The experience of trauma can have a significant and long-term impact for survivors. Besides effecting a person’s psychological, emotional and physical well-being, trauma can also interfere with a person’s normal sleep cycle.
Traumatic stress can lead to a variety of sleep problems. When the autonomic nervous system is activated, the brain becomes flooded with neurochemicals, such as epinephrine and adrenaline. These neurochemicals can make it difficult to wind down at the end of the day and interrupt your normal sleep cycle. This can lead to insomnia and other sleep-related problems, nightmares, daytime fatigue and concentration difficulties due to sleep deprivation.
Following trauma, sleep disturbances can be exacerbated by a survivor’s experience of:
Hypervigilance (a state of feeling on high alert and on guard).
Flashbacks, intrusive thoughts or memories of the event.
Triggers such as night-time, darkness and the bedroom environment.
Nightmares can contribute to a fear of falling asleep or difficulty re-settling after a nightmare.
Night terrors which are episodes of screaming, intense fear and flailing during sleep.
Self-medicating with alcohol or depressant drugs which increases the production of the sleep-inducing chemical adenosine, enabling the fast onset of sleep but reducing the quantity and quality of the restorative rapid eye movement (REM) sleep.
Day-time fatigue which may lead to day-time naps which can potentially interfere with night-time sleep if overdone.
Sleeping pills can be an effective treatment for chronic insomnia but tend to be a short-term solution. Like many drugs, sleep medications can have side effects, lead to dependence and interfere with your natural ability to develop good sleep habits.
If you are struggling with sleep difficulties consult your GP to find out what the best options for you are. Depending on your situation, your GP may recommend the short-term use of medication either on their own or in conjunction with psychotherapy and sleep enhancing tips such as those listed below.
TIPS FOR MAXIMISING SLEEP
While there is no single solution for overcoming trauma-related sleep difficulties, the following tips can help to create good sleep habits and
maximise the possibility of getting a good night of sleep.
Maintain a consistent sleep schedule by going to bed and getting up at the same time everyday. Over time this will train your body to develop good sleep habits.
Morning exposure to sunlight can contribute to an earlier production of nocturnal melatonin which can help realign your circadian clock and assist you to fall asleep earlier.
Avoid caffeine, alcohol, recreational drugs and sugar for at least 4-6 hours prior to bed. These can act as stimulants and interfere with your ability to fall asleep, stay asleep or achieve restorative REM sleep.
Regular exercise relieves stress and tires you out. It is recommended however to avoid strenuous exercise within 4 hours of going to bed as this can stimulate the production of cortisol and adrenaline and inhibit sleep.
Avoid naps during the day as they can impact on your ability to sleep at night. If you are so exhausted that you need to take a nap, do so before 3pm and for no more than 20 minutes.
Eating too close to bedtime or heavy meals can interrupt sleep, as can going to bed hungry.
Avoid LED, fluorescent bulbs or devices that emit blue light in the hour before bedtime, as they can reduce melatonin, impact circadian rhythm and disrupt sleep. Research shows that dim red lights are the most conducive to sleep. Blue light emitting devices include smartphones, tablets and e-readers.
Create a sleep inducing environment that is quiet, dark and a comfortable temperature.
Develop sleep rituals that prepare the body and mind for sleep. This might involve deep, slow breathing, gentle stretches or having a non-caffeinated drink such as chamomile tea.
Hot baths 1-2 hours prior to bedtime have been shown to assist with sleep. Research shows that sleepiness is correlated with a drop-in body temperature.
Create an association between bed and sleep by only using your bed for sleep or intimacy. By using your bed for other activities such as reading, using electronic devices, eating and watching TV you can strengthen the association of bed as a place of activity and stimulation, rather than a place for sleep.
Get up out of bed if you are still awake after 20 minutes and engage in a non-stimulating activity that is calming or boring until you feel sleepy, then return to bed and try again. Keep lights off or dim, as exposure to light can further delay the onset of sleep.
Avoid clock watching as this can contribute to worry or frustration which can further exacerbate sleep difficulties.