving/drowsy-driving
- 10National Heart, Lung, and Blood Institute. Sleep deprivation and deficiency: diagnosis. Updated July 30, 2026. nhlbi.nih.gov/…/diagnosis-treatment
- 11Living Concussion Guidelines. Appendix 7.6: Sleep diary (adapted from the National Sleep Foundation). 2023. concussionsontario.org/…/appendix-7-6.pdf
- 12National Heart, Lung, and Blood Institute. Sleep deprivation and deficiency: how sleep affects your health. Updated June 15, 2022. nhlbi.nih.gov/…/health-effects
- 13Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine. 2021;17(2):263-298. doi.org/10.5664/jcsm.8988
- 14Wheaton AG, Chapman DP, Presley-Cantrell LR, Croft JB, Roehler DR. Drowsy driving: 19 states and the District of Columbia, 2009-2010. MMWR. 2013;61(51):1033. cdc.gov/mmwr/preview/mmwrhtml/mm6151a1.htm
- 15National Institute for Occupational Safety and Health, CDC. Module 11. Driving, warning signs. Last reviewed March 31, 2020. cdc.gov/…/03.html
- 16Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
This article reflects the safety priorities of sleep health, concussion recovery and road safety education. It is general information, not medical advice, and it cannot diagnose a sleep disorder or clear you to drive. Check official sources, review your own health plan, and talk with your care team before you change any sleep habit, device or medicine. Reviewed October 2026.
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