A coma is a state of unconsciousness caused by injury or disease, where a person is unresponsive and cannot be woken up. A coma could be caused by a severe head injury or a stroke, for example. It usually lasts less than two to four weeks.
The following information is for anyone whose friend or loved one is in a coma, and covers:
What a coma means
When someone slips into a coma, their brain activity is minimal. They are alive but cannot move or be woken up. Their potential for recovery depends on the cause of the coma.
A person in a coma is unresponsive to their environment, such as voices or even pain. However, it’s possible that they have a level of awareness of their surroundings. Every coma experience is unique.
Occasionally, a person in a coma may open their eyes, grimace or make a noise. They may not be aware of these movements, though, or have any control over them.
Being in a coma means the person has a low level of consciousness. Their level of consciousness depends on how much of their brain is functioning, and it may change over time.
For example, a person may start in a very deep coma, where they are unresponsive to pain, and may gradually recover to a lighter coma, where they respond to pain. They may continue to improve and reach a state where they are conscious of their surroundings and can begin to communicate.
The ability to make a clearly conscious response to external instructions shows that the person is no longer in a coma.
Caring for and monitoring a person in a coma
Doctors score a person's level of consciousness using a tool called the Glasgow Coma scale. They monitor this level constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses three things:
- eye opening – a score of 1 means no eye opening, and 4 means opens eyes spontaneously
- verbal response to a command – 1 means no response, and 5 means alert and talking
- voluntary movements in response to a command – 1 means no response, and 6 means obeys commands
A higher score on the scale suggests that less brain function has been lost. A score of 8 or less is often used to mean that someone is in a relatively deep coma.
While someone in a deeper coma generally has a poorer outcome, the cause of the coma is important in determining their recovery. For example, a young person who took an alcohol or sedative drug overdose may be deeply comatose to begin with, but may make a very good recovery with appropriate medical care.
A person in a coma may be unable to maintain normal body function. For example, they may not be able to breathe unaided and may not have stable blood pressure.
Caring for a person in a coma involves making sure their condition is stable and their body functions, such as breathing and blood pressure, are supported, while the underlying condition is treated.
Healthcare staff will try to prevent infections, provide good nutrition and prevent bedsores by moving the person’s position regularly.
At least in the early stages, most people in a coma will be cared for in an intensive care unit.
What you can do as a visitor
The experience of being in a coma differs between people and also depends on how deep the coma is.
Some people remember events that happened around them while they were in a coma, while others do not. Most memories are likely to relate to the period when the person was emerging from the coma.
Some people have reported feeling enormous reassurance from the presence of a loved one when coming out of a coma, and the box on this page reports one man’s account of this.
You may find the following advice helpful:
- When you arrive, announce who you are and generally speak positively.
- Talk to them about your day, as you normally would.
- Be aware that everything you say in front of them might be heard.
- Show them your love and support – even just sitting and holding their hand can be a great comfort.
- You could play them their favourite music through headphones.
Recovering from a coma
A coma usually lasts for less than two to four weeks. It’s possible to remain in a coma for months or even years, but this is unusual.
Recovery depends on how much of the person’s brain has been affected by the underlying disease or injury. Generally, the longer the person has been in a coma, the poorer the outlook.
People do not usually suddenly "wake up" from a coma, but tend to come round gradually and regain brain function over time. Often, the period of emerging from a coma is associated with agitation and confusion, and the person may need to be sedated for their safety.
Some people will recover fully and are completely unaffected by the coma. Others may not be able to do some of the things they used to do, and may rely on physiotherapy and occupational therapy for the rest of their lives.
Some people who recover from a coma will be in a vegetative state. This means that they may open their eyes and appear to be awake, and may have recovered basic body functions (such as being able to breathe unaided and control their blood pressure). However, people in a vegetative state have lost substantial brain function and are not aware of their surroundings.
Support and more information
For more information and support from professionals and families of people in a coma, you may find the following resources helpful:
- Headway (the brain injury association)
- ICUsteps – the intensive care patient support charity