Trauma and Insomnia: A Vicious Cycle - Part 1

It’s common knowledge that sleep disruption often follows a traumatic experience. Estimates vary, but up to 70 percent of trauma survivors report trouble falling and staying asleep. And those sleep problems may persist for decades (45 years in one study!).1

Trauma survivors are also likely to have their sleep disrupted by nightmares. Almost three-fourths of survivors report trauma-related nightmares that interfere with their sleep.2 

But the fact that sleep disruption is common after trauma doesn’t lessen how debilitating this can be for survivors. In fact, we’re learning that sleep disruption may actually make it harder for individuals to recover following a trauma.

Why do sleep problems follow trauma?

Many unpleasant reactions are common after trauma. Nightmares and insomnia are only two of these. Survivors also commonly experience intrusive memories, anxiety, irritability, and other mood changes, difficulty concentrating, feeling unsafe, feeling disconnected from others, and wanting to avoid reminders of the event.

For many individuals, these symptoms naturally improve in the weeks following the trauma. But there is a subset of individuals who continue to experience intense symptoms for months or years afterward. These individuals may be diagnosed with post-traumatic stress disorder (PTSD).

How does PTSD impact sleep?

We are learning more and more about the specific ways that PTSD may impact sleep. For example, there is some evidence that PTSD changes our sleep architecture, or how we move through the different stages of sleep. 

More specifically, PTSD may increase how much time we spend in the lightest stages of sleep while decreasing how much time we spend in deep (restorative) sleep and fragmenting REM sleep.1,3 These changes can lead to more frequent awakenings, as well as to feeling less refreshed even when you think that you got a decent amount of sleep.

In addition, PTSD-related nightmares may change a person’s emotional relationship with sleep. Sometimes trauma survivors become anxious about going to sleep because their nightmares are so upsetting. They worry about whether they will have a nightmare that night, whether they’ll be able to get back to sleep afterward, and how they will feel and function the next day. Of course, any time you’re anxious about sleeping, it becomes that much harder to fall and stay asleep.

Can your coping skills be hurting you?

It’s also important to think about whether the ways you cope with your post-trauma reactions help or hurt your sleep. For example, practicing relaxation skills to cope with anxiety may also have a positive effect on your sleep. However, if you use substances to help you cope (including legal substances like tobacco and alcohol), those can make it harder to fall and stay asleep.

Not a one-way street

It’s important to know that the relationship between trauma and insomnia seems to be bi-directional; not only does trauma cause sleep disruption, but insomnia can make it harder to recover from a trauma. Check out part 2 of this post, where I discuss how insomnia affects trauma recovery and how you can break the vicious cycle.

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