More people are significantly affected by post-traumatic stress disorder (PTSD) than we think. But unlike other mental health conditions, PTSD is accompanied by multiple symptoms that are disruptive when it comes to everyday life, and sometimes, even destructive to the one who suffers from it.
One of the most common symptoms associated with PTSD is the challenges in sleep. PTSD can immensely affect the duration, intensity, continuity, and the type of your sleep. But thankfully, there are strategies you can practise for the improvement of your sleep quality. To get started, we must understand how PTSD actually affects your sleep.
How Does PTSD Affect Your Sleep?
Post-Traumatic Stress Disorder (PTSD) is a mental condition that can develop after being exposed to traumatic events like physical or sexual assault, natural disasters, accidents, or military combat, among a slew of others. Along with other symptoms, those who suffer from PTSD often face sleep disturbances, which hugely impacts their day-to-day living.
Types of Sleep Challenge
1. Insomnia
A common sleep challenge among those who suffer from PTSD, insomnia involves difficulty in falling and staying asleep, as well as in experiencing non-restorative sleep. PTSD sufferers who struggle with insomnia often experience anxiety, hyperarousal, and intrusive thoughts, which are huge roadblocks to relaxation and more importantly, to starting a sleeping session.
2. Nightmares and Night Terrors
Often experienced by those who suffer from PTSD, nightmares and night terrors are vivid and distressing dreams which most of the time are replays of traumatic events you’ve experienced. Nightmares and night terrors can lead to extreme fear, emotional distress, and most importantly, sleep disruptions that lead to cycles if left untreated by a mental health professional.
3. Sleep Apnea
Sleep apnea is another type of sleeping disorder characterized by brief interruptions in breathing when you sleep. It can also occur among those with PTSD, as research suggests that sleep apnea is associated with hypervigilance and hyperarousal as well.
4. Hypersomnia
Related to insomnia, hypersomnia is characterized by excessive sleepiness during daytime, as well as difficulty in staying awake. Hypersomnia can also affect those with PTSD, especially with symptoms like hypervigilance and constant state of alertness.
5. Sleep-Wake Cycle Disturbances
Circadian rhythm disruption and irregular sleep patterns are some of the side effects of an abnormal sleep-wake cycle, and those with PTSD may struggle with the maintenance of a consistent sleep schedule. They may either be excessively sleepy during the day or have trouble falling asleep at night.
Factors Influencing Sleep Difficulties of Those with PTSD
1. Hyperarousal and Anxiety
Those with PTSD often experience a state of heightened alertness and physiological reactivity, also known as hyperarousal, which makes it harder for PTSD sufferers to relax and fall asleep, as the body remains in a state of readiness.
2. Flashbacks and Intrusive Thoughts
Known as hallmark symptoms of PTSD, intrusive thoughts and flashbacks of past traumatic events can all disrupt sleep, as the memories, emotions, and distressing images to resurface at night. This makes it all the more difficult to achieve good quality sleep among PTSD sufferers.
3. Avoidance Behaviors and Hyper-Vigilance
Some coping mechanisms we typically observe among those with PTSD are avoidance behaviours and hyper-vigilance, which can disturb sleep by causing those with PTSD to stay awake and scan for non-existent threats in their environments.
4. Co-occurring Conditions
Those with PTSD often have co-occurring mental health conditions as well. Some of the most common types of conditions include substance abuse, anxiety disorders, and depression. Co-occurring conditions contribute largely to sleep difficulties as well.
5. Medications and Their Effects on Sleep
To manage PTSD symptoms, medications can be prescribed to counter them. However, this can also affect the sleep quality of those who have PTSD and are on medication.
For example, some types of antidepressants may induce insomnia or excessive sleepiness during the day. These side effects need proper monitoring and management, as it can be dangerous when biking or driving.
Strategies for Improving Sleep
1. Good Sleep Practices
Some key components of good sleep practices include establishing a consistent sleep routine, creating a sleep-friendly environment, limiting caffeine and stimulant intake, and practicing relaxation techniques before bedtime.
2. Relaxation Techniques
Aside from good sleep practices, you could use some relaxation techniques like deep breathing exercises, progressive muscle relaxation, guided imagery, and meditation, which can all help decrease hyperarousal and induce relaxation that conditions your mind and body for sleeping.
3. Cognitive-Behaviour Therapy for Insomnia (CBT-I)
Known to be a highly effective therapeutic approach for insomnia, CBT-I helps those with PTSD to identify negative thoughts and behaviours that contribute to sleep challenges and change them into healthier ones. This leads to better quality sleep patterns.
4. Exposure Therapy for Nightmares and Night Terrors
A therapeutic technique that can help those with PTSD manage the frequency and intensity of nightmares and night terrors, exposure therapy works by gradually exposing the PTSD sufferers to their source of trauma in only controlled amounts and within a safe environment.
In turn, those with nightmares and night terrors regain control over their triggers (psychological presses) and reduce the distress associated with their condition.
5. Addressing Underlying Anxiety and PTSD Symptoms
To successfully address PTSD, the underlying anxiety disorders must also be paid attention to, in order to improve your sleep quality significantly. Some types of therapies such as mindfulness-based interventions, cognitive behavioural therapy (CBT), and eye movement desensitization and reprocessing (EMDR) have all proven to be effective in managing and treating symptoms of PTSD.
In Summary
For those with PTSD, something as simple as sleeping is quite the struggle. As PTSD impacts people’s well-being and quality of life, those who struggle with it need treatment plans that are highly effective and evidence-based for proper management and treatment.
Seeking professional help means you’ll be receiving comprehensive support, tailored to your unique needs as someone with PTSD-related sleep challenges. By prioritizing sleep and ultimately, your mental health, you can enjoy the improvement of your sleep quality and in turn, reclaim control over your life.
Archways Centre for CBT and NuVista Mental Health: Dedicated to Helping Canadians with PTSD and Sleep Problems
All the methods and techniques mentioned above must be facilitated by highly trained and board-certified mental health professionals. Archways Centre for CBT and NuVista Mental Health are dedicated to using evidence-based therapies grounded in cognitive-behaviour therapy (CBT) to provide comprehensive assistance to adults, adolescents, and children, especially to those with PTSD-related trauma and sleep challenges,
Author Joanna Jeffers, M.A., C.Psych.
