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Coma & Disorders of Consciousness

A coma is a deep state of unconsciousness after a serious injury or illness. Some people wake within days or weeks; others move through slower stages of recovery. This guide explains what families can expect, how to work with the care team, and how to look after yourself.

Call 911 if someone can’t be woken up, doesn’t respond, or is not breathing normally. Tap their shoulder, shout “Are you okay?” and look to see whether they are breathing normally — gasping or gurgling is not normal breathing (MedlinePlus). Emergency instructions for an overdose and for severe low blood sugar both say to turn an unconscious person onto their side, stay with them until help arrives, and give food or drink only once they are awake and able to swallow safely (CDC, FDA drug label, DailyMed). If a neck or spine injury is possible, for example after a fall or crash, leave moving them to emergency responders, who use a collar and backboard to protect the spinal cord (NINDS).

Not breathing, or only gasping? Call 911, start CPR and send someone for an AED if one is nearby. Reading about CPR is not the same as hands-on training, so a CPR class is the best way to be prepared (MedlinePlus).

Possible opioid overdose — signs include being unable to wake up, slow or shallow breathing or choking sounds, bluish or discolored lips or nails, and tiny “pinpoint” pupils. Give naloxone (Narcan) if you have it and call 911, try to keep the person awake and breathing, lay them on their side, and stay until help arrives (CDC). Naloxone is sold over the counter in all 50 states, more than one dose may be needed with strong opioids such as fentanyl, and it won’t harm someone who has overdosed on something other than opioids (CDC). Stay with them until emergency help arrives (CDC), and if they are not breathing normally, start CPR (MedlinePlus).

Diabetes and possible low blood sugar: very low blood glucose can make a person lose consciousness or have a seizure, and severe low blood sugar is dangerous and needs treatment right away. Glucagon, given as an injection or nasal spray, is the best way to treat it; family and friends can be taught when and how to give it, and should call 911 right away after giving it or if no glucagon kit is on hand (NIDDK). If the person is unconscious, turn them onto their side, and offer a fast-acting source of sugar such as juice only once they can swallow safely (FDA drug label, DailyMed).

What is a coma?

A coma is a long, deep state of unconsciousness. A person in a coma is alive but cannot move or respond to their surroundings (NINDS). They may look asleep, but unlike sleep, their eyes stay closed and nothing — on its own or in response to sound or touch — rouses them (MSKTC, Intensive Care Medicine, 2026). A coma rarely lasts more than 2 to 4 weeks (MedlinePlus).

Many people in intensive care are also given sedating medicines. These can mask how alert someone really is, so the team keeps them to the lowest amount and shortest time that works and, when possible, checks the person’s responses without sedation (Intensive Care Medicine, 2026).

What causes it?

Coma happens when an illness, injury, medicine or drug disrupts the brain systems that keep us awake and aware — mainly a network in the brainstem and its connections through the thalamus to the outer layer of the brain. Some causes switch these systems off without destroying them and may be reversible; others damage the brain directly (Intensive Care Medicine, 2026). Causes include (Intensive Care Medicine, 2026):

  • head injuries (traumatic brain injury), including bleeding in the brain;
  • stroke, from a blocked blood vessel or bleeding in the brain;
  • lack of oxygen, for example when the heart stops (cardiac arrest);
  • overdose or poisoning, for example with opioids, sedatives or carbon monoxide;
  • severe infections such as meningitis, encephalitis or sepsis;
  • metabolic problems, such as very low or very high blood sugar, very low or high sodium, liver or kidney failure, or certain hormone emergencies;
  • seizures, including ongoing seizures that can only be seen on a brain-wave test (EEG), and bleeding, swelling or fluid buildup that presses on the brain.

How doctors assess consciousness

The Glasgow Coma Scale (GCS) is a nearly universal tool, used by everyone from emergency responders to critical care nurses, for following a person’s level of consciousness during a hospital stay. It scores three things — eye opening (1 to 4), speech (1 to 5) and movement (1 to 6) — for a total from 3 to 15; the lower the score, the more severe the injury, and doctors often describe a score of 8 or less as coma. It has limits: it leaves out some brainstem reflexes, it is harder to use when someone is sedated or has a breathing tube, and the same total can describe quite different conditions (Cureus review, 2025).

Doctors also examine the person carefully, repeat the exam over time, and use blood tests, brain scans and brain-wave tests (EEG). From the start, they gather history from family, witnesses and medical records to look for causes that can be reversed, such as drugs or poisoning, metabolic problems or infections (Intensive Care Medicine, 2026). Tell the team about any medicines, drugs or alcohol, recent injuries or falls, fever, and illnesses such as diabetes or seizures.

Coma and other states of consciousness

As people recover from a severe brain injury, they usually pass through stages, and recovery can stop at any one of them (MSKTC). Knowing the names helps you follow what the care team is saying:

  • Coma — unconscious and unaware, unable to respond to the environment, such as pain or light. A coma generally lasts a few days or weeks; afterward the person may regain consciousness, die, or move into a vegetative state (NINDS).
  • Vegetative state, now often called unresponsive wakefulness syndrome — the person has sleep–wake cycles and periods with eyes open, and may groan, move or show reflexes, but is unaware of themselves and their surroundings (NINDS). These movements are not purposeful, and the person may cry, smile or make other expressions without apparent cause (MSKTC). That can be very hard for families to see.
  • Minimally conscious state — the person shows some definite awareness, such as following simple commands or giving yes-or-no responses (NINDS), but not consistently: they might follow an instruction one time and not the next (MSKTC).
  • Locked-in syndrome is different again: people are conscious. They are awake, can think, understand and hear normally, but cannot move or speak; most can blink and move their eyes up and down. It is caused by damage to the part of the brain near the spinal cord, for example from a stroke, and can be missed because the person appears unconscious (NINDS).
  • Brain death (also called death by neurologic criteria) is different from all of these. It is the permanent loss of function of the brain as a whole, including the brainstem, and it is legally the same as death. Breathing on their own or any remaining brainstem reflexes show the brain is still working and rule it out. Specially trained, credentialed clinicians follow strict national guidelines and tests before determining it (American Academy of Neurology, 2023).

Telling these states apart is hard. The 2018 U.S. guideline notes that diagnostic error has consistently hovered around 40 percent, including mistaking locked-in syndrome for a disorder of consciousness, which is why repeated, standardized exams by experienced clinicians are recommended (American Academy of Neurology, 2018).

What recovery can look like

We want to be honest with you: the outlook varies widely, and no one can promise how a particular person will recover. It depends on the cause, how severe and where the damage is, and how long the unconsciousness lasts (MedlinePlus, MSKTC). Some people come out of a coma with physical, thinking or emotional problems, and some remain in a coma for years (MedlinePlus).

  • The cause matters. Coma from drugs, metabolic problems or infection often reflects brain systems that are switched off rather than destroyed, and prompt treatment of the cause is closely linked to the outlook; coma from direct structural damage to the brain more often means a worse outlook and less chance of reversal (Intensive Care Medicine, 2026).
  • Traumatic vs. other injuries. For adults with a prolonged disorder of consciousness, a minimally conscious state and a traumatic cause are both linked with better outcomes (AAN, 2018). About half of people in a vegetative state one month after a traumatic brain injury eventually regain consciousness, usually slowly and with some lasting disabilities; recovery after stroke or lack of oxygen tends to be more limited (MSKTC).
  • Recovery can be slow and late. Some people keep improving more than a year after injury, and a minority recover consciousness after the point once called “permanent”, though most of them remain severely disabled. For that reason, the guideline recommends replacing “permanent vegetative state” with “chronic”, with the length of time stated (AAN, 2018).
  • Children: the course of recovery, outlook and treatment for children are not well established (AAN, 2018).

When someone does wake, it is rarely sudden like in films. After a long period of unconsciousness, emerging is a gradual process, and going straight from coma to full consciousness is very rare. People almost always go through a stage of confusion, which can include disorientation, memory problems, restlessness and poor sleep; almost everyone who reaches this stage goes on to make further progress (MSKTC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Emergency and ICU care to protect the brain and treat the cause; preventing complications such as pressure injuries, infections, stiff joints and blood clots; repeated expert assessments; specialized disorders-of-consciousness rehabilitation; amantadine for some adults after traumatic injury; palliative care at any stage, and hospice when appropriate. ICU care: cost estimate being researched. Medicare inpatient rehab (2026): a $1,736 deductible covers days 1–60 of a benefit period, then $434 a day for days 61–90. Medicare hospice: $0 for covered hospice care. Varies widely with the cause, severity and how long unconsciousness lasts. Some people recover well; others improve slowly over months or years, often with lasting disability. No one can promise an outcome.
Chiropractic No role. We found no studies of chiropractic care as a treatment for coma or disorders of consciousness. Not applicable. Not a treatment for coma. Ask the medical team before any hands-on spinal care.
Acupuncture Studied as an add-on to hospital care, especially after stroke and head injury. Not among the treatments recommended in the 2018 U.S. guideline. Cost estimate being researched. Reviews report possible gains in coma scores, but the trials are of low quality and the evidence is too weak to recommend it routinely. Treat it as unproven.
Herbal medicine No role. Never give anything by mouth to someone who is unconscious; nutrition is given by feeding tube under medical care. Not applicable. Nutraceuticals and similar products lack evidence for disorders of consciousness, and supplements can interact with medicines.
Massage therapy Gentle touch for comfort and connection — holding hands, lotion on the hands or face — plus range-of-motion and positioning by nurses and therapists. Gentle touch from family is free; therapy is part of hospital and rehab care. Private massage: cost estimate being researched. Comfort and closeness, not a cure. Only move joints if the care team has shown you how, and watch for signs of overstimulation.
MBHA Wellness Coach Support for families: talking with the care team, keeping a notebook, family meetings, advance directives and POLST, caregiver self-care and respite, grief support, and finding financial and legal help. Cost estimate being researched. Many states offer free advance directive forms. Supports — never replaces — the medical team, and helps your family make decisions and care for yourselves.

Approach 1 of 6

Conventional medicine (AMA)

Care for someone in a coma usually starts in the emergency department and continues in an intensive care unit (ICU). We name treatments but never doses — the care team tailors them.

1. Protecting the brain and treating the cause

  • The first priorities are the airway, breathing and circulation: the team may place a breathing tube to protect the airway, steadies blood pressure and checks for low blood sugar, all to prevent more damage to the brain (Intensive Care Medicine, 2026). After a severe head injury, they also monitor blood flow to the brain, brain temperature, pressure inside the skull and the brain’s oxygen supply (NINDS).
  • Treatment depends on the cause: for example, glucose for low blood sugar; naloxone for a suspected opioid overdose; seizure medicines for ongoing seizures; and infection-fighting medicines for meningitis or encephalitis (Intensive Care Medicine, 2026). After a severe head injury, surgery may be needed to relieve pressure inside the skull or remove pooled blood, and medicines can help reduce fluid buildup and pressure in the brain (NINDS).

2. Preventing complications

People in a coma need extensive care, which may include tube feeding, help with bladder and bowels, and help with breathing such as suctioning (MSKTC). Lying still for a long time can cause:

For people with a prolonged disorder of consciousness, complications are common — including agitation, muscle stiffness, sleep problems, urinary infections, pneumonia and fluid buildup in the brain — and doctors should watch closely for them. Pain should always be assessed and treated (AAN, 2018).

3. Careful, repeated assessments

Because responses come and go, a single exam can miss signs of awareness. The 2018 guideline recommends treating anything that could dull alertness (such as sedating medicines or infection), helping the person be as alert as possible before testing, and using standardized exams such as the Coma Recovery Scale–Revised, repeated over time by trained clinicians (AAN, 2018).

4. Rehabilitation and specialized programs

  • Once stable, many people move to an inpatient rehabilitation hospital for intensive physical, occupational and speech therapy; others go to a sub-acute program, skilled nursing facility, long-term acute care hospital or home. These settings vary widely, so work with the social worker or case manager and choose a program experienced with your loved one’s needs (MSKTC).
  • The guideline says people with a prolonged disorder of consciousness are likely to have a better chance of recovery in a specialized setting with a multidisciplinary rehabilitation team (AAN, 2018). Ask whether a disorders-of-consciousness or brain injury program is available.
  • Amantadine: for adults with a vegetative or minimally conscious state after a traumatic brain injury, between 4 and 16 weeks after the injury, the guideline recommends the medicine amantadine to help speed early recovery. It is the only treatment shown to help adults (ages 16 to 65 in the studies) (AAN, 2018). Ask the team whether it applies.
  • Unproven therapies: treatments such as hyperbaric oxygen, nutraceuticals and stem cell therapies do not have enough evidence to support or rule out their use, and many carry risks (AAN, 2018).
  • Locked-in syndrome has no cure, but supportive care, physical and speech therapy, and eye-tracking computers, letter boards and other communication devices can make daily life easier and more meaningful (NINDS).

5. Palliative care and hospice

Palliative care focuses on comfort and quality of life for people with a serious illness and support for their families. It can start at any stage, alongside treatment aimed at recovery, and its team — doctors, nurses, social workers, chaplains and others — helps families understand choices and make sure care matches the person’s goals and values. You can ask for a referral (NIA). Our Cancer guide has more on palliative care.

Hospice is palliative care for the final months of life, when treatment to cure is stopped but comfort care continues; it can be given at home or in a facility, and it includes support for the family (NIA).

What it costs

  • ICU and acute hospital care: cost estimate being researched.
  • Inpatient rehabilitation (Medicare Part A, 2026): after the $1,736 deductible you pay nothing for days 1–60 of a benefit period, then $434 a day for days 61–90 and $868 a day for lifetime reserve days; there is no new deductible if you transfer straight from the hospital or are admitted within 60 days of a hospital stay (Medicare.gov).
  • Medicare hospice: you pay nothing for covered hospice care from a Medicare-approved provider, except up to $5 per prescription for pain and symptom medicines and 5 percent of the Medicare-approved amount for inpatient respite care. Room and board in a nursing home is not covered (Medicare.gov).
  • Palliative care may be covered by Medicare, Medicaid and private insurance; ask your plan (NIA). Long-term nursing care: cost estimate being researched.

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Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating coma or disorders of consciousness. We found no studies of chiropractic care as a treatment for these conditions.

Spinal manipulation can occasionally cause serious problems, including rare strokes linked to neck manipulation, and the risk may be greater in people with underlying health problems (NCCIH). After a recovery, if back or neck pain becomes a concern, talk with the rehabilitation team before seeking any hands-on spinal care.

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Acupuncture

Acupuncture has been studied as a way to help people wake from a coma, mostly as an add-on to standard hospital care. It is not among the treatments recommended in the 2018 U.S. guideline on disorders of consciousness (AAN, 2018), and the evidence is weak.

What the research says

Safety

Complications are uncommon, but acupuncture done improperly can cause infections, punctured organs or nerve injury; in the U.S., needles must be sterile and single-use (NCCIH). Acupuncture in a hospital or rehab setting should only be considered with the medical team’s agreement.

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Approach 4 of 6

Herbal medicine

Herbal medicine has no role in treating coma or disorders of consciousness.

Never give an unconscious person anything by mouth — no food, drink, herbs or remedies. Even emergency instructions for severe low blood sugar say to wait until the person can swallow safely before offering food or drink (FDA drug label, DailyMed). People in a coma receive nutrition through a feeding tube under medical care (MSKTC).

  • The 2018 guideline lists nutraceuticals and primrose oil among therapies without enough evidence to support or rule out their use, and notes that many proposed treatments carry risks. Families may be drawn to them out of love and desperation, which is understandable — please talk with the team first (AAN, 2018).
  • Supplements can interact with medicines and may pose risks around surgery, and some products contain ingredients not listed on the label (NCCIH). Never add a product to a feeding tube without the doctor and pharmacist. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage is not a treatment for coma. But gentle, loving touch can be a way for families to feel close, and hands-on therapy helps protect the body while a person can’t move.

Touch, comfort and connection

  • Some family members say that giving a gentle massage or putting lotion on their loved one’s hands or face helps them feel close. Avoid overstimulation, which can show up as fast breathing, tight muscles, teeth grinding, restlessness or fatigue (MSKTC).
  • Ask the care team whether you can help with simple care such as bathing and grooming, and get as much training as you can for any care you take on (MSKTC).

Range of motion and positioning

The care team manages muscle tightness with positioning, special equipment and range-of-motion care, and turns the person in bed to help prevent pressure sores. Families can learn to help, but only do range-of-motion exercises if a doctor, nurse or therapist has shown you how (MSKTC). At home, changing position about every two hours and using pillows and other products that relieve pressure helps protect the skin (MedlinePlus).

Safety

The risk of harm from massage appears low, but rare serious problems such as blood clots, nerve injury or broken bones have been reported, some with vigorous deep-tissue massage or in people at higher risk (NCCIH). Blood clots can form during long periods of inactivity (NINDS), so use only light touch and check with the nurse first.

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Approach 6 of 6

MBHA Wellness Coach

Having someone you love in a coma is one of the hardest things a family can face. An MBHA Wellness Coach can help you organize, ask good questions and look after yourself — alongside, never instead of, the medical team.

Talking with the care team

Keeping a notebook

Progress can be very slow, with long stretches of no visible change. Keeping a journal of the changes you notice can be comforting and lets you look back at how far your loved one has come (MSKTC). A coach can help you set up a simple notebook for questions, answers, names of team members, and changes you see.

Advance directives and POLST

  • Advance directives — a living will and a durable power of attorney for health care, which names a health care proxy — take effect only when a person can’t speak for themselves. If there is no advance directive, state law decides who makes decisions, typically a spouse, parents or adult children (NIA).
  • POLST (Physician Orders for Life-Sustaining Treatment) is a medical order for seriously ill people covering CPR, breathing machines, how much treatment to give, and tube feeding. In California it is printed on bright pink paper and signed by the patient or their legal decision-maker and a physician, nurse practitioner or physician assistant (Coalition for Compassionate Care of California).
  • Forms are free or low-cost in most states, and a lawyer isn’t required (NIA). If your loved one’s situation brings this home for you, a coach can help you start your own plan.

Caring for yourself

  • Managing alone is too much to ask of one person. Lean on family, friends and faith communities, take regular breaks, and over time make room for everyday matters, other family members and your own physical and mental health. A rotating visiting schedule can give you breaks while letting others spend time with your loved one (MSKTC).
  • Caregivers are at higher risk of physical and mental health problems. Tell your own doctor you are a caregiver, and reach out to a counselor if you feel anxious or depressed (NIA).
  • Respite care gives short-term relief, from a few hours to several weeks. For someone in hospice, Medicare covers most of the cost of up to five days of respite in a hospital or nursing facility (NIA).
  • If you are struggling or in crisis, call or text 988 for emotional support (988 Lifeline).

Financial and legal help

Ask the hospital social worker or case manager about programs such as Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) and disability insurance through work. Your state brain injury association can help too. If your loved one can’t make decisions, an attorney can explain guardianship, which can be reversed when it is no longer needed (MSKTC).

Another approach

For families: being there, decisions and support

Being with your loved one

The most natural thing is to talk to your loved one, even if they can’t respond — about family news, your day, or what you are doing as you help with care (MSKTC). Some programs use sensory stimulation to try to promote recovery, but because recovery varies so much, its value is hard to judge outside research studies; ask about your program’s approach, and avoid overstimulating your loved one (MSKTC).

Family meetings and big decisions

  • Decisions about life-sustaining treatment, such as a breathing machine (ventilator), may need to be made with the doctors. A living will or a named health care proxy guides these choices when the person can’t speak for themselves (NIA).
  • People’s wishes and families’ values differ and can change over time, so they should be discussed early and revisited. When the outlook is poor, long-term care should be discussed honestly — while recognizing that the outlook is not always poor (AAN, 2018).
  • After a catastrophic brain injury, families may face difficult end-of-life decisions. Clinicians should support and guide you, with clear, simple explanations and emotional support (AAN, 2023). A palliative care team can help you through these conversations (NIA).
  • If brain death is being considered, the team should try to tell the family beforehand and offer you the chance to watch the exam. They should also explain that reflex movements coming from the spinal cord can still happen and do not rule out brain death (AAN, 2023). People can record their wishes about organ and tissue donation along with their advance directive (NIA).

Grief and loss

Many families grieve the relationship they had before the injury, even while their loved one is alive (MSKTC). If your loved one dies, there is no right or wrong way to mourn. Grief counselors, support groups and hospice bereavement services can help — and you can ask a hospice for bereavement support even if hospice wasn’t used (NIA).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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