How Sleep is Affected By Post-Traumatic Stress Disorder?
In medical and psychological terminology trauma, an umbrella term for psychologically and physically damaging experience in itself can be defined as “any form of major damage to an individual with the potential for negative after-effects.”
Trauma could be categorized into two types;
Basically, physical trauma is equivalent to an injury or any form of bodily harm.
This often leads to secondary conditions such as shock and respiratory failure that may seem like purely medical illnesses.
It is harm caused to one’s psyche by an emotionally upsetting or distressing event.
Many times we will find both these happening at the same time
e.g. a person losing a limb in a roadside accident immediately suffers from physical trauma
This is followed by the psychological trauma of not being able to cope with routine life events.
Sadly trauma is very common in our society.
According to the National Centre for PTSD, roughly 60% of men and 50% of women suffer from trauma once in their lifetime.
These traumas can lead to a multitude of negative effects on one’s health and sleep pattern, causing problems like insomnia and nightmares.
Common traumatic events include:
- Verbal, physical, emotional or sexual abuse
- Domestic violence
- Physical assault
- Rape or sexual assault
- Vehicular collisions
- Workplace accidents
- Military combat experiences
- Natural disasters
- A serious or life-threatening illness
- The death of a spouse, child, or another relative, or a close friend
- Any instance where a person witnesses harm coming to someone else (i.e.; a public beating or shooting)
- Any injuries resulting in a traumatic brain injury (TBI)
This article is written to describe, in common language, the realities of trauma and how traumatic events can impact our sleep patterns and routine.
Further, we will discuss common sleep disorders associated with trauma, treatment options, and resources for those among us specifically vulnerable to trauma
e.g. children and elderly.
Post Traumatic Stress Disorder (PTSD)
PTSD usually comes in a very similar fashion whether it is an elderly man or a young woman.
Terrifying recurrent dreams that cause you to wake up in the middle of the night sweaty and hyperventilating.
Making it near to impossible to fall asleep again is one-way trauma affects you.
Trauma could have been caused at a battlefield or in the four walls of your own home.
A traumatic event usually leaves a person distant and disoriented, unwilling to speak and unable to comprehend what another person is saying to them.
This is usually followed by symptoms of anxiety such as mood swings, irritability, and feelings of impending doom, etc.
In many cases, this anxiety develops into a condition known as PTSD.
PTSD was previously known as ‘shell shock’ – a term first formulated in World War 1 when the troubled soldier returned home from battlefield bringing along with them flashbacks and memories of bloodshed and torture.
However, PTSD is not restricted to survivors of major trauma such as warfare and natural disasters or assault only.
Anyone who has experienced trauma is susceptible to this condition.
According to a study, PTSD basically originates from “fight or flight” response.
That had initially occurred during the traumatic event but does not cease to exist even when the person is safe from harm.
This is the early stage of PTSD.
According to NIMH people with PTSD begin to experience symptoms of the disorder within three months of their trauma event.
When treating PTSD, it can be classified either as acute (short term) or chronic (long term).
Acute can be treated within six months.
Chronic PTSD may take years to treat-and in some cases, patients never fully recover.
Current diagnosis list four distinct criteria for PTSD.
In order to be diagnosed with the condition, a patient must experience all four for at least one month.
A Re-experiencing event
It could take the form of flashbacks, nightmares, and/or disturbing thoughts.
These could be triggered by certain words or phrases and could disturb everyday routines.
An Avoidance Symptom
People with PTSD uncharacteristically avoid places, people and activities that remind them of the trauma event.
e.g. someone who witnessed a public crime may steer clear of the location where the event took place however inconvenient this maybe for them.
Arousal and reactivity symptoms
Another characteristic of people with PTSD is that they get easily scared or startled, getting edgy and disturbed and may show excessive anger on minor issues without any triggering.
This happens at least twice a month.
At least two mood and cognition symptoms
Which may include difficulty remembering details of the event and feelings of negativity and detachment towards previously cherished people and places.
It could also take the form of guilt or blame associated with the trauma event.
How Does PTSD Affect Sleep?
PTSD effect sleep pattern and cycle in multiple ways. Some common PTSD-related sleep symptoms include:
- Being unable to fall asleep due to anxiety or agitation
- Frequent nightmares making it difficult to stay asleep
- Poor quality of sleep due to nightmares. It could take a severe form where people wake up many times and have difficulty falling back asleep called sleep insomnia.
- Sleep problems related to drugs or alcohol initially taken to cope up with the anxiety related to PTSD.
This could also include some medications taken to relieve anxiety such as benzodiazepines that make it difficult to wake up in the morning.
Insomnia in itself could be caused by multiple reasons other reasons than PTSD.
A study compared people with insomnia who did not have PTSD and those with PTSD.
In the study, many important differences were found in the two categories.
- More repetitive nightmares in people with PTSD.
- More anxiety during the day in people with PTSD
- More fatigue during the day among people with PTSD
There is a feedback loop in the lives of people with insomnia and PTSD where one problem aggravates the other problem.
Trauma and sleep problems in children
Children often present with similar sleep disturbances as adults, like onset and maintenance difficulties, nightmares, anxiety, and nightmares while sleeping, sleepwalking and other forms of parasomnias.
Just like adults a direct traumatic event in the life of a child e.g. abuse, vehicular accidents, etc.
Will make him more susceptible to trauma-related sleep issues that indirect traumatic events e.g. witnessing an act of violence.
In 1986, Challenger Space Shuttle explosion found that children who watched news coverage of the disaster experienced trouble sleeping for about a week.
A survey of children living in areas of New Orleans damaged by a hurricane named Katrina had trouble sleeping for about 24 to 30 months after the disaster.
Although teenagers are better at handling trauma than younger children.
Parents are encouraged to seek medical advice for a child experiencing sleep issues more than a month following a traumatic event.
It could indicate a more serious underlying problem.
Yoga or meditation works for some people.
Others say that guided imagery or positive mantras help them in sleep.
Stress and anxiety managing strategies can be especially helpful.
Medications including anti-anxiety and sleep medications can be helpful for managing PTSD related sleep problems.
However as long as the underlying cause is not addressed, sleep problems will likely return as soon as you stop using medication.
Therapy can be a very important treatment option in PTSD related sleep disorders.
A compassionate therapist will help you work through your trauma by setting goals and cultivating new tools for managing stress.
He/she could also work with your doctor to decide if any medication is needed.
Strategies For Coping With PTSD Related Sleep Problems
Other than the treatment plan listed above.
There are a few ways that traumatized people can use to enhance their quality of sleep using everyday interventions and lifestyle changes.
These include the following:
- Establish a consistent sleep schedule by going to bed and waking up at the same time.
- Try to be active throughout the day and replace periods of inactivity with physical exercise.
- Realign your circadian rhythm by getting plenty of sunlight.
- Avoid napping for more than 20 minutes in the day – studies have shown that the ideal nap time is 20 minutes.
- Abstain from alcohol, caffeine, and sugar in the hours leading to bedtime.
- Eat with a balance where you are neither too full nor too hungry at bedtime. An ideal scenario is one where you avoid eating about 60 minutes before bedtime.
- Use your bed for sleep and sex only. Avoid video games, reading, etc. in bed.
- Try to avoid electronic-based devices an hour before bedtime. These devices emit blue light reducing the melatonin level in the human body and disturbing sleep.
- Install adjustable lights with a dim setting that you use before sleep.
- If you have experienced trauma in your bedroom reconsider your sleep environment. Another location such as a pull-out couch is a good alternative.
- If you can’t fall asleep in your bed, don’t just stew. Simply get up, have a nice walk for 30 minutes or simply relocate to another room.
Is PTSD preventable?
No, as of now there is no prevention method for PTSD as traumatic events are often unpredictable and random.
However, having knowledge of PTSD may help prevent some serious effects.
What is the most common emotion associated with PTSD?
The most common emotion is anger.
Anger can cause major problems in the life of the person suffering from PTSD leading to wakeful nights and other sleep disturbances.
Recent experiments show that bright light therapy is good for PTSD. Is this true?
Bright light therapy involves giving the patients a dose of 10,000 lux of bright light for 30 minutes each day.
Results of various experimentations prove that using bright light can disrupt poor nocturnal behaviors.
And can have a positive effect on PTSD symptom severity.
PTSD can make you feel incapacitated and unable to cope with your routine activities especially by disturbing your sleep.
This vicious cycle of sleep deprivation leading to day time fatigue and anxiety and vice versa could be treated by seeking medical help when needed and applying tried and tested sleep strategies.
Moreover, reaching out to a therapist could help you find the best possible solution to your particular situation.