Why Sleep Is More Important Than Ever When You've Been Through Trauma

Each year, millions of Americans are exposed to major traumatic events. Family violence, sexual violence, natural disasters, or surviving a deadly accident or incident are an unfortunately common experiences in our modern lives. Coping in the aftermath can often be challenging, and many survivors live every day with symptoms of traumatic stress.

The classic PTSD nightmare involves a repetitive replay of the traumatic incident, complete with related emotions, bodily responses, and movements. Many spouses of trauma survivors tell of frequently being awakened from a deep slumber by a thump, slap, or bloodcurdling scream as their spouses reenact their trauma in their nightmares. 

As a culture, we seem to be forgetting how to sleep in general. It started with irregular work schedules and shift work that messed up our body clocks, and then came a wave of popular heavily caffeinated beverages and energy supplements that kept people too wired to stay awake. Cheap large-screen TVs found their way into bedrooms and primed our brains to equate bedtime with channel surfing as opposed to falling asleep. The arrival of smartphones and tablets brought to our bedrooms a never-ending stream of alerts, notifications, and messages.

In this already sleep-deprived society, trauma survivors have an added exacerbating factor making it even harder to get that critical shuteye.

In the first decade of the 21st century, sleep researchers discovered many sleep-related problems in people who've experienced trauma. In addition to the debilitating issue of nightmares, insomnia is a distinct problem for almost 50 percent of PTSD sufferers. A high incidence of sleep-disordered breathing1 and limb movements2 is also seen in sleeping PTSD patients.

The sleep disturbances common among people who've been through trauma often develop into independent sleep problems. This can create a cycle of negative consequences: As the PTSD creates sleep disorders, those sleep disorders exacerbate the PTSD symptoms, creating a feedback loop that's hard to break.

This means that people who've suffered from trauma don't only require treatment for their PTSD symptoms—their sleep itself requires its own focused treatment as well.

Sleep is, of course, critical to all people: Research tells us that high-quality sleep is a requirement for humans to live well in all dimensions of their lives from the psychological to the hormonal to their daily executive functioning in everyday activities. It boils down to a basic matter of biology; sleep offers the brain an abundance of restorative functions and allows the body rest, recover, and process after being active all day.

Not only is sleep deprivation linked to a bevy of diseases and disorders (from diabetes and obesity to heart disease and stroke to depression and anxiety), but it also deeply affects our ability to process memories and subconscious thoughts, to handle stress, and to think clearly. It can also increase our sensitivity to pain, exacerbate negative emotions, and make you more averse to human connection.

Known as CBTi4, this therapeutic method consists of several sessions that are tailored to one's specific sleep issue. The therapist makes several recommendations to changes in lifestyle or habits that, ultimately, strengthen the bed as a cue for sleep and weaken it as a cue for insomnia. CBTi aims to improve sleep quality and, once this is achieved, focuses on quantity. Initially the time spent in bed is restricted to the hours spent asleep, i.e., no more "tossing and turning" in bed. In subsequent sessions, the time spent in bed is gradually increased. CBTi protocols also include strategies for reducing sleep-interfering worries, stress, and overly active minds that won't shut off.

Current medical practice encourages doctors to avoid prescribing medications for insomnia. Such recommendations come from decades of hard-earned knowledge and the gradual realization that many commonly prescribed hypnotics have serious side effects such as being habit-forming, leading to memory problems and falls, and even contributing to premature death.

Of course, there are times when sleep disruption is severe and contributing to high levels of distress, and in such cases a sleep aid may be warranted. But even under those circumstances, sleep medications should ideally be used as a short-term solution, used at the lowest dose possible in accordance with your doctor's recommendations, and closely monitored.

But as much as possible, prioritizing sleep wellness is the much safer and more effective way of dealing with sleep issues rather than seeking out a prescription.