Health Editor’s Note: Here is a second article on sleep and how to have more success in getting it…..Carol
How Does Trauma Affect Sleep?
By Tuck/Advancing Better Sleep
Trauma — the blanket term for any physically or psychologically damaging experience — is sadly common in our society. According to the National Center for PTSD, roughly 60% of men and 50% of women will experience at least one traumatic event during their lifetimes. Trauma can cause a wide range of long-lasting, negative health effects, including insomnia and other sleep-related problems.
This piece will discuss the realities of trauma and how traumatic events can impact our sleep patterns and routines. Read on to learn more about common sleep disorders associated with trauma, treatment options, and resources that help segments of the population that are considered especially vulnerable to trauma-related symptoms (such as children and war veterans). First, let’s see how the medical and psychological communities currently define different types of trauma, as well as the condition known as post-traumatic stress disorder (PTSD).
What Is Trauma?
Trauma is defined as any form of major damage to an individual with the potential for negative after-effects. Physical trauma is technically any injury caused by bodily harm, although the term is usually applied to severe injuries that lead to secondary conditions like shock or respiratory failure — even death, in some cases. Psychological trauma, on the other hand, is damage to the human psyche that occurs after an emotionally upsetting or distressing event. In many cases, both physical and psychological trauma will occur at the same time.
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 injury resulting in a traumatic brain injury (TBI)
Post-Traumatic Stress Disorder (PTSD)
Immediately following a traumatic event, people often seem distant and disoriented. They may express unwillingness to speak, or ‘zone out’ when being addressed by someone else. In the days and weeks following trauma, they may also display symptoms of anxiety, such as mood swings, inattentiveness, night terrors, and irritability. In many (but not all) cases, this anxiety will develop into a condition known as post-traumatic stress disorder (PTSD).
PTSD is most commonly associated with war veterans and rape/assault survivors; the condition, previously known as ‘shell shock’, first came to light after troubled soldiers returned home from the battlefields of World War I. However, anyone who has experienced trauma is susceptible to the condition. According to the National Institute of Mental Health (NIMH), PTSD stems from the ‘fight-or-flight’ feelings of fear and panic that arise during the trauma event. When these feelings linger long after the event is over and the person is safe from harm, then he or she is likely experiencing the early stages of PTSD.
The NIMH notes that most people with PTSD begin to experience symptoms of the disorder within three months of their trauma event. PTSD may either be diagnosed as acute (short-term) or chronic (long-term); acute PTSD is typically treatable within six months, while chronic PTSD may take years to treat — and in some cases, patients never fully recover. Current diagnostics 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, or reenactment of the trauma, which may take the form of flashbacks, nightmares, and/or disturbing thoughts. Re-experiencing events can be triggered by certain words or phrases, and have the ability to disrupt everyday routines.
- An avoidance symptom, when someone uncharacteristically shuns people, places, and/or activities associated with the trauma event. For example, someone who witnessed a public crime may steer clear of the location where this event took place, or a person involved in a car accident may refuse to drive or ride in a car, despite the inconvenience this may cause for them.
- At least two arousal and reactivity symptoms. These include being easily scared or startled, feeling edgy without provocation, experiencing sleep disruption, and/or lashing out at others. Unlike re-experiencing events and avoidance symptoms, arousal and reactivity symptoms occur independently of triggering, and are usually constant regardless of what the person is doing.
- At least two mood and cognition symptoms, which can include difficulty remembering details of the trauma event, feeling negatively about themselves or their loved ones, feeling guilt or blame associated with the trauma event, and/or feelings of detachment or discontentment toward previously cherished people, places, and activities.
People with PTSD often experience other mental health problems, including depression, substance abuse, and/or anxiety disorders. However, in order to receive a PTSD diagnosis, the symptoms described above must occur regardless of comorbid conditions.
Psychological Trauma in Children
Children are considered exceptionally vulnerable to trauma. The American Psychological Association (APA) estimates that up to 85% of children will witness some form of community violence before they reach adulthood — and as many as 66% of children will be victims of trauma. The APA also estimates that 25% to 43% of children will experience sexual abuse.
Like adults, the way children react to trauma will vary considerably. Many factors come into play, including the child’s cognitive and emotional development levels, family dynamic, socioeconomic status, race or ethnicity, religious background and pre-existing medical, behavioral or psychological conditions.
Arguably the most critical factor is age. Children six and under are highly susceptible to the after-effects of trauma, due to their low development levels. Symptoms of trauma among kids six and younger include:
- Enuresis, or bed-wetting, after they have been potty-trained
- Chronic nightmares
- Unfounded fears toward relatively innocuous things
- Trouble speaking or expressing themselves verbally
- A tendency to obsess over — even re-enact — the traumatic event
- Uncharacteristic clinginess or dependency on their parents and other adults
Many children between kindergarten and middle school age who witness or experience a will constantly feel afraid. These persistent fears can lead to anxiety, as well as disengagement toward everyday activities. Children in this age group often struggle in school and may see their grades suffer as a result. They may also become less interested in hobbies and activities they once enjoyed. Like their younger counterparts, they may also be inclined to obsess over the event and feel the need to constantly discuss it. Feelings of guilt, self-blame, and anger are also common.
For many teenagers, traumatic events represent unwanted attention from peers, teachers, coaches, and other important people in their lives. As a result, they may insulate themselves from school and social activities. Acting out is also fairly common, often in the form of angry outbursts and/or disruptive behavior. In some cases, self-harm may also occur. And because they are at an age of greater independence, they may express a desire to seek revenge or retribution on whomever they blame for the traumatic event.
Diagnosing PTSD in children can prove challenging because the symptomatic criteria closely align with depression, anxiety disorders, and other mental health issues common in children and adolescents. In order to receive a PTSD diagnosis, a child must have “experienced, witnessed, or learned of a traumatic event, defined as one that is terrifying, shocking, and potentially threatening to life, safety, or physical integrity of self or others”. Beyond that, the symptomatic criteria for PTSD in children is slightly different from that of adults. This criterion includes the following symptoms for a period of at least one month:
- At least one re-experiencing event. In exceptionally young children, this may include recreating the event during playtime. They often have nightmares on a regular basis, and in rare cases may experience hallucinations. They may also exhibit severe stress whenever details of the event are mentioned.
- At least three avoidant or numbing symptoms. These often involve stubborn refusal to revisit, or even acknowledge, the traumatic event, as well as any associated people, places, or objects. Children may have a hard time remembering the event. They may also exhibit disinterest in their favorite activities, and detachment from their friends and loved ones. In some cases, they may indicate fears they will die soon, or that something bad will happen to them in the near future.
- At least two hyperarousal symptoms. For many children and adolescents, excessive alertness and vigilance is a common after-effect of trauma. As a result, many struggle to concentrate in school and experience trouble sleeping. Angry or emotional outbursts often take place, as well.
It’s important to stress that not everyone who experiences trauma will develop PTSD or other serious mental health disorders. However, psychologists and mental health experts have pinpointed several risk factors that increase the likelihood of a trauma survivor experiencing PTSD. These factors include:
- Living through the trauma (also known as ‘survivor’s guilt’)
- Being injured during the traumatic event
- Witnessing the injury or death of another person
- Being a child or adolescent
- Not having a sufficient support system (i.e., few family and friends available)
- Supplemental problems with work, family, and other life that can exacerbate the effects of the trauma
- A history of mental illness or alcohol/drug abuse
Likewise, the NIMH notes that there are ‘resilience factors’ that can decrease the risk of PTSD, such as:
- Having a healthy support system of family and friends, or the willingness to seek out supportive individuals
- Accepting how the trauma unfolded, and recognizing that there was nothing that could have been done to prevent it or change the outcome
- Developing positive routines — such as daily exercise — that can be used as coping strategies
- Feeling confident and willing to face the future despite lingering feelings of fear and/or dread
In addition, the National Center for PTSD has identified the following PTSD risk factors for children who have experienced or witnessed a traumatic event:
- Being female
- Previous exposure to traumatic events
- Pre-existing psychological conditions
- Having one or more parents with a pre-existing psychological condition
- Insufficient support network of family and friends
Traumatic Brain Injury (TBI)
A traumatic brain injury (TBI) occurs when a person experiences violent, physical trauma to their head or body. The trauma can be any kind of impact that jolts the head and body, including a physical object entering the brain tissue as a result of the trauma, such as shattered skull fragments or bullets. TBIs can be caused by a car accident, combat or warfare, physical violence, or sports.
Doctors differentiate mild TBIs from moderate to severe TBIs. Mild TBIs affect the brain for a temporary basis and account for 80% of all TBIs. Moderate to severe TBIs result in physical damage to the brain that can lead to further complications, such as infections, fluid buildup in the brain, or death. Regardless of the label, all TBIs are serious injuries that require immediate medical attention.
TBIs affect the person physically, emotionally, and mentally. A person who has incurred a mild TBI will display symptoms immediately and up to weeks after the trauma. Symptoms of a mild TBI include:
- Temporary loss of consciousness up to a few minutes
- Confusion or disorientation
- Vertigo or dizziness
- Nausea or vomiting
- Difficulty speaking
- Difficulty concentrating or remembering things
- Mood swings, changes in mood, depression, or anxiety
- Sensory difficulties, such as ringing ears, inability to smell, o blurred vision
- Sensory sensitivities, particularly to light or sound
- Sleep issues, including fatigue, sleeping more than normal, or difficulty sleeping
When a person has a moderate or severe TBI, they typically experience more extreme or intense versions of these symptoms (such as frequent headaches or a loss of consciousness for hours), and more symptoms overall. They are also more likely to display symptoms much earlier, within hours to days after the traumatic event. Additional symptoms include:
- Dilation of the pupils
- Clear fluid drainage from the ears or nose
- Weak fingers or toes, or a numb sensation
- More changes in mood, particularly toward aggressive or combativeness
- Difficulty waking up from sleep
The CDC estimates that each year, 50,000 people die from a TBI. TBIs, or TBIs in conjunction with additional injuries, account for 282,000 hospitalizations and 2.5 million ER visits each year.
In order of prevalence, the common causes of TBIs include:
- Falls. Falls are the leading cause of TBIs, accounting for 47% of TBIs. Fall-related TBIs are especially common older adults above age 65, where they represent 79% of TBIs.
- Being hit by or against an object. This may include physical assault and violence, car accidents, intentional self-harm, or sports-related injuries. These account for 15% of TBIs.
- Motor vehicle accidents. Car accidents account for 14% of TBIs.
- Combat and explosions. TBIs account for nearly a quarter of combat injuries, and between 60 to 80% of soldiers who are injured from a blast or explosion also have a TBI.
TBIs in Children
When a child incurs a TBI, they may not be able to communicate their symptoms clearly. Parents and caregivers should watch for these additional signs of a TBI:
- Severe changes in mood, such as quickness to irritability, depression, or prolonged crying
- Change in appetite
- Change in ability to stay focused
- Sleep issues, such as different sleep habits or drowsiness
- Lack of interest in toys or play
The leading cause of TBI-related death for infants and children under 4 is assault. For older children and adolescents, it’s motor vehicle accidents.
Other common causes of TBIs in children are sports injuries and falls. Between 2001 and 2012, the number of sports-related TBIs more than doubled among children age 19 and younger. Falls account for over half of TBIs among children younger than 14.
Next, let’s discuss how physical trauma, psychological trauma and PTSD can affect the way we sleep.
Adults and children are most vulnerable to trauma-related sleep problems when facing a traumatic event that has affected them directly, such as abuse or assault, combat experience, automobile accidents, or the death of a loved one.
How Trauma Affects Sleep
Both physical and psychological trauma can negatively impact sleep, often in the same way. Factors like TBIs in physical trauma and PTSD in psychological trauma can further complicate the effects of trauma on sleep.
TBIs and Sleep
Physical trauma can disrupt sleep due to lingering aches, pains and general discomfort stemming from the initial injury or injuries. Additionally, traumatic brain injuries have been linked to sleep disturbance.
A report from the Model Systems Knowledge Translation Center (MSKTC) notes that 60% of people diagnosed with a TBI will experience difficulty falling and/or staying asleep. These sleep issues have been found in people with TBIs ranging from minor to severe; this is largely due to the fact that our brains are responsible for regulating sleep patterns (among many other functions), and TBIs can tamper with one’s circadian rhythm, or the 24-hour biological clock that tells us when it’s time to go to bed and time to get up.
Common sleep disorders and syndromes found in people with TBIs include:
- Insomnia, defined as difficulty falling or staying asleep. Like PTSD, insomnia may be a short- or long-term condition. People with insomnia feel tired and inattentive no matter how much sleep they get, and this lack of restorative sleep can intensify other behavioral or mental health issues. Excessive daytime sleepiness is a common side effect of insomnia, as well.
- Delayed sleep-phase syndrome, a condition characterized by dysfunctional circadian cycles. People with this syndrome often feel tired in the morning and alert at night.
- Narcolepsy or the sudden, uncontrollable urge to fall asleep regardless of surroundings or time of day.
- Restless legs syndrome (RLS), a condition that causes the individual to feel intense and insuppressible itchiness, numbness or discomfort in their legs. RLS symptoms are typically strongest at nighttime when the person is lying in bed.
- Bruxism, or grinding one’s teeth while sleeping.
- Sleep apnea, characterized by temporary loss of breath while sleeping. Obstructive sleep apnea (OSA) is caused by a physical blockage in the primary airway, while central sleep apnea (CSA) occurs due to faulty communication between the brain and the breathing muscles.
- Periodic limb movement disorder (PLMD), during which the individual uncontrollably flails or jerks their arms and/or legs while sleeping.
- Sleepwalking and other forms of parasomnia, which are defined as abnormal behaviors during sleep. Bed-wetting is another type of parasomnia, though this is uncommon in adults.
Certain factors can increase the risk of sleep disorders and syndromes in people with TBIs. These include:
- Depression. Feelings of depression are common following physical trauma, and these symptoms can significantly affect sleep patterns — particularly in those who take depression medications that elevate moods and increase wakefulness.
- Medications. Many medications prescribed to treat depression can increase feelings of alertness throughout the day and night and may lead to insomnia. Likewise, sedatives and other medications that induce sleep can disrupt sleep onset (falling asleep) or sleep maintenance (staying asleep).
- Daytime napping. Sleeping for more than 20 minutes during the day can affect sleep onset and sleep maintenance, particularly in people who do not exercise regularly.
- Physical pain. Bodily aches and discomfort have been linked to insomnia, and many medications prescribed to reduce pain symptoms can also disrupt sleep.
- Alcohol and other depressants. Consuming alcoholic beverages or using drugs (such as marijuana) before bedtime can negatively affect how we sleep, even though these substances initially cause feelings of tiredness.
- Nicotine, caffeine and other stimulants. Consuming these substances (especially in the afternoon or evening) can increase feelings of alertness, which impact the way we fall asleep and feel restored after a full night’s rest.
Sleep may also play a role in exacerbating trauma-related sleep problems. A 2013 article published in Scientific American noted an interesting finding: people with TBIs may benefit from forcing themselves to remain awake in the hours following a traumatic event. Sleep has been proven to subconsciously reinforce emotional memories, so staying up essentially “disrupts the consolidation of trauma memories”. Patients treated for TBI are encouraged to try and remain awake for up to 24 hours after the injury has taken place.
Post-TBI sleep issues are typically diagnosed using polysomnograms and multiple sleep latency tests.
- A polysomnogram is an overnight sleep study, where the individual sleeps in a lab while connected to machines that monitor their breathing patterns, brain waves, muscle movements, and more. Polysomnograms help diagnose TBI-related insomnia, delayed sleep phase syndrome, sleep bruxism, sleep apnea, and sleep-related movement disorders like RLS and PLMD.
- A multiple sleep latency test (MSLT) is performed during the day. It tests how quickly a person falls asleep during the day, aiding in diagnosis of TBI-related narcolepsy.
Psychological Trauma and Sleep
Patients dealing with psychological trauma/PTSD may experience many of the same sleep disorders and syndromes, including insomnia, delayed phase sleep disorder, obstructive sleep apnea, and sleepwalking. Additionally, people with PTSD may also report the following sleep issues that are somewhat unique to cases involving psychological trauma:
- Nightmares are a common symptom of PTSD and maybe one example of a re-experiencing event used to diagnose the disorder. In some cases, the nightmares will be a re-enactment of the traumatic event; other nightmares will be more symbolic in nature.
- In addition to sleepwalking, other parasomnias are common in people with PTSD. Night terrors, or irrational fears that arise when we wake up, are widely reported, as are sleep talking and night sweats. The condition is known as REM sleep behavior disorder, which is characterized by individuals physically acting out dreams during sleep, may also occur.
John Cline, Ph.D., notes in an article for Psychology Today that our brain chemistry changes following a traumatic event. Our ‘fight-or-flight’ reactions are controlled by a part of the brain known as the amygdala, which triggers the release of stress hormones like adrenaline and cortisol — both of which cause us to feel alert — while simultaneously reducing the production of serotonin, which makes us feel tired. While all types of trauma can lead to increases and decreases in key hormones, these trends have been most commonly reported in people with PTSD from combat, abuse or assault.
As a result, people with PTSD may be hyper-vigilant (or hyper-aroused), and this mindset can affect how they fall and/or remain asleep. Many use alcohol or drugs to mute their constant alertness, and (as discussed above) this can negatively affect sleep to a significant degree. Many medications used to treat PTSD have the same result.
Trauma and Sleep in Children
Children and adolescents who have experienced a traumatic event often report the same sleep disturbances as adults. These include:
- Sleep onset and maintenance difficulties
- Frequent nightmares/anxiety dreams and night terrors
- Sleepwalking and other forms of parasomnia (as well as enuresis)
Additionally, many children have struggle with sleeping alone and may exhibit separation anxiety leading up to bedtime.
Like adults, children are most vulnerable to trauma-related sleep issues when the traumatic event has affected them directly, including cases of abuse, school violence, vehicular accidents, natural disasters, and the death of a loved one. Additionally, children tend to experience sleep problems for longer durations following indirect traumatic events, such as witnessing a death or act of violence. A study conducted after the 1986 Challenger Space Shuttle explosion found that children who watched news coverage of the disaster experienced trouble sleeping for up to seven weeks afterward. Another survey of children living in areas of New Orleans damaged by Hurricane Katrina noted that up to half of respondents had trouble sleeping 24 to 30 months after the disaster.
Teenagers are generally more equipped to handle trauma than younger children, due to their relatively advanced development and maturity levels. However, parents are encouraged to seek medical or psychiatric care for children of any age that experience sleep issues for more than a month following a traumatic event.
Now, let’s look at some of the best-practice treatment methods for physical and psychological trauma symptoms that negatively affect sleep patterns.
Treatment for Trauma-related Sleep Problems
If you experience sleep issues after experiencing a TBI and/or psychological trauma, then you may find relief through non-pharmacological means. Some common treatment methods that do not involve prescribed medication include the following:
- Many people with TBIs and PTSD experience severe mood and/or behavioral shifts. As a result, psychotherapy (or counseling) may be an effective route for these patients to take. The patient’s physician will be able to help recommend options, and may even be able to refer their patient to a reputable therapist.
- Cognitive-behavioral therapy (CBT) is another popular route because it does not involve medication and has proven results. This type of therapy may involve anywhere from four to 12 30-minute sessions with a psychologist, nurse practitioner or another licensed healthcare provider with a background in insomnia and sleep disorder treatment. Patients discuss their sleep habits with the therapist, who provides tips of improved sleep hygiene and helps correct misconceptions the patient may have about sleep psychology. CBT often requires patients to make nightly reports in a sleep diary. Most patients who receive CBT will minimize their sleep latency (the time it takes to fall asleep) by 30 to 45 minutes, and increase their total sleep time by 30 to 60 minutes.
- People with TBIs or PTSD who experience anxiety disorders may also benefit from relaxation therapy or meditation, which soothes their bodies and minds and creates a peaceful mindset leading up to bedtime.
- Light therapy, or phototherapy, can improve sleep for TBI-related delayed sleep phase syndrome by essentially resetting your 24-hour circadian clock. Exposure to bright lights at certain times of the day will stimulate photoreceptors or parts of the eye most sensitive to light; this often causes patients to fall asleep more easily and sleep later. Light therapy boxes are widely available over-the-counter, but you should not resort to this treatment method without approval from your physician.
- Sleep restriction, a form of behavioral therapy, may also work. Sleep restriction is essentially controlled sleep deprivation; the philosophy behind this practice is that one’s sleep efficiency (or how well/restorative our sleep is) will improve if they limit the time they spend in bed. People undergoing sleep restriction therapy are often asked to keep a sleep diary, in which they record their sleep activities night after night. Everyone has different benchmarks, but a good rule-of-thumb is that sleeping should take up at least 85% to 90% of the time you are in bed. There are some health risks to sleep restriction, so this process should always be supervised.
- CPAP or BiPAP therapy is the recommended treatment for individuals with a TBI and sleep apnea. Following their polysomnogram, the individual is fitted for a facial mask they wear while they sleep. The mask is connected to a machine that delivers continuous positive airway pressure (CPAP), keeping their airways open.
- Acupuncture has also been shown to be effective in improving sleep quality for patients with TBIs.
In many cases, patients who seek treatment for trauma-related conditions like PTSD will experience improvements in their nightly sleep. There are currently a handful of therapies used to treat PTSD, as well as some more experimental methods still being studied and evaluated. These include the following:
- Cognitive therapy works by the retraining the way patients perceive the trauma. Cognitive interventions allow patients to pinpoint and dispel false notions about themselves — and to a larger extent, the world around them — that have arisen since the traumatic event took place, often exacerbated by depression and other mental health disorders. This new approach often allows patients to reassess their lives and, in doing so, alleviate lingering feelings of guilt and self-blame.
- Exposure techniques challenge patients by forcing them to confront their anxieties head-on, often through simulated re-enactments of the traumatic event; in recent years, some therapists have utilized virtual reality reproductions. By facing their trauma, patients may become desensitized to its negative effects.
- The relatively new technique of eye movement desensitization and reprocessing (EMDR) is considered one of the leading treatment methods for people with PTSD — as well as one of the most controversial. EMDR is centered around the theory that lateral eye movements can relieve stress — and when these movements are controlled, patients are better equipped to tackle traumatic memories. The multi-phase EMDR process begins with patients identifying difficult memories related to their trauma. Once these memories have been targeted, therapists work to first desensitize patients to them, and then retrain the brain to process these memories in a more positive way — all while controlling lateral eye movements through hand motions, sounds and other stimuli. Body scans are used to assess how the eyes are moving at critical moments during the EMDR process.
- In recent years, researchers have experimented with traditionally recreational drugs— notably cannabis and ecstasy (or MDMA) — to determine if they can be used to treat PTSD. These studies are still in the research stages, and patients with PTSD are discouraged from using these drugs unless they are part of a controlled study with their physician’s approval.
A wide range of sedatives, hypnotics, and other drugs are widely prescribed for insomnia and other sleep disorders, but most of these carry potentially disruptive side effects — so patients are encouraged to try natural remedies before turning to prescription meds. Melatonin supplements are one option. Melatonin is a natural hormone produced in the pineal gland of the brain that regulates the sleep cycle. Taking supplements can boost melatonin levels, and thus help patients sleep better and more soundly. Melatonin supplements also carry very few side effects and do not cause dependency. Herbal teas and valerian root are two other possibilities. Make sure to consult with a doctor before taking natural remedies, though, as they may interact with other medications, and exacerbate — rather than mitigate — sleep issues.
If therapies and natural remedies prove ineffective, then prescribed medication might be the best option. Please visit or guide to sleep disorder medication for more detailed information about prescription drugs that are currently available.
In many cases, patients who seek treatment for trauma-related conditions like PTSD will experience improvements in their nightly sleep.
Treatment Considerations for Children
A 2013 study published in the Journal of Clinical Sleep Medicine noted that PTSD and sleep disturbance share a reciprocal treatment relationship in child patients; those who sought treatment for PTSD reported improvements in their sleep, while treatment for sleep disorders improved PTSD symptoms.
Very few therapy methods specifically target sleep-related issues stemming from PTSD; most therapy techniques aim to tackle all PTSD symptoms through comprehensive intervention. One notable exception is image rehearsal therapy (IRT), used to treat patients who experience frequent nightmares or anxiety dreams as a result of PTSD; although originally designed for adults, IRT has been customized to accommodate adolescent patients as well. Patients describe their nightmares to a counselor, and then devise positive endings for them; the goal is to subconsciously redirect the patient’s brain when they are actually dreaming. Throughout IRT sessions, patients keep a sleep diary to monitor their progress.
Treating PTSD in children can be especially delicate. The following treatment methods have proven most effective for children and adolescents diagnosed with PTSD.
- Cognitive-behavioral therapy (CBT) is the “most effective approach” to treating children with PTSD, according to the National Center for PTSD. The best-practice methods involve open discussion of the traumatic event, anxiety management, and correction of any misconceptions of misplaced feelings the patient may feel about their role in the event.
- Many younger children with PTSD respond well to play therapy, which involves arts and crafts, games, music, and other activities that enable children to express themselves in a supportive, controlled environment.
- In recent years, organizations like the World Health Organization have promoted EMDR as an effective way to minimize the painful memories and associations that stem from PTSD. However, this form of therapy has so far proven more effective in adults than in adolescents and children.
- In severe cases, children and adolescents with PTSD may benefit from spending some time at an outpatient treatment facility that specializes in intensive trauma therapy. Many clinics and care centers today focus on treating PTSD in children of all ages. Interventions may be needed for children and adolescents who exhibit violent or inappropriate sexual behavior or appear to have a substance abuse problem.
For children who have experienced trauma, a strong support network of family and friends can make a huge difference, especially during the treatment phase. This is true for all age groups, though needs will manifest differently depending on age. Young children may require physical affection and consolation, while teenagers often rely on strong communication with and verbal encouragement from their parents and peers.
Tips for People with TBIs, PTSD, and Trauma-related Sleep Problems
In addition to the treatment options listed above, there are several ways that trauma patients can improve their sleep patterns through everyday interventions and lifestyle adjustments. These include the following:
- Establish a consistent sleep schedule by going to bed at the same time each night, setting an alarm, and doing your best to get up at the same time each morning.
- Limit periods of inactivity throughout the day and replace them with activities and/or physical exercise.
- Get plenty of sunlight, especially during times of the year when natural light is scarce. This will help realign your circadian clock.
- Avoid napping for more than 20 minutes during the day. Believe it or not, sleep studies have determined that this is considered the ideal nap duration.
- Abstain from alcohol, recreational drugs, caffeine and sugar in the hours leading up to bedtime. Avoid in the afternoons if possible, as well.
- Find the right balance for eating before bed. Too much food can cause discomfort in the night, but feelings of hunger can also disrupt sleep. Try to avoid eating up to 60 minutes before going to bed.
- Use your bed for sleep and sex only. This means no TV, video games, reading, et al., in bed.
- Speaking of TV and video games, try to avoid electronics-based activities up to an hour before bedtime. This also includes tablets, smartphones, and e-readers. All of these devices emit ‘blue light’, which reduces melatonin levels and disrupts sleep.
- LED and fluorescent lights also emit blue light, as well as ‘artificial light’, which can also affect melatonin production. A good workaround: install adjustable lights with a dim setting that you can use before bed. Dim lights can increase feelings of tiredness.
- Don’t stew in bed if you can’t fall asleep within 30 minutes. Instead, get up and walk around for a few minutes, or relocate to another room and try reading a non-electronic book with a dim light. This will help dispel negative associations with your bed.
- Reconsider your sleep environment — particularly if you have experienced trauma in your bedroom. A guest room, a pull-out couch, or even another location (such as a hotel or a friend’s house) are all good alternatives.
It’s important to stress that nothing can replace the care and treatment provided by physicians, therapists and other licensed healthcare professionals. These tips may be effective, but if you believe you are experiencing PTSD, TBI or other trauma-related conditions, you should immediately contact your doctor.
Additionally, here are some tips for parents, guardians, and caregivers of children and adolescents with PTSD:
- Establish the home as a safe place where open discussions can take place — and always have time to listen if the child needs to talk.
- Give children a few days to cope following a traumatic event, but try to guide them back into their normal routines as soon as possible. This may be especially difficult in cases of severe trauma. However, returning to school, extracurricular activities, and social lives can help children and adolescents process their trauma more effectively.
- Schedule lots of fun, relaxing activities in the weeks following the traumatic event. Day-trips, meals at restaurants they like, and outdoor activities involving physical exercise can help boost their spirits as they deal with the after-effects of trauma.
- Limit or restrict the child’s pre-bedtime exposure to anything referencing the traumatic event, such as TV news stories or newspaper articles. If they are young, set parental controls on the television and computer to prevent them from seeing materials that could potentially upset or disturb them. If they insist on watching something, make sure you are in the room with them from start to finish to answer questions and calm them down if needed.
- Monitor their diet and make sure they are eating plenty of nutritious foods, which will elevate their mental and physical states. Also, keep an eye out for significant weight gain or loss.
- For children of younger ages, security is especially vital during the post-trauma stages. If you are able, drop them off at school and pick them up on time; also consult with their teachers to ensure that they are never alone in the classroom or on the playground.
- Establish healthy, consistent sleep routines that the child can follow during the week and on weekends. Try to limit their exposure to TV, video games, and other blue light sources before bedtime, and also limit their nighttime intake of sugar and caffeine.
- If the child is of school age, check in on them regularly to ensure they are doing their homework and getting acceptable grades. Schedule meetings with their teacher(s) if there is any indication they are struggling academically.
- Take extra precautions when disciplining children with PTSD. Some forms of regression — such as emotional outbursts or disruptive behaviors — should be expected in children who have experienced trauma, particularly those of a younger age. According to Northwest Trauma Counseling, parents can divide household rules into three groups: non-negotiables, preferred behaviors, and ideal behaviors. Focus on disciplining children for non-negotiable acts (such as physically harming another person in the house), while doing your best to guide them with preferred behaviors (such as doing chores) and ideal behaviors (such as getting straight As).
- Lastly, don’t be afraid to seek professional help if the child exhibits PTSD symptoms for more than one month. Guide the child through this process by explaining that it is meant to help them and that they will have a strong support system behind them the whole time.
Visit the Web pages below for more information about diagnosing and treating trauma-related conditions that negatively impact sleep. We have also included hotlines for veterans, abuse survivors, and other individuals who have experienced trauma.
- PTSD Foundation of America: The following hotlines are staffed 24 hours a day to provide round-the-clock support for PTSD survivors and other people who have experienced serious trauma:
- Veteran Crisis Talk (800-273-8255)
- National Veterans Foundation Hotline (888-777-4443)
- Rape, Abuse, and Incest National Network (800-656-4673)
- National Domestic Violence Hotline (800-799-7233)
- National Council on Alcoholism and Drug Dependence Hope Line (800-622-2255)
- Gulf War Veteran’s Hotline (800-796-9699)
Physical Trauma and TBI
- National Institute of General Medical Sciences: This FAQ post features information about the causes, effects and treatment options for physical trauma.
- Science Daily: Browse different articles about physical trauma and TBI in the article archive for this reputable online scientific journal.
- LiveScience: This informative article explores how the human body responds to physically traumatic experiences.
- Traumatic Brain Injury: This website is dedicated to exploring the causes, symptoms, treatments, and other key information about TBIs.
- Centers for Disease Control: The CDC’s TBI page features general information, statistics, and treatment options for people who have experienced serious head injuries.
Psychological Trauma and PTSD
- American Psychological Association: The APA features a webpage dedicated to the ‘theory, research, practice, and policy’ of diagnosing and treating psychological trauma and its associated conditions.
- National Center for PTSD: This division of the U.S. Department of Veterans Affairs offers a handful of online resources related to diagnosing, treating and seeking support for PTSD.
- National Institute of Mental Health: The NIMH features an extensive report detailing the current definitions, symptoms, treatment options, and scientific studies related to PTSD.
- Agency for Healthcare Research and Quality: The AHRQ offers his exhaustive list of ‘psychological and pharmacological treatments’ for adults with PTSD.
- American Nurses Foundation: This ‘PTSD Toolkit’ from the ANF features the guiding theories and approaches to medical and psychological treatment for veterans with PTSD.
Trauma and Sleep
- Psychology Today: In this article titled, ‘Trauma and Sleep: Disorders’, Dr. John Cline describes the most common sleep-related issues stemming from PTSD and traumatic experiences.
- National Center for PTSD: This detailed summary of sleep disorders related to PTSD includes symptoms, risk factors, treatment options, and tips for improved sleep hygiene.
- Behavioral Sleep Medicine: This 2012 study highlights the differences in sleep disturbance between men and women who experience traumatic events.
- Defense Centers for Excellence for Psychological Health and Traumatic Brain Injury: This 99-page report highlights the latest findings and treatment options available to veterans with sleep problems related to PTSD, TBI, and other traumatic experiences.
- The Sleep Paralysis Project: This 2013 short-film project highlights the individual experience of sleep paralysis, a condition characterized by feelings of paralysis upon waking; the condition has been widely reported among people who experience traumatic events.
- Journal of Clinical Sleep Medicine: This 2014 study explores ‘trauma associated sleep disorder’, a proposed condition characterized by symptoms like sleep deprivation and parasomnia.
- Disturbed Sleep in Post-traumatic Stress Disorder: Published by the University of Oxford’s Center for Evidence-based Intervention, this study poses (and answers) a fundamental question: is disturbed sleep a secondary symptom of PTSD, or one of the telltale indicators?
- Sleep Disorders — Case Studies of War and Trauma: Dr. Meir H. Kryger of the Yale School of Medicine conducted this study of people who had experienced firsthand some of the most devastating human events of the last century, including the Holocaust, the Vietnam War and the Rwandan genocide.
- The Journal of Nervous and Mental Disease: This study outlines the primary sleep disturbances and other physical health symptoms of women who survive rapes and sexual assaults.
- Stress, Trauma and Sleep in Children: Conducted by Avi Sadeh of Tel Aviv University, this extensive study explores the connection between trauma and various sleep disorders in children of all ages.
Trauma Resources for Veterans
- National Center for PTSD: This detailed guide to ‘Sleep Problems in Veterans with PTSD’ highlights the latest findings and treatments available for combat veterans.
- Journal of Injury and Violence Research: This study highlights insomnia, sleep apnea, parasomnia, and other common sleep disorders in combat veterans with PTSD stemming from their service.
- Psychology Today: Michael J. Breus, Ph.D., penned this article about common sleep disturbances in soldiers and combat veterans, including conditions that may occur independently of PTSD.
- The Huffington Post: This 2016 article by Krithika Varagur explores a proposed, as-yet-unnamed sleep disorder characterized by frequent combat dreams.
- Journal of Clinical Sleep Medicine: This study focuses on a widely underreported trend: the prevalence of obstructive sleep apnea (OSA) in combat soldiers who have been diagnosed with PTSD or experienced a traumatic event during their service.
Trauma Resources for Children
- Child Mind Institute: This report (also available in Spanish) highlights grief expression, sleep issues and other common signs of trauma in children.
- Fostering Perspectives: This guide for foster parents of children with PTSD or other trauma-related issues includes an age-by-age breakdown of behavioral expectations and a few tips to create a peaceful, supportive home environment.
- National Child Traumatic Stress Network: The NCTSN’s official website is a compendium of information and resources pertaining to the diagnosis and treatment of children with PTSD.
- Psychiatry: Dr. Sricharan Moturi and Dr. Kristin Avis penned this extensive list of pediatric sleep disorder symptoms and treatments, including sections dedicated to sleep apnea, movement-related disorders, and childhood insomnia.
- Annals of Behavioral Medicine: This 2011 study explores the connection between trauma from childhood abuse and difficulty sleeping during adulthood.
Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.
She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – one daughter-in-law; Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with her husband Gordon Duff, many cats, and two rescues.
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Extreme excellence, clearest and most comprehensive examination of one of our plagues of “modern life” I’ve ever seen.
You deserve some kind of award, Carol—beyond that of knowing how much this might help so many people. Thank you.
Ludwig, I thought this article was quite comprehensive so I chose to share it but note that I did not write it. It was written by Tuck for Advancement of Better Sleep. http://www.tuck.com
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