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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. Unconsciousness or any sudden, unexplained change in alertness is a medical emergency. While you wait, check their breathing often; if they are breathing and you don’t suspect a neck or spine injury, roll them onto their side. Never give an unconscious person food or drink, and don’t leave them alone (MedlinePlus).

Not breathing, or only gasping? Start CPR and use an AED if one is nearby (MedlinePlus). A CPR class teaches you how.

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). If the person is not breathing, give naloxone without interrupting CPR (MedlinePlus).

Diabetes and possible low blood sugar: call 911 for an unconscious person who has diabetes, and give nothing by mouth — offer something sweet only once they are awake (MedlinePlus). Severe low blood sugar is an emergency that can cause seizures and brain damage; get help right away for anyone with diabetes who cannot be woken up (MedlinePlus).

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). Their eyes stay closed and they cannot be roused, although some automatic reflexes may remain (Merck Manual). They may look asleep, but unlike sleep, a loud noise or gentle shaking won’t wake them (MedlinePlus). A coma rarely lasts more than 2 to 4 weeks (MedlinePlus).

Sometimes doctors place a person in an induced coma on purpose, using medicines, to protect the brain after a serious illness or injury. It is temporary and closely monitored, and the medicines are reduced slowly when it is time to wake up (Headway).

What causes it?

Coma happens when an illness, injury, medicine or drug affects large areas of both sides of the brain, or the specialized areas that keep us awake and alert (Merck Manual). Common causes include (Merck Manual):

  • head injuries (traumatic brain injury), including bleeding in or around the brain;
  • stroke, from a blocked blood vessel or bleeding in the brain;
  • lack of oxygen, for example when the heart stops (cardiac arrest) — brain cells begin to die after even 4 to 5 minutes without oxygen;
  • overdose of alcohol, opioids, sedatives or other drugs, which can also slow breathing;
  • severe infections such as meningitis, encephalitis or sepsis;
  • metabolic problems, such as very low or very high blood sugar, very low or high sodium, or kidney or liver failure;
  • long or repeated seizures, and brain tumors or other causes of pressure inside the skull.

How doctors assess consciousness

The Glasgow Coma Scale (GCS) is the most widely used tool for measuring how conscious someone is. 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. A score of 15 means fully awake; generally, 8 or lower means coma, and the lower the score, the deeper the coma. Its best use is tracking change over time, and it has limits: it may not be usable when someone is on a breathing machine, and it is not the only thing doctors use to judge the outlook (Cleveland Clinic).

Doctors also examine the person, run blood tests and brain scans, and rely heavily on family and friends. Tell the team about any medicines, drugs or alcohol, recent injuries, illnesses such as diabetes or seizures, recent travel, and any hunches you have — this information is often more helpful in finding the cause than tests are (Merck Manual).

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 done on purpose, which can be very hard for families to accept (Headway).
  • 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 is different from all of these. It is the complete and permanent loss of all brain function, including the brain stem, and it is legally death. People in a coma still have some reflexes; in brain death there are none, and no one recovers. Specially trained doctors follow strict national criteria and tests before diagnosing it (Cleveland Clinic).

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, Merck Manual). 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. Recovery is likely after a sedative overdose unless breathing stopped long enough to harm the brain; complete recovery is often possible after a promptly treated infection; substantial recovery can happen after a head injury even when coma lasts weeks; while after a stroke, coma lasting 6 hours or more usually means permanent damage (Merck Manual).
  • 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. People usually emerge gradually and are very confused at first, and some go through a stage of restless or out-of-character behavior called post-traumatic amnesia, which is usually temporary (Headway).

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 and medicines are given by 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 ICU team watches heart rate, blood pressure, temperature and oxygen closely and corrects problems quickly to prevent more damage to the brain. Many people need a breathing tube and a ventilator (Merck Manual).
  • Treatment depends on the cause: for example, glucose through a vein for low blood sugar, which often brings a fast recovery; naloxone for a suspected opioid overdose; and treatments to lower pressure inside the skull, which can include draining fluid, cooling the body after cardiac arrest, or surgery (Merck Manual).

2. Preventing complications

People who can’t move need comprehensive care, usually including tube feeding (Merck Manual). Lying still for a long time can cause:

  • pressure injuries (bed sores), prevented by frequent repositioning and padding under the heels and other pressure points (Merck Manual) — see our Bed Sores guide;
  • stiff, shortened muscles (contractures), prevented by physical therapists gently moving the joints or splinting them; starting therapy early can help recovery (Merck Manual);
  • blood clots, prevented with medicines, compression and leg elevation; dry eyes, treated with eye drops; and urinary tract infections, reduced with careful catheter and skin care (Merck Manual).

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.

Find a medical doctor in our directory

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.

Find a chiropractor in our directory

Approach 3 of 6

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.

Find an acupuncturist in our directory

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 (MedlinePlus). People in a coma receive nutrition and medicines through a feeding tube under medical care (Merck Manual).

  • 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 nurses whether you can help with simple care, such as wiping your loved one’s face or brushing their hair (Headway).

Range of motion and positioning

Physical therapists gently move the joints to prevent stiffness and contractures, and regular repositioning helps prevent pressure injuries (Merck Manual). 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 every 1 to 2 hours and cushioning pressure points with pillows or foam 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). People who have been immobile are at risk of blood clots (Merck Manual), so use only light touch and check with the nurse first.

Find a massage therapist in our directory

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

  • Take regular breaks from the bedside, accept offers of meals or childcare, keep your employer informed, and try to eat well and rest (Headway). 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 families play favorite music, read aloud or show photographs. There is limited evidence that this helps people wake, and too much can overwhelm, so ask the team how much is right (Headway).

Family meetings and big decisions

  • When someone stays in a deep coma for more than a few weeks, decisions about the ventilator, feeding tube and medicines need to be made with the doctors, guided by any advance directive the person has (Merck Manual).
  • 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).
  • In some severe cases, continuing treatment may no longer help. Decisions to withdraw treatment should involve the family and specialists, and you should be given time with your loved one, clear explanations and emotional support (Headway). A palliative care team can help you through these conversations (NIA).
  • If brain death is diagnosed, the doctors will explain the tests and what they mean, and give you time to be with your loved one before the ventilator is removed. Some people use their advance directive to say they want to donate organs (Cleveland Clinic).

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).

Member stories

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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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