PTSD & Sleep
By: Anna Smiley
This month, we will dive into the connection between Post-Traumatic Stress Disorder (PTSD) and sleep. I’m sure we have all experienced a good night’s sleep before, or at least a good nap, where we wake up a little disoriented and very well-rested. Imagine, however, that you struggle to even close your eyes because you are plagued by reliving past traumatic events. Sleep is undoubtedly important for any type of recovery (whether recovering physically from a taxing workout, emotionally after a breakup, or mentally from a traumatic event that could precipitate PTSD). How can we help those struggling get the rest they so desperately need?
It is important to define PTSD, and determine the relationship between sleep and PTSD. PTSD is a condition that stems from a reaction to a traumatic event. In a literature review conducted by Biasson et al. (2013), the authors found that PTSD is “characterized by symptoms of re-experiencing the trauma (in the form of nightmares, flashbacks and distressing thoughts), avoiding reminders of the traumatic event, negative alterations in thoughts and mood, and symptoms of hyper-arousal (feeling on edge, being easily startled, feeling angry, having difficulties sleeping, and problems concentrating)” (Biasson et al., 2013). The hyperarousal symptoms are particularly notable where sleep is concerned, as feeling on edge and being easily startled are not conducive to quality sleep. Diving right into medical terminology, physical changes in the brain can affect sleep quality in those with PTSD. Differences in the uncinate integrity, which is a part of the brain that helps to regulate behaviors and nervous system activity, have been shown to cause hyperarousal, one of the main tenets in PTSD. Damage to this pathway “could create vulnerability for sleep problems” in individuals with PTSD (Bottari et al., 2021).
As early as 1989, poor sleep quality has been associated with PTSD. In fact, sleep disturbances and nightmares are symptoms of PTSD. But just how closely are the two related, and can they be separated? While the initial thought was that PTSD caused issues with sleep, sleep disturbances tend to persist even after PTSD is treated (Zayfert and DeViva, 2004). So what causes these sleep disturbances? The literature suggests that insomnia and sleep disturbances develop their own maintenance patterns. For example, if an individual with PTSD develops an aversion to going to bed early (a common trick for dealing with insomnia) due to fear of reliving traumatic experiences, the pattern of late nights will be ingrained even after the PTSD is addressed (Talbot et al., 2014). The results from one study indicated that the more nightmares an individual with PTSD experiences, the more significantly their sleep efficacy will be (Short et al., 2017).The same found “only baseline fear of sleep and daily PTSD symptoms predicted nightmares significantly.” The authors of that article proposed a solution: instead of using cognitive behavioral therapy, which can reduce PTSD symptoms but not necessarily help improve the quality of sleep, treatments that target the nightmares themselves, as well as other PTSD specific factors like a fear of sleep (Short et al., 2017).
There are also small and specific things that can be done to address insomnia in those with PTSD. In an informational article, Villines (2018) suggests developing and sticking to a relaxing bedtime ritual, keeping the bedroom quiet, using your bed only for sleeping (and not for reading or work), and avoiding alcohol, cigarettes, heavy meals, or caffeine before bed. Additionally if you cannot fall asleep, try getting up to do something else for a little while (Vilines, 2018). Further help could come from trauma-focused therapy and sometimes medications. It is important to remember that there is help and there is hope when dealing with PTSD and sleep disturbances.
Works Cited:
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd003388.pub4
Short, N. A., Allan, N. P., Stentz, L., Portero, A. K., & Schmidt, N. B. (2017). Predictors of insomnia symptoms and nightmares among individuals with post‐traumatic stress disorder: an ecological momentary assessment study. Journal of Sleep Research, 27(1), 64–72. https://doi.org/10.1111/jsr.12589
Talbot, L. S., Maguen, S., Metzler, T. J., Schmitz, M., McCaslin, S. E., Richards, A., Perlis, M. L., Posner, D. A., Weiss, B., Ruoff, L., Varbel, J., & Neylan, T. C. (2014). Cognitive Behavioral Therapy for Insomnia in Posttraumatic Stress Disorder: A Randomized Controlled Trial. Sleep, 37(2), 327–341. https://doi.org/10.5665/sleep.3408
Villines, C. B. Z. (2018, October 8). Breaking the Vicious Cycle of Sleep Problems and PTSD. Good Therapy. https://www.goodtherapy.org/blog/breaking-the-vicious-cycle-of-sleep-problems-and-ptsd-1008187Zayfert, C., & DeViva, J. C. (2004). Residual insomnia following cognitive behavioral therapy for PTSD. Journal of Traumatic Stress, 17(1), 69–73. https://doi.org/10.1023/b:jots.0000014679.31799.e7
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