A good night’s rest means feeling safe, and peaceful while drifting off into a land of slumber. It means feeling refreshed the next morning, as you rub the sleep from your eyes, awake and ready to tackle the day. Sleep helps the brain work properly, improves capability for learning, focus, and generally improves mood. It also adds to an individual’s physical health, such as repairing heart and blood vessels, and lowering your level of hunger-hormones. Sleep also helps by boosting hormone production that surrounds growth and development (NIH, 2012). Sleeps aids in our general ability to function throughout the day, adding to our overall health and productivity; so it isn’t surprising that the National Institute of Health (NIH) recommends 7-8 hours of sleep for adults (including the elderly) and 9-10 hours for teens.
However, those who have witnessed or experienced one or more traumatic events; such as military combat, rape or sexual assault, accidents, violence, natural disasters, or loss; may have difficulty with getting a good night’s rest. For those who experience PTSD; sleep schedules are often disrupted and irregular, leaving those affected groggy, and poorly functioning. This later leads to more chronic health problems like high blood pressure, heart disease and stroke.
Trouble sleeping and nightmares are two symptoms of PTSD. “The stories are eerily similar. The patients awaken from a terrifying recurrent dream, sweating, heart beating fast, and often unable to fall asleep again that night. Some are elderly men, others are young women. Some have suffered trauma on the battlefield, others at home”(Kryger, 2016). Individuals and their experiences vary, but one running trend is that their trauma continues to haunt them even in their dreams. Sleep, if achieved, comes ridden with difficulties including insomnia, and night terrors. The following are patient stories that portray the relationship between traumatic events and sleep, from Meir H. Kryger, M.D., a physician with a 30+ year career in sleep medicine.
“Holocaust. The patient in front of me was in his 60s, referred to me because of a sleep problem. Every night for about 35 years he awakened in a cold sweat, his heart beating rapidly from a dream about terrible events he witnessed in a concentration camp during the Holocaust. The dream and the result were always the same — he could not go back to sleep because of fear. I never asked him exactly what he dreamt because it was early in my career, and I was reticent. His doctor did not know what to do with him and neither did I. It was a problem that would continue to challenge me throughout my career in sleep medicine.”
“Bosnia. A soldier on active duty came in complaining of insomnia, awakening from sleep with a terrifying nightmare. In his recurring dream, he saw his best friend bleeding and dead, next to a building. The soldier had been on a peacekeeping mission in Bosnia. He was a driver. He had backed up his truck, failing to see his friend behind the truck, and crushed him. He came to the clinic for a sleeping pill to keep from waking up; he was too ashamed to be treated for posttraumatic stress disorder.”
“Korea. The man came to our clinic because he awoke early every morning and could not get back to sleep. He would get up, go to the bathroom, and when he looked at the mirror he saw the face of a young Korean boy. When I asked him if he recognized the face of the boy, he told me that while he was on patrol in Korea more than 50 years before, he saw in the distance a person that he assumed to be an enemy and shot him. When he went to identify the body and saw the face, he realized that it was a boy, barely 10 years old.”
“Civilian life. A woman in her 20s came into the clinic. She had narcolepsy, a condition in which people have severe daytime sleepiness as well as hallucinations (actually vivid dreams, as she would fall asleep). She also suffered severe insomnia because of recurring dreams. The dreams were always the same. She was being raped by her stepfather. This had happened more than 10 years before.”
Sleep also represents the chance at a new day, so even if we may not have accomplished all our goals; tomorrow represents a new opportunity to move forward. We can count on the night to bring us sleep, solace, and a fresh chance at starting over. However, when sleep is so profoundly interrupted, how can we feel ready for a new day? How can one feel that the next day is a bright, new opportunity for accomplishment when we are unable to get undisturbed, consecutive hours of sleep?
So why is sleep so profoundly impacted by experiences of the past? When patients “re-experience” traumatic events in their sleep, these reactions and nightmares often come hand-in-hand with feelings of fear. It can be triggered by sight, sounds or smells that remind an individual of past incidents, thus why affected individuals try to avoid objects, places, events, or emotions that trigger traumatic memories. PTSD’s impact on sleep is so dramatic, it can cause dysfunction in the individual’s lives. Individuals may be on alert; and feel the need to be on guard in order to protect themselves from danger. These feelings of alert may make individuals restless, or put people on the fence when they hear noises or see lights. Another impact includes worry of have negative thoughts, general problems, or specific concerns about being in danger. Even worrying about being unable to sleep may lead to further difficulty in getting a good night’s rest. Even once you’re able to shut your eyes and finally get to sleep, rest can be impacted by bad dreams, nightmares, or night terrors that wake individuals up at all hours of the night and disrupt the possibility of consecutive hours of sleep. Additional medical problems, such as chronic pain problems, can also be detrimental to sleep patterns. Drugs or alcohol, sometimes used to cope with symptoms, or even prescribed medication’s side effects, can make falling into a deep, consistent slumber difficult. (United States Veterans Affairs, 2015)
Though we all have our restless nights, we can surely account for making it up the next night. For those living with PTSD, sleep may be chronically inhibited by memories, physical pains, and inability to sleep due to medicinal side effects. For those who live affected by traumatic experiences, improvement in sleep can lead to reports of improved mood, health and improved management of symptoms. Studies suggest that sleep may enhance the treatment of PTSD symptoms, as with sleep comes a new tomorrow.
PTSD: National Center for PTSD. (2015, August 13). Sleep and PTSD. Retrieved from http://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
Kryger, M. H. (2016). PTSD and Sleep. Retrieved from https://sleepfoundation.org/sleep-topics/ptsd-and-sleep/page/0/5
NHLBI, NIH. (2012, February 22). Why Is Sleep Important? Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why