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Sleeping after a trauma

Filed in
  • PTSD
  • poor sleep
  • trauma

By Lynn Celmer  |  Apr 24, 2013
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The individuals who were affected by the Boston Marathon bombing tragedy on April 15 are facing what could be a long, hard road to recovery.  This process can involve a struggle to sleep well.

Many people develop what doctors call “acute stress disorder” after a terrifying event. This can occur even in people who only hear about danger or harm that a close friend or relative experienced.

People with acute stress disorder may feel numb or “in a daze.” They have intense feelings of fear, helplessness and horror. This can produce efforts to avoid thinking or talking about what happened. The sufferer also may avoid people or places that are reminders of what occurred.

Sometimes this response is delayed. Symptoms may not appear until a few days or even weeks after the event. An acute stress disorder may last from only a couple days up to a month.

“Sleep problems are expected stress reactions in the first few weeks following traumatic events like the bombings in Boston,” said Dr. Anne Germain, who studies sleep disturbances in PTSD as associate professor of psychiatry and psychology at the University of Pittsburgh. “Other stress reactions are also expected – they are all normal reactions to unexpected events. Most people will bounce back without any kind of treatment or interventions. Intrusive thoughts and images at bedtime or in the middle of the night (including bad dreams and nightmares) again are expected NORMAL reactions to these events.”

When the problem lasts for more than one month it is called post-traumatic stress disorder (PTSD). Trouble sleeping and nightmares are two symptoms of PTSD.

Other common signs of PTSD include memory loss, depression and anger. Everyone who suffers from PTSD continues to experience disturbing effects of the event. This often occurs in the form of recurrent dreams or nightmares.

According to the American Academy of Sleep Medicine, it is the nightmares that tend to be most disturbing to people with PTSD. In these dreams they may relive the event in a way that seems shockingly real.

Most people with PTSD also report having disturbed sleep. It can be very hard to fall asleep or stay asleep. This is known as “adjustment insomnia.” The lack of restful sleep can make feelings of anxiety, anger and depression even worse.

About half of people with PTSD get better within three months. For others it can be a lifelong problem.
A severe case of PTSD may need to be treated with intensive counseling by a trained therapist. Some forms of cognitive behavioral therapy may help you sleep better. One example is relaxation training. The short-term use of medications also may improve your sleep.

“If the sleep difficulties persist for over a month despite healthy sleep practices, it may be time to consider seeking help,” said Dr. Germain. “PTSD is not diagnosed until stress symptoms like nightmares, insomnia, hypervigilance, avoidance, intrusive thoughts and images, irritability and detachment from others last for over a month. At that time, people may want to consider psychological treatments that have been shown to work for PTSD, including exposure-based treatments, cognitive processing therapy or eye movement desensitization and reprocessing (EMDR).  Regardless of the treatment, people with persistent posttraumatic stress symptoms should also make sure they get help for sleep problems. Behavioral therapy for insomnia or nightmares can be effective. Prazosin is a medication that can often be helpful for nightmares.”

Sleeping After a Trauma

• Don’t stay in bed if you are struggling to fall asleep.
• Get out of bed to do some low-stimulation activities to occupy your mind until tired.
• Allow your mind to rest.  Don’t read or watch upsetting news reports or TV shows in the evening.
• Contact an AASM accredited sleep center for help if sleep problems are severe or persist for more than a month.  Use the online directory at to find a sleep center near you.