Our sleep is frustratingly easy to disrupt, even under normal circumstances. You could be a healthy, sleep-conscious person, and all it takes is one coffee cup too many to make you groggy and tired at work the next morning. Most people aren’t sleep-conscious at all, which means they regularly engage in behavior that ruins their ability to get good rest. It doesn’t take a sleep disorder to disrupt our circadian rhythm and compromise our health and immune system. However, in the world of nasty sleep disruption, very few things compare with trauma.
The word trauma often refers to the damage caused by any physically or emotionally harmful experience. Sources of potential trauma are way more common than anyone would reasonably expect, which unfortunately means a lot of people have sleeping problems or other health issues as a direct consequence of whatever hardships they’ve endured. In this article, our goal is to present information on the many ways that people can experience trauma, as well as how that affects their sleep and subsequent health situation. That way, some readers with sleeping problems might be able to recall a traumatic event that has led them to this issue, which can help them seek proper therapy. Let’s get into it.
The Many Sources of Trauma
There are two main kinds of trauma – physical trauma and psychological trauma. Physical trauma occurs as a result of physical injuries. While the phrase can adequately be used to describe mild injuries, it’s most commonly used to refer to serious ones – injuries that come with a state of shock, breathing failures or even death, in the worst case scenario. On the other hand, the term “psychological trauma” refers to emotional damage caused by highly distressing events and experiences. When people use the word “trauma,” they refer to psychological trauma in most situations.
Both types of trauma can be encountered in many different scenarios, with some particularly threatening and horrific situations being able to cause both physical and psychological trauma at once. Traumatic events can happen out of nowhere, which makes them difficult or impossible to prepare for. In the context of psychological trauma, there are scenarios that people think about in advance and mentally brace themselves for – and then get seriously affected by anyway. Let’s look at a list of some common traumatic experiences, to showcase how common this phenomenon can be:
- Physical, emotional, verbal or sexual abuse. This one is a no-brainer, but the scary part is that it’s often hard to break out of. Many cases of abuse happen over a period of time, which exacerbates the traumatic aspect even further.
- Physical assault or sexual assault (especially rape). Many victims or physical or (especially) sexual assault develop a fear of other people, on top of other health-related issues.
- The death of a close friend, partner or family member. This emotional damage can be amplified if you directly witness them pass away. Grief can be incredibly hard to deal with, to the point of being life-changing.
- Experiencing combat while deployed in the army. There is a reason the phrase “post-traumatic stress disorder” is so commonly associated with war veterans. War can tear families and friends apart, which is a horrific experience for everyone involved, but being in combat is especially traumatic.
- Being in an accident, usually on the road or at work, can cause both physical and emotional trauma quite easily.
- Natural disasters. Multiple potentially traumatic events can occur during a natural disaster, including (but not limited to) injuries, the death of loved ones, massive property damage and so on.
- Being afflicted with a serious disease or similarly crippling condition (such as losing a limb). It is very easy to spiral into mental issues and believe your life is ruined. Most diseases are inherently physical but have considerable mental and emotional consequences as well.
- Seeing severe harm come to other people (even strangers). Public muggings, beatings or shootings have a high chance of causing some psychological trauma.
Traumatic Brain Injury (TBI) and Its Effects on Sleep
TBIs happen as a result of a violent and traumatic injury, primarily to their body or head. This trauma can be roughly anything that severely shakes up the head and body, with the most severe cases often including a physical object entering the brain tissue. Example causes include car accidents, violence (including military combat) or even sports activities. It is important to differentiate between mild TBI and moderate or severe TBI, as the consequences and symptoms differ wildly between the two. Most cases of TBI (around 80% to be specific) are mild, thankfully. Still, the CDC estimates that around 50,000 people die each year from traumatic brain injury.
Mild TBI can have a plethora of possible symptoms, including a temporary loss of consciousness, difficulty speaking, nausea (with frequent vomiting), dizziness, headaches, sensitivity to sound or light, mood swings, anxiety, depression, and sleep problems. These symptoms typically kick in a couple of days after the traumatic event, and last several weeks, at worst. However, moderate and severe TBI is much worse. Every symptom that you experience with mild TBI gets much worse, and additional (and horrific) symptoms are added on top. These symptoms include a much higher difficulty waking up from sleep, coma, seizures, increased aggression, and clear fluid drainage from the nose or ears. Any symptoms of moderate or severe TBI will appear sooner than those of mild TBI. As for causes, you’re looking at a list that includes falls (which are considered responsible for 47% of all TBI cases), being struck by an object (through accidents, violence or self-harm), military combat and vehicle accidents.
As TBIs happen due to physical injuries, the resulting pain and discomfort are obviously capable of disrupting sleep. It has been estimated that around 60% of all TBI patients experience difficulties falling or staying asleep. It’s easy to see why, as the brain is where our circadian rhythm is regulated, so direct injuries to it are almost guaranteed to disrupt our biorhythm and cause other complications. In particular, people who suffer from TBIs can expect to tangle with one or more of the following sleep disorders:
- Insomnia, one of the most common and well-known sleeping disorders. People who suffer from this condition have trouble falling or staying asleep, and experience a lot of fatigue during the day. Insomnia has a habit of destroying a person’s sleep cycles, which weakens their immune system and makes them more susceptible to other health conditions.
- Delayed sleep-phase syndrome, a condition that often comes with a dysfunctional circadian rhythm. Most commonly, this syndrome makes the person very alert in the evening, as they become sleepy much later than normal, usually during morning hours.
- Narcolepsy, a condition that creates an almost irresistible urge to fall asleep at random points during the day, no matter how tired the person is or what time of day it is.
- Sleep apnea, a disorder that causes a temporary loss of breath at night. Two types are generally diagnosed – obstructive sleep apnea and central sleep apnea – and they have slightly different treatment methods.
- Sleepwalking, a parasomnia that is characterized by abnormal behaviors during sleep. Typically the person gets out of bed at night and wanders around, risking injury and other problems.
- Sleep-related movement disorders like bruxism, restless legs syndrome (RLS) or periodic limb movement disorder (PLMD).
PTSD and Its Effects on Sleep
Post-traumatic stress disorder (or PTSD for short) is a very common condition affecting those who have experienced trauma in the past. It typically occurs within a three-month period after experiencing the traumatic event and is “announced” by intense feelings (and symptoms) of anxiety. Not everyone that goes through trauma will have to deal with PTSD, but the odds don’t look great. PTSD was “discovered” during World War I when deeply troubled soldiers were examined – at that time, this condition was called shell shock.
Two types of PTSD exist – acute (another word for “short-term”) and chronic (long-term). Acute PTSD, while harmful and crippling, typically succumbs to treatment over the course of six months or so. On the other hand, chronic PTSD is much harder to treat, often taking years – and unfortunately, sometimes the patient never fully recovers from this condition. For someone to be diagnosed with PTSD, they have to experience all of the following symptoms for as long as a month:
- Avoidance: The person with potential PTSD will avoid some element of what they experienced. For example, someone that has been injured in a car accident may refuse to drive or ride in a car most of the time.
- Re-experiencing event: At some point, the person will mentally re-enact the traumatic event, usually through what is known as a flashback; others may have recurring nightmares or generally disturbing and unpleasant thoughts. This symptom is usually “triggered” by a specific phrase that reminds them of the trauma.
- At least two mood or cognition symptoms. These symptoms may include the person having trouble remembering the exact details of the traumatic event, blaming themselves for what happened, self-loathing and dissociation from their loved ones and activities they once enjoyed.
- At least two reactivity and arousal symptoms. The person may be easy to upset or startle, or they might run into sleeping problems. They could also suddenly lash out at others out of panic. Unlike re-experiencing events, the person doesn’t need a subtle reminder to experience this symptom.
When it comes to how PTSD affects sleep, you can expect to encounter many of the same sleep disorders and syndromes that affect TBI patients. These include narcolepsy, insomnia, delayed sleep-phase syndrome, sleepwalking, obstructive sleep apnea, bruxism, RLS, and PLMD. However, the psychological damage associated with PTSD also manifests itself in a couple of unique ways. For example:
- Frequent and vivid nightmares. As people who suffer from PTSD are often forced to involuntarily re-enact the traumatic event in their minds, it should come as no surprise that they have to deal with nightmares. In fact, nightmares are used to help diagnose PTSD. Not every bad dream will be a re-enactment, but the presence of strong negative impulses such as fear or anxiety tends to remain, even if it’s more symbolically.
- Parasomnias. While sleepwalking occurs for both TBI and PTSD patients, PTSD is often accompanied by other parasomnias, such as night terrors, sleep talking, night sweats and irrational fears. The most notable condition in this context is REM sleep behavior disorder. This condition forces the person to physically act out their dreams, which can be quite disastrous for someone with PTSD.
Treatment Methods for Trauma-Related Sleeping Problems
Due to the nature of TBIs and PTSD, any side-effects that come with prescription and over-the-counter medication could be extremely harmful to multiple aspects of your health. As a result, people dealing with trauma often seek out drug-free therapy methods, which includes:
- Cognitive behavioral therapy (CBT), an increasingly popular treatment method for a variety of sleeping disorders and conditions. This approach relies on the patient’s ability to track their sleeping patterns to produce information that helps the therapists and sleep specialists in offering good advice. A lot of techniques that fall under this category try to affect how the patient treats sleep in their mind and change any misconceptions they have. The result of effective CBT can reduce sleep onset latency by as much as 45 minutes, and improve the amount of time you spend asleep by 30-60 minutes.
- Light therapy (also known as phototherapy) is an approach used to treat TBI patients by fixing or stabilizing their circadian rhythm. TBI patients almost always have disrupted circadian rhythms, and light therapy helps by stimulating the photoreceptors that tell their master biological clock (located within the brain) when it should secrete proper sleep-related hormones.
- CPAP or BiPAP therapy is mandatory for TBI or PTSD-affected patients who suffer from sleep apnea as a consequence of the trauma. This non-drug method uses an airflow generator to pump pressurized, humidified air straight into the person’s nose and mouth to help bypass airway blockages in their throat.
- Exposure techniques can help patients with PTSD. This method boils down to a re-creation of the traumatic event (or something close to it, usually), which forces the patient to face their fears and anxieties head-on. Prolonged exposure therapy can have a massive positive effect, as the person becomes largely de-sensitized to the negative effects and feelings associated with the event.
- Acupuncture has been showing promise as a treatment method specialized towards TBI patients. While researchers don’t necessarily agree on everything about acupuncture, results show that it could help improve sleep quality, as well as remove negative misconceptions about sleep.