Trauma and Insomnia: A Vicious Cycle - Part 2
In part 1 of this post, I started to describe the relationship between trauma and insomnia, focusing on how trauma may impact sleep. But this relationship is not a one-way street. We are learning more about why good sleep is important for trauma recovery and how insomnia can impede healing.
The importance of sleep
Sleep is not a passive experience where your brain and body shut down for the night. Although you can’t feel or directly see them, there are a lot of important processes taking place in your brain and body during sleep, including muscle growth, tissue repair, and even immune system functions.
Good quality of sleep is at least as important as quantity because different processes take place in different stages of sleep. In order to garner all of the benefits, we need to move through the different stages of sleep each night, from the lightest (N1), to the deepest (N3), and including REM sleep.
How do sleep problems impact trauma recovery?
Some of the most important functions in trauma recovery are hypothesized to occur during REM (rapid eye movement) sleep. REM sleep is known to help humans to process emotional memories (like traumatic memories). REM sleep is also when we learn to distinguish between safe and dangerous situations. Unfortunately, multiple studies demonstrate that REM sleep becomes fragmented (in that we don’t get as much of it) for individuals with post-traumatic stress disorder (PTSD).1,2
A vicious cycle
Taken together, this means that one of the things that we need most (good sleep) to recover following trauma is one of the very things that becomes harder to get. In fact, if individuals continue to experience insomnia for a month post-trauma, they are more likely to have difficulty recovering from the trauma. These individuals are more likely to be diagnosed with PTSD.2 Of course, PTSD may make it even harder to obtain good sleep, so the vicious cycle continues.
Breaking the cycle
Since insomnia and trauma seem to interact in a feedback loop, you can begin breaking the cycle by addressing either issue. Evidence-based treatments exist for both trauma/PTSD and insomnia.
While treating one condition may not completely resolve both conditions, it can improve both by breaking the feedback loop. And once you’ve overcome one set of symptoms, it may be a lot easier to cope with the other.
What do I focus on first?
In my clinical experience, there is no “right” answer to the question of “should I address my trauma or insomnia first?” It seems most helpful to choose a treatment that makes sense to you, that addresses the symptoms that are bothering you the most, and that you can commit to. It may be helpful to ask yourself the following questions:
- Which symptoms are bothering me the most right now?
- Which condition or symptoms are having the biggest impact on my work/family/social life?
- Which issue do I feel most prepared to deal with right now?
- What treatment fits best with my schedule and obligations?
Discussing your answers to these questions with your medical provider can help you collaboratively develop a treatment plan to break the cycle between trauma and insomnia.
Will you take our Sleep Disorders Survey to raise awareness for insomnia?