For many, sleep is a luxury. For those recovering from trauma, it’s often the first thing to suffer. Research shows that sleep disturbance is a strong predictor of overall mental health decline and posttraumatic stress disorder (PTSD) severity. Sleep isn’t just about feeling rested – it’s about cognitive function, emotional regulation, and resilience.
In recognition of National Sleep Awareness Week, we sat down with Deborah C. Beidel, Ph.D., ABPP, Executive Director of UCF RESTORES, and Candice Alfano, Ph.D., DBSM, University of Houston Professor of Psychology and Director of the Sleep and Anxiety Center of Houston, to discuss the profound impact of sleep on trauma recovery, how sleep deprivation manifests differently in adults, first responders, adolescents, and women, and what strategies we can all use to improve our the quality of our sleep.
1. Sleep and Trauma: A Critical Connection
Q: Dr. Beidel, in your experience working with trauma survivors, how does disrupted sleep factor into their recovery process?
In the immediate aftermath of a traumatic event, sleep difficulties are very common. For most people, normal sleep patterns gradually return within a few weeks. However, for individuals who develop PTSD, sleep disturbances – such as insomnia, nightmares, or waking due to panic attacks – are a more frequent issue.
So, if someone is not sleeping well, what they learned and experienced throughout a given day may not be processed and consolidated into long-term memory.
Sleep plays a critical role in memory consolidation and learning. So, if someone is not sleeping well, what they learned and experienced throughout a given day may not be processed and consolidated into long-term memory. Because cognitive-behavioral PTSD treatments rely on learning new coping strategies, disrupted sleep may reduce their effectiveness. This is why some PTSD treatment approaches, like our Trauma Management Therapy program, incorporate direct interventions to improve sleep as part of the recovery process.
Q: Dr. Alfano, you focus quite a bit on sleep’s role in child and adolescent mental health. How do trauma-related sleep disruptions impact younger populations differently?
When trauma disrupts sleep, it can create a ripple effect — impacting emotional stability, behavior, academic performance, and even social health.
Children and adolescents require more sleep than adults, making them particularly vulnerable to the negative effects of sleep disruption. Sleep is critical for developing self-regulatory skills, which young people are still in the process of mastering. When trauma disrupts sleep, it can create a ripple effect — impacting emotional stability, behavior, academic performance, and even social health. The combination of trauma-related stress and poor sleep can make it even harder for adolescents to process their daily experiences and function effectively.
2. First Responders & Sleep: An Occupational Hazard
Q: Dr. Beidel: First responders often work unpredictable hours, with long shifts and high exposure to trauma. How does this profession uniquely impact one’s sleep health?
For first responders, this rhythm is often thrown off by long shifts, unpredictable schedules, and exposure to trauma.
Our bodies follow a natural, 24-hour internal clock – known as the circadian rhythm – that regulates sleep, alertness, and many other critical functions. For first responders, this rhythm is often thrown off by long shifts, unpredictable schedules, and exposure to trauma. The fire service’s 24-hours on/48-hours off schedule, in particular, presents unique challenges.
A former graduate student of mine, Jeremy Stout, conducted research to study how this shift schedule affects firefighters’ sleep. He found that even brief sleep disruptions — such as answering calls during overnight hours — significantly impact firefighters’ cognitive processing, reaction times, and coordination. Generally, the fire service understands this, and departments are exploring alternative schedules to mitigate these effects. But, to some degree, sleep disruption remains an unavoidable occupational hazard.
3. Sleep Disparities: Gender Differences in Sleep & Mental Health
Q: Dr. Alfano, studies suggest that women experience sleep disturbances at higher rates than men. What are some of the key differences you’ve observed?
Studies show that women experience higher rates of sleep disturbances, particularly insomnia. While the exact reasoning isn’t fully understood, several factors likely contribute.
Yes, that’s true – studies show that women experience higher rates of sleep disturbances, particularly insomnia. While the exact reasoning isn’t fully understood, several factors likely contribute. Hormonal fluctuations across the lifespan (such as during menstruation, pregnancy, and menopause) can disrupt sleep patterns. Women are also more likely than men to experience anxiety and depression, both of which are closely linked to sleep difficulties. Additionally, the demands of balancing caregiving, home life, and professional responsibilities may play a role.
Interestingly, women need slightly more sleep than men, and research suggests that women find sleep loss more distressing than men. This may influence how frequently these sleep-related issues are identified and reported: men, who may experience similar issues, could be underreporting due to differences in distress perception or social conditioning.
4. Evidence-Based Sleep Interventions: What Works?
Q: Both of you work extensively in developing treatment strategies. What are some evidence-based approaches to improving sleep, both for trauma survivors and the general public?
Trauma-focused interventions can have positive effects on sleep, but emerging data largely suggest that sleep problems need to be a direct, specific target of treatment for optimal long-term outcomes.
A: (CA) Trauma-focused interventions can have positive effects on sleep, but emerging data largely suggest that sleep problems need to be a direct, specific target of treatment for optimal long-term outcomes. This might mean integrating a sleep component into trauma-focused treatment, or using a sequential approach (i.e., treating someone for PTSD first, followed immediately by targeted treatment for sleep disturbances).
Several behavioral interventions have proven effective for trauma-related sleep issues. CBT-I is considered a gold standard for insomnia, helping individuals restructure unhelpful sleep-related thoughts and behaviors. For trauma survivors who experience chronic nightmares, Imagery Rehearsal Therapy (IRT) has shown success by helping patients re-script distressing dreams into less threatening ones.
A: (DB) For many years, we’ve treated trauma using a combination of behavioral interventions — including exposure therapy, anger management, and social reintegration strategies. Initially, we measured changes in sleep to see if these interventions had a positive effect on insomnia, total sleep time, and nightmares.
However, to Dr. Alfano’s point, we saw that participants’ sleep-related issues often persisted; because we did not directly address sleep problems, our treatment did not result in healthier sleeping.
Since making this change, we’ve seen notable improvements in sleep quality among participants.
Recognizing this gap, we revised our treatment approach to incorporate elements of Cognitive Behavioral Therapy for Insomnia (CBT-I) into our overall program. Since making this change, we’ve seen notable improvements in sleep quality among participants — though I believe there’s still more we can do to optimize outcomes.
5. Sleep Hygiene Tips for Immediate Impact
Q: If someone is struggling with poor sleep – whether due to trauma, stress, or lifestyle factors – what is the most important change they can make today?
The most important factor for quality sleep is maintaining a consistent sleep schedule — going to bed and waking up at the same time every day, even on weekends.
A: (CA) The most important factor for quality sleep is maintaining a consistent sleep schedule — going to bed and waking up at the same time every day, even on weekends. Sleep quality is highest when sleep occurs at the same time every day. When people struggle with sleep, they often develop compensatory habits that actually make things worse; taking long naps, drinking alcohol before bed, going to sleep too early, or worrying excessively about sleep are all known to worsen sleep problems. It’s important to remember that occasional sleep difficulties are normal. However, sticking to a regular sleep-wake cycle (even if you feel a little tired some days) helps prevent short-term sleep issues from turning into chronic ones.
A: (DB) To build on Dr. Alfano’s advice, I’d add one more thing: put down the electronic devices at or before bedtime. Cell phones, tablets, and other screens emit an artificial blue light, which can suppress melatonin production and disrupt natural sleep signals, keeping us awake.
According to the National Sleep Foundation, blue light exposure before bed not only delays sleep onset but also reduces the deep sleep stages necessary for cognitive recovery.
According to the National Sleep Foundation, blue light exposure before bed not only delays sleep onset but also reduces the deep sleep stages necessary for cognitive recovery – meaning it’s really against your best interest to have electronics around at bedtime. The solution is straight-forward: turn off screens at least 30-60 minutes before bed and opt for relaxing, screen-free activities (like reading or journaling) instead.
6. When Poor Sleep Becomes a Serious Problem
Q: Sleep issues are so common, yet often overlooked or neglected. If someone feels their sleep struggles are impacting their mental health, when should they seek help – and what’s the risk of putting this off?
If sleep difficulties persist for several months and begin to interfere with daily life it is time to seek professional help.
A: (DB) It’s important to remember that traumatic stress will impact sleep. For many people, their sleep will recover as the stress decreases. However, if sleep difficulties persist for several months and begin to interfere with daily life — energy levels, mood, focus, or overall well-being — it is time to seek professional help.
A: (CA) When poor sleep begins to undermine your mental or physical health or affect daily functioning, it’s time to take action. The longer a sleep issue goes untreated, the harder it tends to be to treat: sleep is a behavior, and like any learned behavior, we can fall out of practice with healthy, proper sleep patterns.
The good news is there are effective, evidence-based treatments available for sleep.
Untreated sleep problems significantly increase the risk of developing depression, anxiety, and other mental health conditions. The good news is there are effective, evidence-based treatments available for sleep – including telehealth and online interventions – that make treatment more accessible than ever.
Quality sleep is essential for both mental and physical health, playing a critical role in everything from emotional resilience to cognitive function. If sleep-related challenges are negatively impacting your daily life, don’t be afraid to seek help! Exploring solutions early on can make a real difference.
For more expert insights on trauma, mental health, and resilience, explore our ongoing Director’s Cut series. Each month, we’ll bring you conversations with leading experts tackling some of the most pressing challenges in behavioral health today.
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