Sleep is an essential part of both mental and physical wellness. It’s also important for a young person’s development, supporting physical and psychological growth.
Among children and adolescents, a lack of sleep is associated with impaired daytime functioning, fatigue, depression, anxiety, decreased academic performance, and an increased risk of developing substance use disorders.
Young people may experience sleeping problems for many reasons. Sleeping disturbances, such as taking a long time to fall asleep, waking up during the night, or experiencing frequent nightmares, are linked to stress, depression, and eating disorders. In some cases, sleep disorders may seem to develop independently of any other condition.
Over the past decades, researchers have explored the connection between experiences of trauma and sleep in young people. They have found that childhood trauma and stressful life events are both linked to sleep disturbances in adolescents.
Equally, sleeping problems that follow traumatic experiences may play an important role in the development of PTSD (post-traumatic stress disorder).
This blog offers some more information on the connection between trauma and young people’s sleep, outlining some key explanations and treatment approaches.
How Do Experiences of Trauma Affect Sleep Among Young People?
Traumatic events and other stressful experiences can have both short-term and long-term effects on sleep.
Young people who have experienced trauma may find it hard to fall asleep or stay asleep, feel unrested after sleeping, or have frequent and distressing nightmares. These nightmares, often relating to a traumatic experience, can lead to a fear of sleeping.
Childhood Abuse and Neglect
Scientific studies have consistently found a link between childhood trauma and sleeping problems. Children who have experienced physical or sexual abuse tend to be more active at night, spend less time in quiet-motionless sleep, and spend less time asleep while they are in bed than those without a history of abuse.
These effects may continue into adolescence and adulthood: in one study among university students, those who reported childhood abuse or trauma had significantly more nightmares and other sleep disturbances as young adults.
Surviving War and Disasters
Children who live in war zones, survive terror attacks or are exposed to other violent and threatening events often develop sleeping disorders or sleeping problems. But research also shows some counterintuitive and contradictory results.
For example, one study found that children who lived in areas with massive terror threats slept for longer and with fewer nightmares than those in less threatened war zones. The authors suggest that children’s adaptability may help them to cope with constant threats and prevent sleeping disorders.
As might be expected, young people who directly experience traumatic events (such as being in a natural disaster or surviving an attack) tend to experience the greatest sleeping difficulties.
Young people may experience high anxiety dreams and sleeping difficulties years after the event. On the other hand, while research shows that hearing about war and disasters on the news can also affect young people’s sleep, these effects are more likely to fade with time.
Family Stress
A young person’s home environment can have a big impact on their quality of sleep. Different kinds of family stress, including moving house, illness, and emotional turmoil may cause school-aged children to wake up more during the night and sleep for fewer hours.
These effects may be long-lasting: some research shows that young people who experience family conflicts growing up are more likely to develop insomnia at the age of 18.
Why Are Trauma and Sleep So Connected?
At the moment, scientists still don’t have a clear, proven theory that explains the relationship between trauma and sleep. However, they have produced several ideas and approaches that may explain how trauma can lead to sleep disorders and nightmares.
Hypervigilence and Hyperarousal
Young people who have faced stressful or traumatic events may experience hyperarousal. Hyperarousal is an unusual state of high alert that persists even when there is no specific danger or threat.
Young people with hyperarousal may feel irritable, have increased startle responses, be hypervigilant (constantly assessing the environment for threats), and struggle to concentrate. Hyperarousal and hypervigilance are common symptoms of PTSD.
Hyperarousal can result in delayed sleep onset, more awakenings during sleep, and more movement while sleeping. Because restorative sleep usually requires the perception of the sleeping environment as a secure space, hypervigilance can act as a barrier to quality sleep.
Young people who are hypervigilant may continue to sense threats or insecurity while they are sleeping, causing movement, nightmares, or awakenings.
Patterns of Sleep Disturbances
Sometimes, patterns of sleep disturbances can continue even when the initial triggers and causes have stopped.
Children who were unable to sleep or wake up during the night because of stress or hyperarousal may continue to do so if they recover from these symptoms. This means that insomnia and other sleeping disorders may continue independently of trauma or other underlying causes.
Nightmares: Stress Reactions or Threat Simulations
There are many different theories about why nightmares happen and how they relate to trauma. Some scientists think that during sleep, emotional states develop into dreams that build stories around these emotions.
For example, if a young person is feeling threatened and anxious, they may experience a nightmare where they are chased, attacked, or otherwise in danger. As a result, constant states of stress or hyperarousal may cause frequent and distressing nightmares.
Some experts understand dreams as ‘threat simulations’. Dreams become opportunities for young people to reenact and rehearse responses to threatening situations, to improve their reactions when threats occur in real life.
Children who have experienced or are experiencing trauma may experience a hyperactivation of these processes, causing frequent nightmares with serious threats.
Young people who experience distressing nightmares may develop a fear of falling asleep. Sometimes, this fear can continue even when nightmares lessen, and young people may continue to avoid sleeping even when other PTSD symptoms have improved.
Trauma, Dreams, and Memory Recall
Some evidence suggests that dreams are a way for the body to process stressful or distressing events. With time, dream content often starts to differentiate from the initial event and becomes less distressing.
However, young people with PTSD often experience the same dream over and over again, sometimes exactly replicating the actual event. This may reflect the way that experiencing trauma affects the integration and processing of memories, preventing the mind and body from moving on from the experience.
What Does Sleep Affect the Impact of Trauma Among Adolescents?
Experiences of trauma often have a big impact on adolescents’ development and their mental health as adults. Some experts think that sleep disturbances following trauma could play a key role in this process.
Adolescents who experience sleep deprivation may find it harder to control their emotions, become frustrated more easily, and find it harder to concentrate.
These changes can affect different aspects of a young person’s life, in school, with friends, or at home, leading to interpersonal and other problems that reinforce negative moods and perceptions. Sleep may also help young people to self-regulate and manage their emotions: in turn, a lack of sleep can make emotional regulation more difficult.
The impact of sleep on emotional regulation and the processing of social and emotional information may be one pathway from traumatic events (such as abuse) to the emotional difficulties that many young people who experience trauma face as adults.
Sleep disturbances are a risk factor for the development of PTSD while treating nightmares among adults can improve a wide range of PTSD symptoms. Restorative sleep may also be important for certain types of emotional learning involved in recovery from trauma.
Treating Sleep Disorders Connected to Trauma
Treating sleep disorders among young people who have experienced trauma is important, both for their mental and physical well-being and their development and journey into adulthood.
Behavioural therapies are usually the first-choice treatment for sleep disorders, sometimes accompanied by medication. Psychologists may also work with young people to establish better ‘sleep hygiene’, including regular bedtimes, sleeping environment control, and bedtime routines.
Sleeping problems may also be treated by addressing underlying causes, such as anxiety or experiences of trauma. Young people who experience sleep disturbances related to anxiety but not to traumatic events may find that their symptoms improve with the treatment of their anxiety condition.
On the other hand, research suggests that standard treatment for PTSD may not adequately treat sleep disorders among traumatised children.
Sleeping disturbances following trauma often appear to be an independent concern rather than simply part of a PTSD diagnosis, and can remain a problem even after PTSD treatments are effectively completed.
For children who have experienced trauma, whether or not they have a PTSD diagnosis, one of the most important steps is to create the safest sleep environment possible.
This might involve working with a young person to understand what parts of nighttime, the bedroom, and sleeping are scary. It may also involve supporting young people to identify and develop cues and ideas that they find soothing and can help them find a calm state of mind.
Young people with trauma-related nightmares may benefit from imagery rehearsal therapy. Image rehearsal therapy involves daytime rehearsing of alternative, less scary narratives to their nightmares. This means that when a young person goes to sleep, they may also experience these less fearful dreams.
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