Sleep News

Paradox: Trauma requires sleep to heal, but people with trauma can’t sleep

Trauma of every variety can significantly alter the quality and quantity of sleep... a problem when sleep is also necessary for healing.

Understanding the root cause can help, but the challenges are still significant, regardless the kind of trauma

trauma can have a significant impact on one's ability to sleep

Insomnia, sleepwalking, night terrors, and nightmares are common experiences shared by people who have experienced some kind of trauma. Their challenges are complex when it comes to addressing these symptoms, as it’s critical to get to the root cause for their symptoms.

Definitions of trauma when considering sleep disorders

For today’s SHC curation, we’re speaking specifically of three arenas of trauma which have been shown to have a significant impact on sleep health: Traumatic Brain Injury (TBI), Emotional Trauma, and Post-Traumatic Stress Disorder (PTSD).

Traumatic Brain Injury (TBI)

The Brain Injury Association of America lists multiple kinds of head trauma that qualify as TBI:

Check out these 10 links that uncover the challenges of poor sleep and struggles with wakefulness for people who suffer from TBI:

MAR 24: Dr. Diane || Brain Health
I can’t sleep: Sleep problems from brain injury?
From the website: ” ‘Common complaints I hear when doing a consult or intake are the following: 1) Problems falling asleep; 2) Staying asleep (disrupted sleep) or 3) Both. Some of my clients and patients say they can sleep anytime or can sleep for 10-14 hours. However, the majority of my clients and patients ask, “I can’t sleep. Is it from my Concussion?” The answer is YES.’ ”

MAR 15: Advances in Clinical Neurosciences and Rehabilitation
Addressing sleep-wake disturbances in patients with traumatic brain injury
From the website: “The data on the prevalence of sleep problems following TBI is relatively limited; various studies looking into this have reported overall prevalence rates of between 40 and 70%. Furthermore, TBI patients with sleep problems often have difficulty identifying their symptoms, making it more difficult to establish the true nature of these. Numerous factors contribute including the direct effect of trauma, neuropsychiatric consequences, psychotropic medication and increased risk of primary sleep disorders such as sleep apnoea if inactivity leads to increased weight gain. The relationship between the type or location of injury and sleep disturbance is not well established.”

MAR 10: Defense Video Imagery Distribution System
NME challenges everyone to “Think Ahead” of brain injuries—an all-ages threat
From the website: ” ‘Traumatic brain injuries can happen to anyone. So it’s especially important we think ahead when it comes to the prevention of brain injuries—whether driving your kids to school, enjoying a recreational activity or playing a sport,’ said Capt. Gail H. Manos, NME Wounded Ill and Injured, Psychological Health, and Traumatic Brain Injury program manager. ‘Everyone should learn the signs and symptoms of brain injury and when to get checked out. Early detection, evaluation and treatment will shorten recovery time.’ ”

DEC 8, 2016: Sound Sleep Health
Concussions: Can they lead to sleep disorders?
From the blog: “There are 4 main kinds of sleep problems that can occur at the result of TBI: hypersomnia disorders, sleep apnea, insomnia disorders, and circadian rhythm disorders.”

OCT 10, 2016: Times of India
Accident injuries could result in insomnia
From the article: ” ‘Sleep disturbances such as insomnia are very common following traumatic brain injury and have been reported in substantially high frequency. Sleep disruption may be related to TBI itself or secondary to neuropsychiatric or neuromuscular conditions associated with TBI,’ Dr Akhilesh Jain, senior specialist and head of the psychiatry department, ESIC model hospital, said.”

JUN 17, 2016: Catherine Wiseman-Hakes via ResearchGate
Sleep and Concussion Questionnaire-Revised
From the document: “The SCQ is currently being used as part of the Common Data Elements for the Ontario Concussion Strategy, is available as part of the Ontario Neurotrauma Foundation Guidelines for the Management of Concussion and Persistent Symptoms (adult version) and in numerous clinical and research settings across Canada and the USA.”

2015: Brain Injury Association of America
Insomnia is more likely among persons with mild brain injuries or depression
From the website: “In the post-acute rehabilitation phase of recovery, what contributes to insomnia among people with brain injuries?”

2015: Brain Injury Association of America
Sleep Disorders and Thought Processing
From the website: “What is the relationship between sleep difficulties and thought processing among individuals with traumatic brain injury?”

MAR 2010: Brainline
Sleep and Traumatic Brain Injury
From the article: “Many people who have brain injuries suffer from sleep disturbances. Not sleeping well can increase or worsen depression, anxiety, fatigue, irritability, and one’s sense of well-being. It can also lead to poor work performance and traffic or workplace accidents. A review of sleep disorder studies and surveys suggest that sleep disorders are three times more common in TBI patients than in the general population and that nearly 60% of people with TBI experience long-term difficulties with sleep. Women were more likely to be affected than men. Sleep problems are more likely to develop as the person ages.”

APR 3, 2007: American Academy of Neurology via Science Daily
Mild Head Injuries Increase Risk Of Sleep Disorders
From the article: ” ‘As many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia,’ said study author Liat Ayalon, PhD, with the University of California, San Diego. ‘This is concerning since sleeping problems may exacerbate other brain injury symptoms such as headache, emotional distress, and cognitive impairment, making the rehabilitation process much harder.’ ”


Emotional Trauma

Incidents of emotional trauma can include:

  • the full range of traumatic experiences that happen during childhood (which can impact human development)
  • traumatic experiences due to natural disasters or horrific accidents
  • trauma associated with abuse, violence, and/or assault (physical, psychological, emotional, and/or sexual) at any age

SHC offers these 10 links that discover how emotional trauma can lead to problems with sleep:

APR 4: Daily Journal
Treating the unseen wounds 
From the article: ” ‘Whether we want to accept it or not, violence and trauma is a healthcare issue. These patients will come into our offices with pain, nightmares, insomnia, depression, anxiety and (post-traumatic stress disorder),’ said Jenny Lee, a nurse practitioner at Johnson Memorial Health. ‘Without being addressed from the root causes, we’re just feeding them medications or such without getting to the root causes.’ ”

MAR 31: The Press
Editorial: Quake brain is real and the cost of Canterbury’s psychological recovery has been underestimated
From the commentary: “Many Cantabrians will recognise the symptoms–forgetfulness, an inability to focus, difficulty in completing simple tasks, anxiety, irritability, insomnia. This is ‘quake brain,’ something we have often talked about since the earthquakes of 2010-2011… Now, results from a scientific study have been released which suggest it is a measurable phenomenon.”

MAR 15: Katrinaosity
Story Time: I attacked my husband in my sleep?! Night terrors, and how I stop them now (video)
From the video transcript: ” ‘My first story time video, my worst night terrors, and what I do now to help curb them, and keep myself and my husband safe. My night terrors are a symptom of severe PTSD. Post traumatic stress disorder impacts many people differently, and after trauma therapy, this is what remains.’ ”

MAR 7: Huffington Post
Adult Children of Narcissists Face Trauma-Induced Health Risks
From the article: “Steele described the body’s response to years of ‘being on hyperalert, white-knuckling it.’ She listed common health problems among her clients resulting from disrupted cortisol (stress hormone) levels: autoimmune disorders such as Lupus and Chronic Fatigue, thyroid problems, back pain, irritable bowel, arthritis, depleted adrenals, and complex PTSD symptoms such as anxiety, depression, insomnia, and nightmares.”

DEC 13, 2016: University of Zurich via Science Daily
Sleep helps process traumatic experiences
From the article: “A study conducted by a team from the Department of Psychology at the University of Zurich and the Psychiatric University Hospital Zurich has now tackled the question as to whether sleep during the first 24 hours after a trauma has a positive impact on highly emotional distress and memories related to traumatic events.”

SEPT 2016: Sunrise House
PTSD: The Emotional Damage of Natural Disasters 
From the website: “Researchers were surprised that PTSD symptoms ‘continued in such a high percentage of children almost two years’ after Hurricane Charley struck. The symptoms included:

  • Tension and difficulty concentrating
  • Recurring dreams about the hurricane
  • Fear of another hurricane
  • Isolation and depression
  • Insomnia”

JUN 25, 2016AsiaOne
He had nightmares, insomnia after car accident
From the article: “He was suffering psychological symptoms after a traumatic experience…. This can happen to those who have been exposed to major trauma such as war, traffic accidents, or the sudden death of a loved one. …The symptoms include insomnia, flashbacks, nightmares and feelings of distress.”

JUN 17, 2016: Medical Daily
Trouble Sleeping? Childhood Trauma And Abuse May Contribute To Insomnia In Adulthood
From the article: “[D]ata on the sleep habits and childhood experiences of 1,007 adults aged 22 to 60… revealed that people who experienced childhood abuse, parental depression/anxiety, or divorces were more likely to have mild or moderate-severe insomnia.”

MAY 10, 2016: News-Medical.net
Researchers identify new psychological disorder, maladaptive daydreaming
From the article: “The data showed that individuals affected by the disorder spent about 60% of their waking time in daydreaming, and more than half said that the disorder disrupted their sleep and that the first thing they are aware of when they wake up in the morning is their urge to daydream.”

2014: American Academy of Pediatrics
The Medical Home Approach to Identifying and Responding to Exposure to Trauma (PDF)
From the guide: “Children suffering from traumatic stress may be clingy and fearful of new situations, easily frightened, difficult to console, irritable, impulsive, and inattentive. They may also have difficulty sleeping, struggle with their appetite, and show regression in functioning and behavior. It is important for parents to know that these symptoms are indicative of when the body’s normal fight, flight, or freeze response to stress or a threat is ‘turned on too much’ or ‘turned on too long.’ ”


Post-Traumatic Stress Disorder (PTSD) 

While we fully acknowledge that PTSD can include traumatic brain injuries and emotional trauma, and that it can happen to people of any gender and at any age, we are focusing on the concerns of military personnel here because of the ongoing emergence of sleep disorders in veterans that are associated with this kind of all-encompassing trauma.

The following 10 links highlight the complexity of what it means to suffer from PTSD, through the framework of insomnia, challenged reality perceptions while awake, hypersomnia, nightmares and other related symptoms:

APR 5: Emergency and Disaster Management Digest
Recognizing the Symptoms of PTSD
From the article: “Many people suffering from PTSD complain about a variety of sleep disturbances. Some people can’t get enough sleep, some can’t sleep at all and others are tormented by nightmares when they do fall asleep. The National Center for PTSD lists some of these sleep disturbances on their website, along with frequently asked questions about sleep disturbances and PTSD.”

APR 3: ABC.net.au
PTSD symptoms go beyond psychological, from sleep apnoea to irritable bowel syndrome: study
From the article: “Researchers looked at the health of 298 Australian Vietnam war veterans, and 108 of those veterans were confirmed as having PTSD…. Miriam Dwyer, the CEO of the Gallipoli Medical Research Foundation, said they found a large range of health conditions among the veterans. ‘They were four times more likely to have suffered a heart attack in the past,’ she said. ‘[They were also] three times more likely to have suffered from sleep apnoea and other sleep conditions.’ ”

MAR 23: Fort Leavenworth Lamp
Army doctor discovers new sleep disorder
From the article: “Dr. (Col.) Vincent Mysliwiec, a sleep researcher, said that upon returning home from combat duty, some veterans were having nightmares with ‘dream-enactment behaviors.’ … These behaviors were troubling, he said. ‘They’d strike out, scream, yell at their spouse and even run around their bed and at times hurt themselves or others.’ ”

MAR 16: Uniformed Services University of the Health Sciences (USU) via Newswise
Study Sheds Light on Prognosis of mTBI Symptoms for Returning Soldiers
From the article: “The most commonly reported symptoms were sleep problems, forgetfulness, irritability, headaches, and trouble concentrating.”

MAR 8: Closer
Army widow suffered five miscarriages as PTSD husband ‘lashed out’ in sleep
From the article: ” ‘While he was asleep he thought he was handling prisoners of war. Andrew would wake up thinking he had been captured and believed he was fighting the enemy. …It was as if he was possessed, his eyes would be open but he wasn’t really awake. He was trapped in a nightmare. I would be woken up by being physically hit when he was writing around in bed. …He would thrash about and it would quickly escalate. When I woke up I would be petrified, I would shout his name trying to wake him up but you can’t wake someone up from sleep walking, and he was just like that.”

FEB 24: Psychiatric Advisor
CPAP May Improve PTSD in Veterans With Sleep Apnea
From the article: ” ‘The findings indicated that treatment of OSA reduced PTSD severity and diminished frequency of nightmares to a degree that was both reliable and statistically significant,’ the investigators wrote. …The researchers noted that prior research speculated that PTSD may be caused in part by an underlying REM sleep dysfunction that is amplified by OSA. …’The repetitive arousals induced by recurrent hypoxic episodes disrupt emotional reprocessing of traumatic memories that occur normatively in REM sleep, and function to reduce their impact on current cognition,’ they wrote. ‘Utilizing CPAP is thought to promote consolidation of emotional memory, which may assist in recovery from traumatic events.’ ”

JAN 16: Hannibal Courier-Post
NEMO congressman files resolution supporting veterans with PTSD
From the article: ” ‘Sleep apnea can be brought on by the PTSD that far too many military men and women face after serving in combat,’ Rep. Graves continued. ‘With this resolution, I hope we can find solutions to this very real problem and begin providing our veterans with the resources needed to curb the effects of PTSD. Our soldiers bravely sacrifice so much to protect our freedoms, the least we can do is give them everything they need to lead healthy, successful lives once they come home.’ ”

DEC 1, 2016: Yahoo! Sports
Always on High Alert: Addressing Hyperarousal in PTSD Treatment
From the article: “…[H]yperarousal, in particular, can make it difficult to concentrate, disrupt sleep and increase the likelihood of angry outbursts. Many people who don’t seek treatment in a timely fashion experience worsening of the symptoms, especially with regards to hyperarousal, including sleep problems and anger management, says Dr. Yuval Neria, professor of medical psychology at Columbia University Medical Center and director of Trauma and PTSD at the New York State Psychiatric Institute in New York City.”

NOV 10, 2016: SOURCE
Occupational Therapy program offers veterans much-needed REST
From the article: “Aaron Eakman, assistant professor and director of research for the New Start for Student Veterans program at Colorado State University, is helping post-9/11 student veterans sleep more soundly… Eakman heads the Restoring Effective Sleep Tranquility (REST) program in the Department of Occupational Therapy. The program, initially funded by Wounded Warrior Project and presently sustained within the New Start for Student Veterans program, aims to help veterans reduce symptoms of chronic insomnia that may stem from their military service. Each year, Wounded Warrior Project releases a survey-generated annual report. ‘It was the first year they had identified sleep as the most significant problem their alumni were having,’ Eakman said. ‘In past years, post-traumatic stress disorder has been of highest concern.’ ”

No date: National Sleep Foundation
How trauma can affect your dreams
From the website: “If you struggle to sleep following a traumatic experience, you’re not alone. Nearly all trauma survivors experience some type of sleep trouble, such as insomnia. But for anywhere from half to three quarters of people, it’s vivid dreams that make it difficult to sleep soundly. … Having flashbacks to traumatic events, also called re-experiencing, is a hallmark symptom of posttraumatic stress syndrome. For roughly half of  PTSD patients, those flashbacks occur at night, while sleeping. And these are more common among those who’ve served in the military. For instance, 53% percent of  Vietnam veterans experience vivid nightmares, compared with just three percent of civilians.”

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