There is a close connection between trauma and the development of sleep disorders.
Trauma comes in all different shapes and sizes and is much more common than one might believe. According to one statistic from the National Center for PTSD, roughly 60% of men and 50% of women will experience at least one traumatic event during their lifetimes
One common response to trauma, whether it a physical trauma such as a car wreck or assault, or psychological trauma such as grief, verbal, or emotional abuse, is hypervigilance. The parts of the brain that evolved to detect threats remain overactivated and even the slightest sign of danger, real or perceived, can trigger an acute stress response along with highly negative emotions and sensations.
For this reason, many survivors of trauma have a hard time dropping down into sleep. Their minds are often on high-alert for danger and this high level of arousal makes it very difficult to relax and fall into a restful, restorative sleep.
After a traumatic event, it is common for the traumatised to seem distant and disoriented. They may dissociate, or disconnect from their own internal states and those around them. In the following weeks, negative emotions can escalate and express themselves vividly in disturbing night terrors or nightmares, further disrupting sleep.
The Relation Between PTSD and Sleep Disorders
In some cases, traumatic events can lead the traumatised to develop either acute or chronic Post Traumatic Stress Disorder (PTSD) in the months after the event. According to one study, 70-91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling or staying asleep. Their sleep disturbances range from sleep movement disorders, sleep breathing disorders, insomnia, or frequent awakenings.
In traumatic events that occur during the night, fear conditioning can cause the sufferers to fear falling asleep, leading to a fear of the onset of darkness when the trauma occurred. When sleep does occur, frightening nightmares are common occurrences in PTSD and in traumatised individuals. If the traumatic event happened during war, an assault, or even a work-related accident, these events can be re-experienced either nearly directly or symbolically, causing sudden awakenings and, in some cases, fatigue during the day and foreboding at night before sleep comes.
In a study published in the journal Chest, more than half of PTSD patients at an academic military medical centre were found to also suffer from obstructive sleep apnea with a poorer prognosis compared to those with sleep apnea alone. Overall, PTSD has been shown to significantly complicate the treatment of sleep disorders, including physically-based ones such as sleep apnea.
Coping With Trauma and Restoring Restful Sleep
Many of those coping with trauma resort to sedatives like alcohol or other substances to help sleep and numb painful emotions. These poor coping mechanisms can further diminish sleep quality. The interaction between sleep disruption and trauma is one of a positive feedback loop. Poor sleep exacerbates the psychological trauma, which in turn leads to poor sleep that worsens the effects of the trauma. This makes treatments difficult, but a long-term integrative approach can lead to positive, hopeful outcomes.
One of the most important things to regain a sense of control of one’s sleep patterns and a sense of safety after a traumatic event is feeling safe with other people. Safe connections through a therapist, close friends and community can help reduce negative emotion and process and integrate the event, leading to better sleep and a sense of control over one’s body and self.
Often, this happens over time with social support and in some cases alongside medications like SSRIs and benzodiazepines. Other therapeutic techniques can help the recovery process towards better sleep like self-care through sleep rituals, cognitive behavioural therapy and EMDR (eye movement desensitisation and reprocessing) therapy, where traumatic memory fragments can be reintegrated across the brain and stored in a less emotionally volatile way.