Ptsd And Sleepless Nights: Navigating The Challenge

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can affect a person's ability to sleep. Sleep disturbances are a symptom of PTSD, and they can worsen other aspects of the disorder. People with PTSD may experience insomnia, nightmares, hypersomnia, sleep apnea, and other sleep issues. These sleep problems can lead to lower sleep quality, causing daytime sleepiness and fatigue. The extreme anxiety and trauma associated with PTSD can disrupt sleep, with nightmares and flashbacks creating a fear of sleeping and triggering insomnia. Treating sleep disturbances in individuals with PTSD is crucial, as poor sleep can exacerbate PTSD symptoms and impact overall health and functioning.

Nightmares and night terrors

People with PTSD frequently experience nightmares. These are often a replay of the traumatic event, and can involve kicking and screaming, which can be very distressing for a bed partner to witness. Nightmares can also make it hard to fall back asleep, leading to insomnia, which is also a symptom of PTSD.

Night terrors are less common in adults than in children, but trauma can cause them. During a night terror, a person may scream or shout in terror, and may appear to be awake, but they are usually still asleep. Night terrors can be accompanied by sleepwalking, a racing pulse, flushed skin, dilated pupils, sweating, and kicking and thrashing in bed. It can be very difficult to wake someone up during a night terror, and they may have no memory of it the next day.

PTSD-related nightmares can be treated with imagery rescripting, in which the patient rewrites the script of the dream with a less threatening version during waking hours. This is a treatment that works for both PTSD-related and non-PTSD-related nightmares. PTSD-related nightmares also respond to standard treatments for PTSD, such as cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR).

Night terrors, on the other hand, cannot be treated with imagery rescripting because they are not usually remembered. Treatment for night terrors often involves addressing the underlying condition of PTSD with regular therapy, trauma-focused therapy, and sometimes medication. It can also be helpful to manage stress, practise meditation, improve sleep hygiene, and use anticipatory waking, which involves setting an alarm to wake up about 15 minutes before the night terrors usually begin.

Insomnia

Causes

The extreme anxiety associated with PTSD can disrupt sleep patterns. This anxiety may stem from a fear of having nightmares or flashbacks, or from a general sense of being on guard and needing to protect oneself from danger. Trauma can also lead to increased levels of stress hormones, which can interfere with sleep. In addition, people with PTSD may experience depression, which is also associated with poor sleep.

Treatment

The recommended treatment for PTSD-related insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I). This form of talk therapy focuses on a person's beliefs, feelings, and behaviours that affect sleep and has been shown to improve sleep in 70% of people who complete it. Other treatments include medication, such as Prazosin, and sleep hygiene practices, such as maintaining a consistent sleep schedule and creating a relaxing bedtime routine.

Complications

Untreated insomnia can have several negative consequences for people with PTSD. Sleep problems can interfere with the brain's ability to process memories and emotions, slowing down recovery from trauma. It can also lead to or exacerbate substance use, as some people turn to alcohol or drugs to help them sleep. In addition, insomnia can increase the risk of other health problems, including heart disease, depression, kidney disease, high blood pressure, diabetes, obesity, and stroke.

Sleep paralysis

Prevalence and Risk Factors

The prevalence of sleep paralysis varies across different cultures and social groups, with an estimated 8% of the general population experiencing it at some point in their lives. However, this figure is higher among students (28%) and psychiatric patients (32%), and it is also more common in people with PTSD. Occupations that are particularly stressful, such as healthcare professionals, police officers, and firefighters, may have a higher risk of developing sleep paralysis.

Symptoms and Characteristics

Treatment

Relationship with PTSD

There is a clear link between sleep paralysis and PTSD. People with PTSD are significantly more likely to experience sleep paralysis than those without the disorder. The disruption in the circadian rhythm and constant state of alertness associated with PTSD can make it difficult to fall asleep or stay asleep, increasing the risk of sleep paralysis.

Obstructive sleep apnea

OSA involves temporary lapses in breathing during sleep, often accompanied by loud snoring, choking, or gasping sounds. When these symptoms occur, the brain has to kick-start breathing again, disrupting sleep. As a result, individuals with OSA wake up feeling unrefreshed and suffer from excessive sleepiness throughout the day.

OSA is associated with an increased risk of several health issues, including heart failure, dementia, certain cancers, and early death. Individuals with PTSD who experience OSA are also more likely to have more severe depression, a higher suicide risk, increased substance abuse, and a poorer quality of life.

The relationship between PTSD and OSA is bidirectional, with each condition exacerbating the symptoms of the other. The disturbed sleep caused by OSA can worsen PTSD symptoms, making recovery more difficult. At the same time, the more severe the PTSD, the more severe the OSA.

OSA can be treated with continuous positive airway pressure (CPAP) therapy, where individuals sleep with a mask that connects to a CPAP machine, helping to keep their airways open during sleep. CPAP therapy has been shown to relieve symptoms of both OSA and PTSD, including anxiety, depression, and nightmares. However, adherence to CPAP therapy can be challenging for individuals with PTSD due to discomfort, nightmares, and claustrophobia.

If you are experiencing symptoms of OSA, such as loud snoring, gasping for air during sleep, or excessive daytime sleepiness, it is important to consult a healthcare professional for evaluation and treatment.

Delayed sleep-wake phase disorder

There are two types of DSPS, categorised by when the sleep hormone melatonin signals your circadian rhythm:

• Circadian aligned: The melatonin onset is less than two hours before you fall asleep.
• Circadian misaligned: The melatonin onset is more than two hours before you fall asleep, or it doesn't happen until after sleep begins.

Symptoms of DSPS include severe daytime sleepiness, trouble with memory, focus and concentration, and behavioural and/or mood changes like irritability. DSPS is often difficult to differentiate from other hypersomnolence sleep conditions, such as narcolepsy and idiopathic hypersomnia.

DSPS has a genetic cause, and it is more common among adolescents and teenagers because the body's natural circadian rhythm changes during puberty. It is also common among women and people assigned female at birth between the ages of 40 and 60. DSPS may be accompanied by other disorders, such as depression and substance use disorder.

To treat DSPS, a healthcare provider may recommend changing your sleeping habits and schedule, adjusting your bedtime, and using light therapy to reset your internal clock. They may also suggest taking an over-the-counter melatonin supplement to help shift your circadian rhythm. Treatment for DSPS is ongoing and may take several weeks to months to reschedule your sleep-wake cycle.

Frequently asked questions