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Trauma and Sleep

Rob Newsom

Written by

Rob Newsom, Staff Writer

Alex Dimitriu

Medically Reviewed by

Alex Dimitriu, Psychiatrist

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Trauma is an experience that has lasting, negative effects on an individual’s well-being and ability to function. A single traumatic event can lead to psychological trauma, or it can build up over time in response to ongoing stress.

While the definition of trauma has changed over time, it’s clear that experiencing a potentially traumatic event is common. In fact, research suggests that almost 90% of people are exposed to at least one potentially traumatic event during their lives.

Experiencing trauma can increase the risk of mental and physical health issues, including suicide. If you or someone you know is in crisis, the National Suicide Prevention Lifeline provides 24/7, free and confidential support, both online and over the phone.

National Suicide Prevention Lifeline


The Effects of Trauma on the Body

When the brain anticipates a threat, it reacts quickly in order to protect itself from harm. An internal alarm system, called the stress response or the fight-flight-freeze response, triggers physiological changes throughout the body. A cascade of hormones are released, muscles tense, heart rate increases, and breathing becomes more rapid as the body prepares to defend against threats.

After the threat or traumatic experience has ended, the body’s stress response begins to return to baseline. Initial reactions vary and are all considered normal and healthy responses to psychological trauma. These reactions often include confusion, anxiety, physical arousal, and difficulty expressing emotions. Fortunately, humans are incredibly resilient and, for the majority of people, even the most challenging reactions to traumatic experiences will lessen with time as the body and mind integrate the experience and heal.

Some people experience delayed reactions after traumatic events. Delayed reactions may include depression, fatigue, nightmares, and even the development of sleep disorders. If these symptoms persist over time, or if they begin to interfere with work, school, or relationships, they may be a symptom of more severe post-traumatic stress.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a condition characterized by recurrent and involuntary memories of the traumatic event during the day (e.g. flashbacks) and/or during sleep (nightmares). People with this condition may avoid external reminders (people, places, activities) and internal memories, thoughts, or feelings surrounding the event. Friends and loved ones around them may notice mood changes as they become more easily startled and hyper-aware of potential danger.

Research suggests that less than 10% of people exposed to a traumatic event develop post-traumatic stress disorder. It’s important for people with the symptoms of PTSD to talk to their doctor and learn about treatment options. There are effective treatments for PTSD that can help survivors heal from the lingering effects of trauma.

The Impacts of Trauma on Sleep

Sleep issues are common after a traumatic experience. Alertness and hyperarousal related to the effects of the body’s stress response often contribute to the symptoms of insomnia. Many people have difficulty falling asleep, wake up more often during the night, and have trouble falling back asleep after a traumatic event.

Trauma can also affect sleep architecture, which means that it can change how the body moves through sleep cycles and stages. Although experts are still working to understand the implications of the changes observed in sleep architecture after trauma, rapid eye movement (REM) sleep appears to be the stage most affected. REM sleep is important for storing memories and processing emotions, and dreams during REM sleep tend to be more fantastical and bizarre.

Distressing dreams and nightmares are common to trauma. Survivors often have dreams about the traumatic event that either directly replay the experience or contain trauma-related emotion, content, and symbols. Researchers hypothesize that trauma-related dreams are caused by the brain’s fear response combined with hyperarousal, and may represent the mind’s attempt at integrating a traumatic experience.

While sleep issues after a traumatic experience can be distressing, they may also be an important opportunity for treating and healing from trauma. Research suggests that being able to sleep after a traumatic event can reduce intrusive trauma-related memories and make them less distressing. Targeting sleep issues in the early treatment of trauma may reduce the risk of developing PTSD.

Sleep Disorders After Trauma

Insomnia is one of the most common sleep issues related to trauma and resolves on its own in the majority of trauma survivors. More severe and persistent sleep disorders are usually seen in people with higher levels of post-traumatic stress and PTSD. While rare, sleep disorders that may develop after trauma include nightmare disorder, periodic leg movement disorder, sleep terrors, and parasomnias such as REM sleep behavior disorder.

Childhood Trauma and Sleep

Childhood trauma can continue to impact a person’s health long after childhood has ended. The CDC-Kaiser ACE Study investigated the impact of childhood traumas, called adverse childhood experiences (ACEs), on the lives of 17,000 adult participants. This landmark study found that ACEs increase the risk of mental and physical health problems later in life, including depression, anxiety, heart disease, and even early death.

One way in which childhood trauma increases the risk of diseases later in life may be through the development and adverse effects of sleep problems. Up to one half of children show some of the symptoms of PTSD after trauma, including hyperarousal and trouble sleeping. Trauma can have a significant impact on childhood brain development, so sleep problems may persist or get worse as the child progresses through adolescence and into adulthood.

Compared to adults with few or no ACEs, adults with a significant amount of childhood trauma are more than twice as likely to have trouble falling asleep and are also twice as likely to feel tired after a full night’s sleep. The effects of ACEs on sleep can last for up to 50 years, with each ACE experienced in childhood increasing the risk of not getting enough sleep as an adult by 20%.

Trauma experienced during childhood can also affect the severity of insomnia in adulthood. In adult patients diagnosed with insomnia, those with a high number of ACEs wake up more often during the night and have more disturbed sleep than those with few or no ACEs.

Tips for Sleeping After Trauma

It’s normal for a traumatic experience to affect the quantity and quality of your sleep. Be patient with yourself and try to have realistic expectations about the time it will take for your body to heal. Working with a doctor, psychologist or counselor can help you create reasonable, achievable goals for coping with sleep issues after trauma. Here are a few other tips for sleeping as you heal from trauma:

  • Maintain your usual sleep schedule: Routine is important for getting restful, quality sleep. If you can, try slowly getting back to your old sleep schedule. Going to sleep and getting up at the same time every day, even on weekends, helps your body be more prepared when it’s time to rest.
  • Sleep where you feel safe: Traumatic events often leave us feeling unsafe, which can make it challenging to feel calm enough to fall asleep. Consider what changes would make your sleeping environment feel safer while you’re recovering. Maybe that’s having someone else sleeping next to you or on the couch for a while, keeping a phone within reach, or keeping a dim light on in part of the bedroom.
  • Engage the relaxation response: Activating the body’s relaxation response is a natural way to combat stress. Relaxation exercises are one way to engage this response and calm the body and mind before bed.
  • Don’t force sleep: If you find yourself tossing and turning for more than around 20 minutes, it may be best to get out of bed and find a relaxing activity instead. You might try a warm bath, reading, or listening to music, before going back to bed when you feel tired.
  • Understand that your symptoms may be normal: There is no right way to process a traumatic experience, but one essential aspect of healing from trauma is knowing when to ask for support. Doctors, counselors, and social workers are trained in helping people cope with and heal from the consequences of a traumatic event.
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About Our Editorial Team

Rob Newsom

Staff Writer

Rob writes about the intersection of sleep and mental health and previously worked at the National Cancer Institute.

Alex Dimitriu



Dr. Dimitriu is the founder of Menlo Park Psychiatry and Sleep Medicine. He is board-certified in psychiatry as well as sleep medicine.


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