The Role of Sleep in PTSD and Trauma Recovery

Trauma is the natural emotional response to a frightening or life-threatening event. After experiencing a trauma, many people develop symptoms like jumpiness, tension, and hypervigilance. One of the main symptoms people face after going through trauma is difficulty sleeping.

Research shows a vast majority of people who live with post-traumatic stress disorder (PTSD) – a mental health condition that some people develop after going through a traumatic event – experience insomnia or nightmares. Unfortunately, while PTSD makes it difficult to get restful sleep, being sleep-deprived can also make PTSD symptoms worse.

When you’re healing from a past traumatic event, it’s critical to prioritize rest and find ways to allow your body to get the sleep it needs to recover. This article will explore the relationship between trauma and sleep, including why sleep is so important for PTSD recovery.

Sleep and PTSD: How trauma disrupts sleep

Sleep difficulties are an extremely common part of living with PTSD. Nightmares, in particular, are common among people with PTSD. Some reports show up to 90% of people with PTSD suffer from nightmares^[1].
Unfortunately, sleep in PTSD can also get locked in a vicious cycle; PTSD makes restful sleep difficult, but being sleep-deprived can make PTSD symptoms even worse.
There are several ways experiencing trauma can affect your sleep:

The stress response

When we’re faced with a threatening or scary situation, our nervous system releases its stress response. This is a biological reaction that helps us fight or run away from danger. During the stress response, our systems are flooded with stress hormones like cortisol. Cortisol causes changes in the body, such as a rapid heart rate, shallow breathing, and increased muscle tension.

Although these changes are useful when facing an actual danger, they can get in the way of a restful night’s sleep. Research shows an excess of cortisol can interrupt sleep at every stage.

Nightmares and intrusive memories

A great majority of people with PTSD have nightmares. Re-experiencing is one of the core symptoms of PTSD; this symptom causes people to have memories or flashbacks of the traumatic event. For example, someone who is the victim of an assault may be plagued with memories of when they were attacked. A combat veteran with PTSD may have flashbacks of being on the battlefield.

These flashbacks can happen both during waking hours as well as at night in the form of nightmares. This is why nightmares are so common for people with PTSD. Understandably, having nightmares every night makes it difficult to fall and stay asleep and, in some cases, can cause insomnia. People with PTSD may also be so afraid of nightmares they avoid sleep altogether.

Hypervigilance

Another core symptom of PTSD is hypervigilance. This means if you live with PTSD, you’re constantly on edge. Even if the traumatic event has passed, you still feel like you’re in danger. Your body has a hard time relaxing, and you feel like you’re always scanning your surroundings to check for threats. People who are hypervigilant may be jumpy or easily startled.

Although hypervigilance is a sign of your body trying to protect you, it can disrupt functioning in many areas of your life, including sleep. To be able to fall into sleep, your body needs to relax – something that is very difficult to do when you struggle with hypervigilance. When you try to go to sleep at night, you may feel like you’re on guard, ready to deal with any danger that may come your way.

The importance of sleep for trauma recovery

Although it can be difficult for people with PTSD to sleep well, restful sleep is one of the most essential components of healthy trauma recovery. Sleep is so essential to your brain’s healthy functioning, especially when it’s been affected by trauma.

One reason why sleep is so important during trauma recovery is during sleep, especially deep sleep, the brain consolidates memories and processes emotional experiences. While you sleep, your brain integrates the traumatic event into your existing memory network in a way that’s less emotionally charged. Even if you’re not dreaming about the traumatic event, your brain is working hard to make sense of the memory. Without restful deep sleep, this brain process gets disrupted — which can ultimately make it harder to move forward.

Sleep is also essential for physical recovery. Trauma can take a toll on your body, even if the traumatic event did not directly hurt you physically. During sleep, your body works on tissue growth and repairing damaged cells. Sleep is also critical for strengthening your immune system, which can be weakened by stress and trauma.

Being sleep-deprived worsens your overall mental and physical health, which makes you more vulnerable to the stress of carrying a traumatic memory. Sleep deprivation can also worsen emotion regulation, which means you’re more prone to becoming overwhelmed by intense emotions without being able to soothe yourself.

Overall, sleep plays a critical role in the healing process after trauma. It may be difficult to sleep after a traumatic event, but by prioritizing sleep and seeking support, you increase your odds of being able to bounce back.

Treatments for PTSD and insomnia

PTSD and sleep troubles like insomnia and nightmares are frustrating and painful to deal with. However, there are effective treatment methods available that can help you overcome these issues and get the rest you deserve.

According to research, some of the most effective treatments available for insomnia and nightmares include the following:

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-i is the primary treatment method used for all types of insomnia. It’s based on the principles of CBT, which is founded on the understanding that our thoughts, feelings, and behaviors are interconnected. We can work on changing thought patterns and behaviors in order to feel better.

In terms of insomnia, this typically means improving sleep hygiene habits to set yourself up for success each night. For example, a CBT-i therapist might help you implement strategies like setting up a healthy bedtime routine, avoiding alcohol and caffeine before bed, or making your bedroom more comfortable for sleep. They may also use a strategy called sleep restriction, in which you initially spend less time in bed in order to help your body learn to sleep through the night.

CBT-i also involves cognitive restructuring strategies, which help you to reframe irrational or unhelpful thought patterns related to sleep. For example, if you live with PTSD and have recurring nightmares about the traumatic event, you may be understandably fearful of falling asleep at night.

You may have thoughts like, “What if I have a nightmare again tonight? Then I’ll wake up terrified and my whole day will be ruined.” A CBT-i therapist can help you challenge this thought pattern and replace it with something more positive, like “I may have a nightmare, or I may not. I’ve gone through a relaxing bedtime routine, which usually helps me have less nightmares at night. If I do end up having a nightmare anyway, I will be able to cope with it in the morning.”

Many studies have found CBT-i to be effective for helping people with PTSD improve their sleep duration and quality, including a randomized controlled trial conducted by the Department of Veterans Affairs^[2].

Image Rehearsal Therapy (IRT) for PTSD nightmares

Image rehearsal therapy is another CBT intervention specifically designed to help reduce nightmares. In traditional IRT, you and your therapist work together to come up with different endings to the nightmares that are less frightening. Your therapist may ask you to repeat the new version of the nightmare verbally or write a story about it over and over again. Eventually, the goal is for the new ending to begin to appear in your dreams.

However, when it comes to nightmares relating to a traumatic event that actually happened to you in reality, it may not make sense to change the ending entirely. People with PTSD may feel inauthentic creating a fictionalized version of what really happened to them.

But even changing just one small detail of a PTSD-related nightmare can help the nightmares become less powerful and frightening. Sometimes, rehearsing a slightly different version of your nightmare in your waking life can also help you gain some lucidity while you’re dreaming (realize you’re in a dream, and the traumatic event is not really happening again).

The research supporting image rehearsal therapy for post-traumatic nightmares is more limited. One randomized controlled study of veterans with PTSD found IRT did not help reduce nightmares for them^[3]. However, another randomized controlled trial found IRT was effective in reducing both nightmares and PTSD symptoms in sexual assault victims^[4].

Mindfulness and relaxation techniques

A holistic way to address sleep issues that come with PTSD is mindfulness and other relaxation strategies. Mindfulness is an ancient practice taken from Eastern spiritual traditions, but anyone of any religion can practice it and see benefits. In essence, mindfulness is simply about paying attention to each present moment. When you practice mindfulness, you learn to sit with your current experience instead of trying to push it away.

Scientific research has found mindfulness to be an effective intervention for insomnia and other sleep troubles as well as many of the symptoms associated with PTSD.

Relaxation strategies like deep breathing can also help you calm your body’s stress response and set yourself up for better sleep.

Holistic PTSD treatment in Washington state

At The Center ● A Place of HOPE, we offer a unique trauma recovery program using our proven Whole Person Care method. We honor who you are beyond the trauma you’ve been through, and we understand healing from trauma takes a holistic, well-rounded approach.

It may feel impossible when you’re in the depths of PTSD, but we can help you learn how to take care of your body and your mind, allow yourself to rest, and finally get the good night’s sleep you deserve.

Contact us to learn more about our specialized trauma recovery and mental health treatment programs.

1 – https://my.clevelandclinic.org/health/diseases/24464-nightmare-disorder
2 – https://watermark.silverchair.com/aasm.37.2.327.pdf
3 – https://www.ptsd.va.gov/professional/articles/article-pdf/id84153.pdf
4 – https://pubmed.ncbi.nlm.nih.gov/11476655/