Lack of sleep and stress can lead to symptoms like those of post-concussion syndrome (PCS), a new paper reports. While it found that between 11% and 27% of the student athletes questioned had such symptoms, the overall percentage is likely higher in the general population due to lower overall fitness levels.

The findings suggest that a lot of us might unknowingly be bumbling our way through life with concussion-like symptoms, which can’t be good for us. The paper adds that the most reliable predictors of PCS-like symptoms were lack of sleep, pre-existing mental health problems, and stress. All in all, the authors say these findings suggest we need a more individualized treatment approach for athletes recovering from brain injury. It probably also means we should all get more sleep.

Hit in the head

“The numbers were high, and were consistent with previous research in this area, but it is quite shocking,” said study lead author Jaclyn Caccese, assistant professor in The Ohio State University School of Health and Rehabilitation Sciences.

“These are elite athletes who are physically fit, and they are experiencing that many symptoms commonly reported following a concussion. So looking across the general population, they’d probably have even more.”

The participants were healthy college athletes (with no recent history of concussions at the time of the study) from four U.S. military service academies and students who competed in NCAA sports at 26 U.S. higher education institutions. The study was conducted by the Concussion Assessment, Research, and Education (CARE) Consortium.

Between 11% and 27% of 31,000 participants reported combinations of symptoms that meet the official definition of post-concussion syndrome (PCS). Between 50% and 75% further reported one or more symptoms commonly seen in post-concussion individuals, including fatigue or low energy and drowsiness.

Now, the symptoms by themselves aren’t conclusive proof of anything — several things can cause them. Student athlete post-concussion care aims to determine those symptoms caused by injury through a variety of means, including knowing the medical history and baseline symptom status of each individual.

“When a patient comes into a 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. Then we can start treating the concussion-related symptoms to hopefully help people recover more quickly,” Caccese said.

Post-concussion syndrome is a persistent condition following a concussion with symptoms ranging from persistent headaches, dizziness, and fatigue to anxiety, insomnia, and loss of concentration and memory. Although we know it’s associated with concussion, we don’t understand why these symptoms appear.

The research was aimed at bettering our knowledge of concussion effects and recovery among student athletes at colleges, universities, and military service academies. But the findings may be more broadly applicable than the team hoped.

Statistical analyses of the data showed that some of the factors in participants’ medical histories were also more likely to be associated with reported symptoms indicative of PCS. Among military cadets, 17.8% of men and 27.6% of women reported symptom groups that met PCS criteria. Among NCAA athletes, 11.4% of men and 20% of women reported the same.

Sleep problems, particularly getting insufficient sleep the night before the trial, and psychiatric disorders were the most reliable predictors of these symptoms. A history of migraines also contributed to symptoms that met PCS criteria. For cadets, being a first-year student and experiencing academic difficulties were tied to an increased chance of meeting PCS criteria, while for NCAA athletes history of ADHD or depression did the same.

One limiting factor of the study is that it relied on self-reported data, which is notoriously unreliable as it’s subjective. At the same time, some symptoms may be more closely tied to a concussion while others could be due to a variety of causes.

“Perhaps we can create a battery of symptoms more specific to concussion,” said study lead author Jaclyn Caccese, assistant professor in The Ohio State University School of Health and Rehabilitation Sciences.

“This hopefully not only shows clinicians that we need to consider how people would have presented before injury, but also provides some normative data so they can interpret other patients’ data. We really don’t know a lot about why people have persistent symptoms, and it seems to be very variable. So we’re trying to understand this better to help predict who will have a prolonged recovery, and who will not.”

The paper “Factors Associated with Symptom Reporting in U.S. Service Academy Cadets and NCAA Student Athletes without Concussion: Findings from the CARE Consortium” has been published in the journal Sports Medicine.