In the 1999 movie “10 Things I Hate About You,” Heath Ledger’s character tells Julia Stiles’ character she can’t fall asleep after hitting her head on a lamp.
“Sleep is good,” Stiles’ character says.
“Not if you have a concussion,” Ledger’s character responds.
It’s an oft-repeated factoid in pop culture, on Internet message boards, and by parents and onlookers at sporting events—don’t sleep if you have a concussion, it could be dangerous, even deadly.
Just one problem: It’s hogwash.
“Avoiding sleep is the last thing you want to do,” said Matt Axtman, DO, a sports medicine specialist with the Spectrum Health Medical Group. “That’s an old wives’ tale. An urban myth. … Good early sleep, I think, is the biggest factor in a quick recovery.”
An estimated 1.7 million Americans are treated every year after suffering concussions—also known as mild traumatic brain injury—from car crashes, sports injuries, military combat and other causes. Symptoms run the gamut, from headaches to nausea, vomiting, double vision, balance problems, light sensitivity, slurred speech and memory loss.
But despite an increased focus—the U.S. Department of Defense has spent $800 million in research over the last decade and the NFL tens of millions more—a lot of myths and questions about concussions linger.
Michael Lawrence, PhD, who specializes in neuropsychology and concussions at Spectrum Health, describes the brain like a highway toll plaza. Each toll lane is a different brain function: Memory, focus, vision, language and so on.
When you get a concussion, “It’s like a snow globe. All the gates open at the same time, everything floods through and gets shaken up and mixed around,” Dr. Lawrence said.
It takes significant energy to get all the pieces back in the right place. If you stay awake, he said, your brain has to expend energy on many other functions, and it doesn’t have enough energy to rapidly heal. This allows symptoms to linger.
“Sleep allows the gas tank to fill up and the gates to shut automatically,” Dr. Lawrence said. “The more the patient sleeps, the better.”
The recent increased focus on concussions has dovetailed with the NFL’s spike in popularity, former athletes speaking out about head injuries, and soldiers returning home from two wars, often with lingering head trauma.
The first key to dealing with concussions is for parents, athletes, soldiers and physicians to recognize that concussions are serious problems, Dr. Lawrence said, and to pull athletes and soldiers from sporting events and combat situations if they see a possible issue.
“There’s an adage we use: ‘If there’s doubt, sit them out,” noted Dr. Lawrence, who helps run two concussion clinics. “When people continue to play through concussions, the symptoms last a whole lot longer.”
He recommends athletes sitting out 10 to 15 minutes because symptoms are sometimes delayed. In the meantime, physicians should test functions such as attention span, vision, the brain’s processing speed, balance and memory.
Katie Vander Sloot, 18, knows all too well about delayed symptoms and the problems that can be caused by not sitting out. A recent graduate of Crossroads Charter Academy in Big Rapids, Vander Sloot was playing for the softball team May 18, when she was struck in the head by a wild pitch.
The ball struck her helmet, right above her left temple. It was the second inning of the first game of a doubleheader.
“I don’t remember the ball hitting me, all I remember is the ump telling me to go to first base,” she said. “I don’t remember walking to first base, I don’t remember talking to my coaches. … But I ended up playing the rest of game at third base, and played the whole second game in right field.”
Vander Sloot said she told her coaches she was fine because “I’m a bull-headed person, I didn’t want to sit, and it was my senior season.”
Her symptoms were also delayed. It wasn’t until halfway through the first game that she started “feeling more dizzy, double vision, my head really hurt. I started feeling really nauseous.”
But she still didn’t tell anybody. Her symptoms lingered for six weeks, especially a painful persistent headache and double vision in her left eye. She was finally cleared by doctors on June 30 to resume athletics.
If she could do it all again, she would sit out right away.
“I definitely wouldn’t play those two games,” she said. “I do see that that did prevent me from playing (for another six weeks). … I constantly had that headache, it never went away. It was very scary.”
Despite frequent discussions in the media of long-lasting symptoms and brain damage, almost everybody will fully recover from concussions, Dr. Lawrence said. About 75-80 percent of patients recover with just rest.
And after prescribing medication for vision and vestibular health, as well as possible physical therapy, patients have a 95-98 percent success rate.
There are also preventative measures athletes, coaches and parents can take to minimize the effects of a concussion.
Some schools and health systems, such as Spectrum Health, provide baseline testing for the brain. The tests measure reaction time, cognitive function and memory, so if a concussion has affected those brain functions, it can be immediately diagnosed. Furthermore, it can tell doctors when the brain has returned to its normal state and the patient is ready to resume full-time activities.
Dr. Axtman also recommends a six-day return-to-play protocol for athletes, which can speed up recovery and prevent long-term symptoms.
On Day 1, do no activity.
On Day 2, mild activity for 20-30 minutes such as light jogging, biking or light weightlifting.
Day 3 involves a slight increase in intensity from the previous day’s activities.
Day 4 is a high-intensity workout, but still only non-contact sports activities.
Day 5 is participating in a full practice.
Day 6 is participating in a full game.
“It’s always one step forward or one step back,” Dr. Axtman said, adding if you experience any lingering symptoms, you must go one day backward on the protocol instead of one day forward.
Other small tips: Consider scheduling a doctor’s appointment instead of going to the emergency room. Buzzing phones, lots of people, alarms and intercom systems can cause a lot of brain stimulation, which only worsens the symptoms. Also, patients should decrease computer use and take breaks at school or work.