Trauma and Sleep: How to Cope

Updated: September 20, 2020

By: Mary Sweeney RN, BSN, CEN, ONN-CG

What is Trauma?

Trauma is defined as any incident that causes physical, emotional, psychological, or spiritual distress. Traumatic events can encompass a wide range of things, both physical and emotional. These include but are not limited to:

  • Death of a loved one or pet
  • War (both the experience and injuries sustained during)
  • Divorce
  • Domestic violence
  • Terrorism
  • Physical injury (car accidents, physical assault, etc.)
  • Emotional abuse
  • Sexual assault
  • Natural disasters

Did you know that 70% of American adults have experienced trauma at some point during their lives? Trauma can affect anyone, directly or indirectly.Directly affected people are those that experienced the traumatic event first-hand. Indirectly affected people are those that were eyewitnesses to the event. Traumatic events can elicit many types of reactions, and each one is unique to the individual that experiences the trauma. According to the American Psychological Association, victims of trauma may experience feelings of shock and denial immediately following the event.In the days and weeks to come, victims may begin to experience physical and emotional side effects from the traumatic experience, to include sleep issues, flashbacks to the trauma, difficulties with relationships, or even headaches and nausea. Talking to a licensed professional can help with these side effects and can help the victim process what has happened to them.

Disorders Stemming From Trauma

In addition to experiencing short term side effects of traumatic experiences like those described above, there are also psychological disorders that can affect victims long after the initial traumatic event.  While many trauma victims will experience initial anxiety and fearfulness post-trauma, many will recover from those feelings and will go back to their daily routines with a sense of normalcy.  However, there are some people who continue to have those feelings and flashbacks to the traumatic event, and develop disorders stemming from those feelings.

Post-traumatic stress disorder, more commonly known as PTSD, is common and can stem from any type of trauma.  According to the National Institute for Mental Health, PTSD is a disorder that develops after a victim experiences something shocking, scary, or dangerous.  Following an event such as this, the person may experience feelings of fright or anxiety, even if they are not in a dangerous situation.  Certain sounds, sights, or smells may trigger a flashback to the traumatic event, causing the person to react as though it was happening again.  Symptoms typically appear within three months of the event, and are severe enough to interfere with relationships and daily activities.  PTSD can last for as little as a few months, and for some can become a chronic condition that they live with for the rest of their lives.  According to a study performed by the National Survey of Comorbidity Replication, approximately 3.6% of adults in the United States experienced PTSD in the past year, with rates of PTSD markedly higher among women respondents.  For more information about PTSD and ways to treat it, visit the National Institute for Mental Health website.

Another common disorder that trauma victims may experience is acute stress disorder (ASD).  In acute stress disorder, people that have experienced a trauma recently may have flashbacks to the event, avoid situations that remind them of the trauma, and have heightened fears or awareness of their surroundings.  While this may sound strikingly similar to PTSD, the symptoms for ASD begin within 4 weeks after the traumatic event and resolve after no more than a month.  If symptoms last longer than a month, ASD may evolve into PTSD.

Risk Factors for PTSD in Adults and Children

The risk factors for developing PTSD are similar for adults and children, in that it is caused by experiencing or witnessing an event that is perceived to be traumatic.  Not everyone that experiences or witnesses a trauma will develop PTSD, it’s all about an individual’s perception of the traumatic event.  Risk factors for development of PTSD in adults include:

  • Age and gender: Research shows that the stage of life that a person is in may directly affect their chances of developing PTSD after a trauma.  For example, women are more likely to develop PTSD in their early to mid-fifties, while men are more likely to develop it in their mid-forties. Read more on this NIH study here.
  • Family history of PTSD: People that have family members who have developed PTSD are more likely to develop PTSD themselves.
  • History of mental health issues: People with a history of mental health issues like anxiety or depression may be at an increased risk of developing PTSD.
  • Multiple traumatic experiences: If someone experiences a traumatic event in their past and develops PTSD from it, they are at an increased risk of developing PTSD after any traumatic events that may follow.

Risk factors for PTSD in children are similar to those for adults. PTSD in children and teenagers is a little more difficult to diagnose, and the signs and symptoms are different than those of an adult suffering from it.  Children may not suffer from flashbacks, but rather may believe that they have a heightened sense of awareness following a trauma that will help them to recognize and prevent future trauma.  They may often express their feelings through play, reliving their traumatic experiences through their toys, rather than talking about their thoughts and feelings. 

How Does Trauma Affect Sleep?

Traumatic experiences can negatively affect the quality and amount of sleep that a person gets.  Often times, the brain is overstimulated after a trauma and may experience an influx of adrenaline.  That, coupled with a higher level of alertness and awareness, may make it difficult to fall and stay asleep.  People that have developed PTSD that are experiencing flashbacks may notice that the flashbacks happen just as frequently at night as they do during the day.  They may also experience nightmares, which can startle someone awake and make falling back asleep extremely difficult. A person’s environment may also affect sleep – for example, a dark room may create a higher level of anxiety, or complete silence may make someone more nervous about sounds that would ordinarily not be noticeable.

Tips for Better Sleep after a Trauma

To many, it may seem like a good night’s sleep will never exist again, but there is a light at the end of the tunnel.  The National Sleep Foundation provides some helpful suggestions for sleep after a trauma, to include:

  • Sleep in a comfortable and safe environment.  Sleeping in a bedroom is recommended, but if the traumatic event happened in a bedroom, it may not be ideal to sleep there.
  • Create a comfortable sleeping environment.  Have the temperature set where you are most comfortable, preferably on the cooler side.  If dark rooms trigger a stress response, consider a dim nightlight.  If being alone is a trigger, have a friend or family member sleep in the room next to you, or in the room with you. Weighted blankets have also shown to increase comfort levels.
  • Go to bed when you’re ready to sleep.  Lying in bed and thinking about not sleeping will often make insomnia worse.  If you can’t sleep, try doing a low-key activity for a few minutes and then returning to bed.
  • Take naps.  If you’re not sleeping during the day, a quick 15-45 minute nap during the day may help you rest and recharge.  Avoid frequent naps during the day though, as these can lead to decreased ability to fall asleep during nighttime hours.

Other tips for restful sleep include:

  • Turn off electronic devices.  Research has shown that the blue light emitted from handheld devices can negatively affect quality of sleep.  Shut off electronic devices and stop using them an hour before you go to bed.
  • Limit caffeine intake to 3 cups of coffee or less per day.  Try to avoid caffeinated beverages in the few hours before bed.
  • Establish a relaxing bedtime routine.  Whether it’s taking a warm bath, reading a book, or meditating, find something that helps you relax physically and mentally.

Treatment and Living with Trauma

To some, it may seem that the effects of trauma can go on forever, but there’s hope.  Talking to a licensed professional is the first step in getting the help that is needed to deal with acute stress disorder and post-traumatic stress disorder.  If left untreated, these disorders can lead to increased anxiety, depression, and may lead to suicidal thoughts or behavior.  If you or a loved one is suffering from these feelings, call 1-800-273-TALK (8255) or visit the nearest emergency room.

After a consultation with a licensed professional, the following may be ways that can help treat PTSD and ASD:

  • Cognitive-behavioral therapy (CBT): CBT is a form of psychotherapy that is initiated in an office setting with a licensed provider, and is supplemented with at-home work by the patient.  It may involve “exposure therapy,” in which the trauma is recreated through imagery, writing, or a visit to a place that is similar to where the trauma took place.  The idea is that through increased exposure, the individual becomes less sensitive to the trauma.  CBT also involves “cognitive restructuring,” which is a method that involves talking through the traumatic experience to get a more factual perspective on what happened.  Often times, people remember bits and pieces of trauma and the memory of the event may become disjointed.  Cognitive restructuring helps to restore a factual memory of what happened.
  • Present centered therapy (PCT): This form of therapy examines the issues surrounding the trauma while not focusing on the trauma itself.  This may include talking through how trauma affects an individual and determining the best strategies to deal with stress in everyday life.
  • Medications: As a last resort, medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed.

Where to Get Help

There are a variety of resources available to help deal with the aftermath of a traumatic experience.  Remember, feelings of anxiety, confusion, anger, and guilt are all natural following a trauma.  However, if those feelings are beginning to interfere with work, family or friends, and other aspects of everyday life, it’s time to seek help.  A good place to start is your primary care provider – they will be able to refer you to a licensed mental health professional that specializes in trauma.  Websites like the Trauma Survivors’ Network can refer you to support groups in your area.  If you are experiencing suicidal thoughts, don’t wait -- either call 9-1-1 or go to the nearest emergency room.  You can also call the National Suicide Prevention Hotline at 1-800-273-TALK (8255).  Remember, you are not alone!

For more information on any of the above topics, see the links below for articles and studies that were used for the creation of this content.

Trauma and Sleep Frequently Asked Questions

Here are our answers to some of the most frequently asked questions about sleep and trauma.

What is sleep trauma?

Sleep trauma can often cause displays of hypervigilance which is a heighed awareness state the body causes to prevent additional harm. This makes it very difficult to fall and stay asleep.

How does PTSD affect sleep?

PTSD can make it more challenging to fall asleep, and it often causes sleep to stay in the lighter phases. This means restorative sleep and REM are often limited.

Why does trauma make you tired?

The hypervigilance often caused by trauma can make people feel tired because the deepest phases of sleep are limited which are generally the most restorative phases.

Resources and Studies Used in This Article