Sleep Disorders Current Topics in Sleep Disorders

Sleep Advice in Times of Trauma

Sleeplessness and nightmares are common responses-- perhaps even natural and adaptive responses-- to traumatic events. People who were directly involved in the recent violent events in New York, Washington or Pennsylvania, may suffer with severe insomnia, or experience vivid nightmares.

But everyone who has lived through these tragic events, through news reports and stories relayed by friends and family, can anticipate some degree of sleep disturbance. In addition to having been terrifying, these episodes introduced trepidation and confusion about the future that can affect many aspects of our awake and sleeping lives.

What is sleep for?
Although the specific functions of sleep are not fully understood, we know that sleep helps with memory as well as with temperature regulation. Sleep allows the body to heal, to rest, and to regenerate chemicals in the brain necessary for learning. Sleep is essential for our well-being, and in times of undue stress it becomes that much more important.

Nightmares
Nightmares can be an adaptive response to trauma, and for some, nightmares may be short-lived. When nightmares recur frequently and do not lessen in intensity, they can lead to chronic sleep disruption and strong hesitance and anxiety about going to sleep at all. The nightmares for many, especially for those who have experienced trauma firsthand, will likely be vivid, disturbing and include intrusive images of the trauma. During a nightmare, the dreamer and/or a bed-partner may also notice other symptoms such as increased restlessness, sweating, startled responses, and lighter sleep.

There is no specific treatment for nightmares, rather, they will resolve as the underlying stress-response to the event resolves. This underlying stress-response can be addressed by communicating with loved ones, speaking with others who have had a similar experience, or by seeking professional help and/or medication. If nightmares occur for over one to two weeks it is important to talk with a health care provider so that the problem does not become chronic or associated with destructive habits.

Insomnia
Insomnia is defined as: trouble falling asleep, difficulty staying asleep, or feeling as though your sleep is unrefreshing. It is likely the most common sleep problem experienced by people after trauma, and again, like nightmares, insomnia is a normal response.

Regain normalcy
The most important recommendation to people struggling with insomnia is to try to regain some semblance of normalcy. Assume your normal waking routine, and wind down before your normal bedtime. Staying up late, watching the news coverage of the traumatic event and reliving the trauma is obviously NOT a good idea since it will only serve to reinforce the anxiety associated with the trauma. Instead, go back to work, exercise, eat regular meals and then spend the evening winding down. It is also important to talk about feelings associated with this catastrophe but try to do so earlier in the day or evening.

Sleep hygiene principles
In addition, sleep hygiene principles can be very effective in treating insomnia. First, maintain a regular sleep and wake schedule seven days a week. If you are not sleeping for twenty minutes or longer, get out of bed and go to another room if possible to wind down. Read a magazine or book, play a game of solitaire, find some activity that will relax you. You can even try a warm bath or a soothing drink. Return to bed only when you are tired. Avoid caffeinated and alcoholic beverages as they do not help promote good sleep. Try relaxation techniques or aerobic exercise earlier in the day or evening to relieve stress. In most people, the insomnia will eventually resolve. If it does not, speak with your physician or call a Sleep Disorders Center.

Medication
In addition to these recommendations, the people closest to the tragedy or those most deeply affected, may find a short course of sleeping pills helpful in allowing them to sleep and feel some control over their anxiety and stress. However, sleeping pills are almost never a long-term solution. Your physician should work closely with you on the exact duration and type of sleep medication taken. Also, it is important that anyone suffering from an acute stress disorder become familiar with the warning signs of the longer term, posttraumatic stress disorder. Anyone who continues to suffer with acute post traumatic symptoms four weeks after a traumatic event, should seek professional help.