Lack of Sleep, Stress Can Cause Symptoms Resembling Concussion


Because there are multiple sources for concussion-like symptoms, student-athletes’ post-concussion care should zero in on which symptoms are specifically caused by the injury and which may be caused by other issues.

New research suggests that a lack of sleep and stress can cause symptoms similar to those of a concussion, supporting researchers’ arguments that athletes recovering from a brain injury should be assessed and treated on an individualized basis.

The survey was administered to nearly 31,000 cadets from 4 US military service academies as well as students who competed in National Collegiate Athletic Association (NCAA) sports at 26 US higher education institutions. The cadets undergo rigorous training and are required to participate in athletics, according to a press release. The study was conducted by the Concussion Assessment, Research, and Education Consortium established by the NCAA and US Department of Defense.

For the research, 12,039 military service academy cadets and 18,548 NCAA student-athletes completed the Sport Concussion Assessment Tool symptom evaluation as part of baseline testing. The consortium also collected demographic data and personal and family medical histories from participants.

The investigators found that between 11% and 17% of healthy college athletes with no history of a recent concussion reported symptoms that met the criteria for post-concussion syndrome (PCS). The survey found lack of sleep, pre-existing mental health problems, and stress were the most common predictors of PCS-like symptoms. Furthermore, between 50% and 75% of all the athletes surveyed reported 1 or more symptoms commonly experienced by people who have had a concussion, with the most common being fatigue, low energy, or drowsiness.

“The numbers were high and were consistent with previous research in this area, but it is quite shocking,” said lead author Jaclyn Caccese, PhD, in a statement. “These are elite athletes who are physically fit, and they are experiencing that many symptoms commonly reported following concussion. So, looking across the general population, they’d probably have even more.”

The investigators said it is important to understand that there are multiple potential sources for these symptoms. Therefore, student-athletes’ post-concussion care should zero in on which symptoms are specifically caused by the injury and which may be caused by lack of sleep or stress. The authors added that knowing athletes’ medical history and baseline symptom status may help clinicians predict which pre-existing factors could contribute to a slower concussion recovery.

“When a patient comes into the clinic and they are a month or more out from their most recent concussion, we need to know what symptoms they were experiencing before their concussion to know if their symptoms are attributable to their concussion or something else,” Caccese explained in the press release. “Then we can start treating the concussion-related symptoms to hopefully help people recover more quickly.”

A statistical analysis found which factors in athletes’ medical histories were most closely associated with reports to symptoms that aligned with PCS criteria. Among cadets, 17.8% of men and 27.6% of women reported a cluster of symptoms meeting PCS criteria. Among NCAA athletes, 11.4% of men and 20% of women reported combined symptoms mimicking the PCS criteria. In the press release, Caccese said the varied timing of data collection at military service academies compared with NCAA preseason testing likely contributed to symptoms reported by a higher percentage of cadets.

For both groups, sleep problems and pre-existing psychiatric disorders were the most predictive conditions, and a history of migraines also contributed to symptoms that met PCS criteria. In cadets, the investigators found that academic problems and being a first-year student increased odds of having symptoms that met PCS criteria, whereas a history of attention-deficit hyperactivity disorder or depression contributed to meeting PCS criteria in NCAA athletes.

The investigators noted that recognizing a concussion and determining return to play is based on reported symptoms, which can be a complicating factor with high symptom reporting. Although some symptoms may be more closely connected to concussion than others—such as dizziness, head pressure, or sensitivity to light or noise—others, such as fatigue, drowsiness, and headaches, can be linked to a variety of causes.

“Perhaps we can create a battery of symptoms more specific to concussion,” Caccese concluded. “That is another project in this series—trying to see if there are groups of symptoms or specific symptoms that may be more able to identify individuals with concussion.”


Lack of sleep, stress can lead to symptoms resembling concussion [news release]. Ohio State University; January 22, 2021. Accessed January 25, 2021.

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