According to the results of a survey by the National Sleep Foundation, about 30% of Americans reported having difficulty sleeping. This percentage is similar to the numbers found in studies from other countries. Around 25% reported experiencing occasional insomnia, while 9% said that they found sleeping difficult on a regular basis.
The same survey found that insomniacs rarely visit medical or psychological health professionalsto consult regarding their issues with PTSD and sleep. Around 40% chose to self-medicate with drugs bought over-the-counter, or cope with their condition using alcohol. A further 60% said that they were not aware of, or did not understand treatments available for such PTSD and sleep related issues.
It is highly recommended that appropriate treatment from proper medical or psychological consultations be used to address PTSD and sleep related issues. Especially so, because the lack of quality sleep caused by PTSD and sleep apnea, another sleep related issue, is associated with a 2.5 to 4.5 increase in the likelihood of being involved in accidents and falls.
Who needs a good night’s sleep?
Both common sense and science say that sleep is absolutely essential for optimal health. It plays a critical role in the healthy functioning of the cardiovascular, hormonal, and immune systems. Sleep is needed in regulating brain function, memory, metabolism, and appetite. Sadly, not everyone gets a good night’s sleep.
A normal and healthy sleep pattern should be free from conditions that disrupt its regularity and appropriate timing, as well as be of good quality and sufficient duration. A good night’s sleep makes you feel refreshed upon waking.
Certain conditions like PTSD and sleep apnea, however, rob you of this.
What robs you of a good night’s sleep?
Risk factors associated with abnormal and unhealthy sleep include older age, being female, and having medical and psychiatric conditions. The increased risk in the elderly is not clearly understood but is hypothesized to be due to the weakening of sleep regulating and other bodily systems that come with age. Chronic illnesses also present as significant factors for insomnia.
In women, the quality of sleep is found to be significantly impacted by the onset of menses and menopause. Although not an independent cause for insomnia, working night or rotating shifts have also been shown to result in insufficient and low quality sleep in those who are already predisposed.
A medical condition called Obstructive sleep apnea, is a common chronic disorder that is estimated to affect between 2-4% of adults, with the highest prevalence among middle-aged men. Sleep apnea is characterized by repeated episodes of difficulty in breathing while asleep. Although snoring is a common symptom, it is characterized better by 10 or more seconds of pauses between breaths which either awakens the person with the condition, or leaves them feeling tired no matter how long they slept.
Risk factors for sleep apnea include being male, snoring, obesity, menopause in women, large neck circumference, nasal obstructions, enlarged tonsils, and a low-lying soft palate.
Trauma and PTSD
Post-traumatic Stress Disorder (PTSD) is a psychiatric condition that has been the subject of research in relation to sleep in recent years. This is because a large number of experimental investigations have shown that sleep plays a very important role in the processing of emotional memories. This means that the kind of sleep you get either makes you remember or forget painful experiences.
PTSD occurs after a person is exposed to a traumatic event, and is estimated to affect between 2.3-6.1% of civilians, and 30% of veterans. Symptoms fall under four dimensions:
- Avoidance: is seen when a patient with PTSD goes out of the way – no matter how inconvenient it may be – to avoid activities, people, places, things, and events that are linked to the traumatic event. An example would be a person who experienced a traumatic event inside an elevator would thereafter, take the stairs all to way to the topmost floor,
- Negative affect – a person with PTSD constantly feels guilt, self-blame, hopelessness, anger, and other similar emotions relating to the traumatic experience,
- PTSD dreams – a patient with PTSD experiences anxious dreams, or nightmares which are directly or indirectly about the traumatic event. These can also turn into PTSD night terrors where the person wakes up confused, acting out and believing that the dream was real,
- Hyperarousal – a person with PTSD experiences an energy-draining, prolonged and increased state of alertness. This eventually leads to fatigue when energy runs out. This state may also be accompanied by irritability or angry outbursts.
PTSD patients typically complain of difficulty in falling asleep, that they are easily and frequently awakened, have reduced sleep duration, have restless sleep, and suffer from fatigue as a result. PTSD dreams which elicit anxiety quickly become PTSD night terrors, so much so that they have been considered a core symptom of PTSD.
Who gets robbed of a good night’s sleep?
If you are any of the above and have experienced trauma, you are more likely to have disturbances in your sleep. Various aspects of trauma such as the type of trauma experienced, how long the traumatic experience lasted, the intensity of the trauma, and the circumstances and events during the traumatic experience may influence the type of sleep disturbance one develops. In numerous studies done on PTSD and sleep, it was possible to group majority of the patients according to similarities in the type of traumatic experienced:
Combat veterans who are diagnosed with PTSD have a hard time falling asleep, cannot stay asleep, and have PTSD night terrors from dreams with violent and aggressive content. Survey results vary, but one study reported 100% of combat veterans contacted reported experiencing difficulty in sleeping.
Sexually or physically abused women
An estimated 35% of women have experienced either physical or sexual abuse from family members, friends, acquaintances, or strangers. Women are also two times more likely to develop symptoms of PTSD compared to men who experience traumatic events, with 90% of victims reporting the inability to sleep, nightmares, constant drowsiness during waking hours, feelings of distress, inability to focus and limited functioning. Moreover, there is strong evidence that cumulative experiences of trauma result to higher levels of sleep disturbance.
Sexually or physically abused children and adolescents
Around 22% of children and adolescents have experienced either physical or sexual abuse from family members, friends, acquaintances, authority figures, or strangers. Victimized children and adolescents have been shown to have more difficulty in sleeping compared to children diagnosed with depression. These victims experience bedwetting even after toilet-training, nightmares, PTSD night terrors, sleepwalking and sleep talking. Poor quality sleep in children is correlated with poor behavior, irritability, problems with paying attention, problem solving, academic learning, depression, anxiety, and aggression. In adolescents, this may include substance dependence, suicidal thoughts and acts, and criminal behavior.
Survivors of life-threatening events, whether man-made or natural disasters
A week after the 9/11 Terrorist Attacks for example, surveys showed that 44% experienced substantial stress reactions after watching the news coverage. Two months after the event, 12% of those who were surveyed reported that they had acute stress symptoms, and 8.9% had symptoms of functional impairment. The NIH reports that initial evidence points to the general US population experiencing symptoms of PTSD because of mass media coverage or personal and family safety concerns about war and terrorism after the traumatic events of 9/11.
Life-threatening medical conditions like cancer, heart attacks, strokes, miscarriages, abortions, HIV-AIDS may lead to developing symptoms of PTSD. An estimated 2-9% of breast cancer patients met diagnostic criteria for PTSD.
How do you get a good night’s sleep back?
The first step to healing is to acknowledge that you have a problem. The second is to get help from appropriate and licensed professionals. In order to get back on your feet, you need to consult a medical healthcare professional to assist you with the physical and psychological problems that rob you of a good night’s sleep.
When you visit a healthcare professional, you can expect them to do an assessment for the purposes of determining what is it you are going through. As we have shown, PTSD and sleep issues have multiple complex layers to work through. For patients with PTSD and have sleep disturbances, several interrelated assessment procedures may be undertaken.
It is also important to note that since your sleeping pattern will be assessed for a period of time, it may help if you start putting down into writing your complaints and observations about your experiences with PTSD and sleep. In this step, the activities you engage in before going to sleep, while asleep, and moments right after waking will need to be observed and documented.
For this procedure, you may request assistance from your partner, family, or someone you have a close relationship with to help you keep track of the different sleeping parameters that you may be experiencing especially when you reach the deep sleep phase. A healthcare facility may also have specialized personnel and equipment for this purpose as well.
Several sleeping parameters to be taken note of are the times when you cannot go to sleep, the number of hours you are asleep, instances when you wake up earlier than usual, sleepiness during the daytime, snoring, quality of breathing pattern, change in work schedule, caffeine and alcohol intake, PTSD night terrors, and restless sleep. Some of these are obviously difficult for you to record on your own, that is why it is best to reach out to others for help.
Once a record of your sleeping habits is established, your healthcare professional may then explore with you the significance behind these different factors related to your quality of sleep. You will also be asked about your medical records since other underlying medical problems might have an effect on your sleep problems.
Another aspect that your health practitioner will look into will be your personal history and the changes you have experienced from different stages in your life – childhood, adolescence, to adulthood. Other possible traumatic events will need to be uncovered.
After assessment, the healthcare professional will determine the appropriate medical and psychological interventions that you can undertake in order to tackle your problem with PTSD and sleep. As part of the intervention process, you may be given a checklist indicating the steps to take on how to properly fall asleep and what should be done before going to sleep.
You may also be informed about other techniques and strategies which will help you handle stressors and triggers before sleep, during sleep, and after waking up from PTSD dreams or PTSD night terrors. Triggers revolving around the traumatic incident that happened to you must be taken into account during the intervention process. Recurring reports of nightmares by you should also be a target of the intervention.
If the medical or psychological healthcare professional will determine that you have high levels of arousal, progressive muscle relaxation techniques may be advised as an intervention. Specific drugs to usher sleep and mitigate other issues may also be used, monitored, and adjusted depending on your response and laboratory test results.
Your sleeping pattern will still be regularly monitored, and if no improvement can be determined, a referral to other specialists with other diagnostic tools and interventions may also be included.
Call a friend if you can’t
Ideally, we should all have our own social support system made up of significant others, family, friends, and acquaintances. A healthy social support system will be our shoulder to lean on, so to speak. We also have countless people who have volunteered to become our friend whenever we are in need, all you have to do is give them a call:
- US Department of Veterans Affairs: for service members, veterans in crisis, or if you are concerned about a family member, friend, or acquaintance who is one, they have specially trained responders 24 hours a day, 7 days a week, 365 days a year. All communications are confidential.
- 1-800-273-8255, and press 1
- Send a text message to 838255
- Start an online chat at VeteransCrisisLine.net/Chat
- Find the nearest VA facility at http://www.veteranscrisisline.net/GetHelpResourceLocator.aspx
- MilitaryCrisisLine.net is also available for those currently in active duty
- If you are deaf, or hard of hearing, contact through http://www.veteranscrisisline.net/GetHelp/Accessibility.aspx
- For adolescents and others who are having suicidal thoughts, or emotional distress, or are concerned about a family member, friend, or acquaintance who is one, they have specially trained responders 24 hours a day, 7 days a week, 365 days a year. All communications are confidential.
- Send a text message to 741741
- OK2Talk.org/about is a safe online community for adolescents who can share helpful stories of struggle, tragedy, recovery and hope
- The US Office on Women’s Health gives the following advice:
- Contact 911 for medical and police emergencies
- Go to the nearest emergency room or law enforcement agency if you need assistance
Being robbed of a good night’s sleep and then having to get it back takes quite a bit of effort and time. It will be difficult to do alone, but research has shown that it is doable. With the right help, a good night’s sleep will be very much within your grasp. We would be happy to know if we helped point you in the right direction. Let us know by sending us feedback below.