The Relationship Between Trauma, Sleep, And Dreams
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In the final scene of the 1970s classic, Carrie, Sue, the sole survivor of the bloody, fiery prom, approaches Carrie’s final resting place. As she kneels to place flowers on the grave, Carrie’s bloody hand reaches up to grab her. Of course, this was just a dream sequence from which Sue wakes up screaming, agitated, and inconsolable, but it’s also a remarkable example of how trauma and dreams are inextricably linked.
In almost half a century since Carrie was written, science has given us plenty of answers about a lot of things, but it has yet to definitively show us why we sleep and the purpose of dreaming. The mystery remains, but we do know this — trauma can lead to distressing dreams and nightmares. Dreams and nightmares, in turn, are the brain’s way of processing and dealing with traumatic events. Naturally, all of the above can and will meddle with our sleep.
Trauma And Sleep
“When we go through a stressful or traumatic experience, our brain initiates an automatic defensive response, known as the fight-or-flight response,” says Annie Miller, a behavioral sleep medicine therapist and founder of DC Metro Sleep and Psychotherapy. “And when our brain initiates the stress response, stress hormones are released, including cortisol and adrenaline. What many people may not know is that the increase in cortisol and adrenaline can impact their circadian rhythm, as well as the ability to fall asleep and stay asleep.”
Miller goes on to explain that sleep disturbance in response to trauma looks different for everyone. “For some people, this means that they won’t get tired until late at night, or early morning, which can throw off their sleep schedules. Others may have trouble falling asleep or may wake up multiple times overnight. Some people may also experience ‘lighter’ sleep during times of stress or trauma, which may feel less refreshing or restorative.”
The link between trauma and sleep disturbances has been well-documented, often showing that typical responses to trauma include sleep disturbances like:
- Poor sleep efficiency
- Fragmented sleep
- Increased nighttime waking
- Difficulty falling and staying asleep
- Changes in sleep architecture (the structure of the sleep stages)
In addition to impacting our sleep quality and quantity, trauma can have an impact on our dreams, too, since they’re often a direct reflection of our waking experiences. Unsurprisingly, nightmares or distressing dreams are not uncommon after a traumatic experience.
Marhya Kelsch, LCSW, a psychotherapist that specializes in trauma and founder of Middleway Psychotherapy, tells Sleepopolis, “The theory is that in our sleep, we process stress from the day, come to some sort of resolve, and our mind files the events away. When there is a major stress or traumatic event that’s not fully processed, we experience nightmares and difficulty falling asleep or staying asleep. Moreover, when the processing in our dreams is highly distressing, we wake up, sometimes panic, and have difficulty relaxing to fall back asleep.”
The Relationship Between Nightmares And Sleep
If you’re processing distressing or traumatic events in your sleep, chances are you’re experiencing a nightmare. We know that nightmares typically occur during REM sleep, so the question now is not whether there’s a link between the two; it becomes, how does that relationship play out in our sleep?
The research shows that while nightmares can fragment your sleep, disrupting sleep quality and quantity, they don’t tinker much with your sleep architecture — or the basic structure of your sleep patterns. So while you may be drifting off a little later or waking more frequently, you’re still hitting each sleep stage as you should, collecting their cumulative benefits throughout the night.
Fortunately for those who find themselves waking from bad dreams so often that it’s creating sleep debt and fatigue, there are ways to avoid those nightmares.
Tips For Avoiding Nightmares
“There is a fair amount of evidence suggesting nightmares are a continuity of negative emotions from our waking lives,” says Dan Ford, Sleep Psychologist and Clinical Director of The Better Sleep Clinic. “Therefore, proactively dealing with the stressors of our waking lives, managing our mental health and emotions, and seeking out support for dealing with traumas may help reduce the likelihood of experiencing nightmares.”
If you’re experiencing nightmares more frequently than you’d like, you might try any of the following to keep them in check.
- Establishing a calming bedtime routine
- Maintaining proper sleep hygiene
- Leaning on your support system
- Talk therapy
And while the tips outlined above can be helpful for most people, those with mental health conditions or severe PTSD can (and should) speak to a qualified professional.
Tips For Calming Down After Nightmares
In addition to feeling distressed, scared, or angry, nightmares can cause physical symptoms, including increased heart rate, sweating, and shortness of breath. And while emotional distress and anger may be a little more difficult to wrangle, there are things you can do to calm down after a nightmare.
“The most important thing to do after having a nightmare is to get up and get out of bed,” says Miller. “Lying in bed after having a nightmare will make it harder to fall back asleep and will cause the brain to associate the bed with something stressful. Get up, get out of bed and engage in a quiet activity to get your mind on something else. Reading, watching TV, or listening to a podcast out of bed can help you shift out of the stressed state that a nightmare can induce.”
Beyond taking your mind off the event, box breathing and grounding techniques could help you calm down after a nightmare.
Using a technique taught to the Navy Seals to help them manage extremely stressful situations, you can use box breathing to help you calm down after a nightmare. And it’s as simple as it sounds. Picture a box with each of the four sides representing the inhales, exhales, and holds.
- Breathe in for a count of four
- Hold your breath for a count of four
- Exhale for a count of four
- Hold for a count of four
Ground Yourself Through Senses
Physical and mental grounding techniques can also help you pull yourself back from the distress of nightmares and negative emotions associated with bad dreams.
Physical grounding techniques engage your five senses to refocus your attention on the present moment. Common practices include:
- Deep breathing exercises (try the 4-7-8 breathing technique: inhale for four seconds, hold for seven seconds, exhale for eight seconds)
- Touching items that are close to you
- Running your hands underwater
- Holding ice
- Smelling your favorite scent
- Taking a short walk
Mental grounding techniques are more about distraction. Ideally, these practices will shift your negative thoughts to more positive ones. Common practices include:
- Mindfulness (being aware of your feelings and accepting them)
- Visualizing your anxiety (picture your anxiety as snow that melts when it hits the ground)
- Reciting something in order (multiplication tables, your favorite poem)
Can Nightmares Cause Trauma?
Typically, it’s trauma that causes nightmares, not the other way around. It is worth noting, though, that while nightmares may not lead to trauma, there’s plenty of evidence to suggest that they’re not without consequence.
As Kelsch mentioned, one of the most widely accepted theories regarding the purpose of dreams and nightmares is that they’re benign events merely meant to help us work some things out, but the research shows otherwise. Specifically, studies have shown that nightmares can actually boost anxiety during waking hours.
For example, one study out of Australia showed that nightmares did little to diffuse the emotional and mental turmoil from stressful events. On the contrary, those who reported being stressed about their dreams or nightmares were more likely to suffer from generalized anxiety during the day. In another study out of Montreal, researchers found that nightmares did not have an ameliorative effect at all; instead, they made dreamers less resilient during their waking hours.
Treatment For Nightmares
Beyond managing your mental health and emotions, Miller says there are two types of therapy that can help with chronic nightmares, both of which are based on very similar techniques — image rehearsal therapy (IRT) and exposure, relaxation, and rescripting therapy (ERRT).
“Image rehearsal therapy is a brief therapy focused on rewriting the nightmare to have a different ending,” says Miller. “The other therapy, exposure, relaxation, and rescripting, also involves rewriting the nightmare, but this one adds elements of relaxation. Both of these therapies are clinically proven to be effective, and the emphasis is on rescripting the content of the nightmare while awake.”
Miller also notes that beyond scripting therapies, progressive muscle relaxation and cognitive behavioral therapy (CBT) can also help reduce the frequency of nightmares. CBT is typically used for treating insomnia, but according to Miller, “it helps with regulating sleep by changing thoughts and habits around sleep, so, in turn, CBT can help reduce nightmares as well.”
The Relationship Between PTSD And Sleep
PTSD can have a profound effect on sleep. According to Ford, “Research shows that around 90 percent of people with PTSD will experience sleep disturbances — the most common sleep disruptors being insomnia and nightmares. And while nightmares are common across many mental health disorders, they are particularly common among those with PTSD, so much so they are considered part of the disorder and one of the key diagnostic criteria.” To further illustrate this point, Ford points to a research study that shows 70 percent of people with PTSD will experience regular nightmares compared to 2-5 percent of the general population.
The Last Word From Sleepopolis
Sleep, dreams, and nightmares have a pretty complex relationship. While traumatic events fuel our dreams and nightmares, it’s very likely that those frightful snippets and images serve a very real purpose — helping us process stressful events.
Helpfulness aside, distressing dreams and nightmares can impair our sleep, ultimately affecting both quality and quantity. Beyond taking proactive steps to manage the stressors that may cause nightmares, you can also try box breathing and grounding techniques or scripting therapies like image rehearsal therapy (IRT) or exposure, relaxation, and rescripting therapy (ERRT). However, in more severe cases, like PTSD, it may be best to speak with a qualified professional.