How Does Trauma Impact Sleep?

Dr. David Wiss

May 10, 2022

Trauma

One of the known consequences of trauma is impaired sleep over the lifespan. Sleep disturbances are one intermediary linking adverse childhood experiences (ACEs) to a wide range of mental health outcomes. Sleep is important for everyone, particularly those with trauma histories and those exposed to “toxic stress.” 

There is a graded inverse relationship between sleep quality and cumulative ACE score [1, 2]. Using the original ACE study sample, those with five or more ACEs were over twice as likely to report trouble falling or staying asleep, compared to those with no ACEs [2]. Many have proposed that impaired sleep might explain the association between ACEs and increased BMI in adulthood.

In a nationally representative study, each ACE increased the odds of short sleep duration by 20% and was not explained by symptoms of poor mental or physical health, suggesting unique causal mechanisms [1]. One potential pathway is through nightmares [3, 4], which is also correlated with post-traumatic stress disorder (PTSD). Among trauma-exposed adults, sleep difficulties played a key role in explaining PTSD, with links through physical factors (e.g., inflammation) and psychological factors (e.g., cognition) [5].

Sleep complaints after exposure to ACEs can persist even in old age. In a national sample of adults ages 60 and older, early parental emotional abuse was associated with impaired sleep through hindered development of supportive social relationships later in life [6]. This in turn was associated with more emotional distress and ultimately decreased subjective sleep quality. Do you see how this can create a negative cycle that can feel hard to break?

An important correlate of sleep disruption is depressive symptoms. Insomnia or hypersomnia is part of the diagnostic criteria for Major Depressive Disorder [7]. While the relationship is likely bidirectional, evidence supports sleep disturbance as predictive of future mood disorders [8–10]. In a meta-analysis of 21 longitudinal studies, the odds of depression following insomnia increased by 260% [10]. Research on college students documented sleep quality as a mediator between ACEs and depressive and anxiety symptoms [11]. Sleep should be considered a first-line lifestyle intervention among mental health professionals. 

Statistical models should account for the U-shaped association between sleep duration and incident depression [12]. A nationally representative study has shown that when sleep duration is less than eight hours, increased sleep is associated with a lower risk of incident depression, whereas when sleep duration is more than eight hours, depression risk increased with longer sleep [12]. Taken together, impaired sleep appears to be one sequela of the life course trajectory following ACEs that is less documented in the context of mental health research.

Adequate sleep could be conceptualized as a resilience factor that moderates the link between ACEs to both depressive and anxiety symptoms. It is also well-established that poor sleep negatively impacts eating behavior and food choices. When symptoms of PTSD are present, it can often lead to binge eating, which also impairs sleep quality. 

 At Wise Mind Nutrition, we offer fourteen strategies known to improve sleep as part of our comprehensive wellness intervention. We invite you to take this journey with us and move into a new chapter of healing and well-being. Is it time to start getting the best sleep of your life? Anti-inflammatory eating should absolutely be a part of that! 

References

1. Sullivan K, Rochani H, Huang L-T, Donley DK, Zhang J (2019) Adverse childhood experiences affect sleep duration for up to 50 years later. Sleep. https://doi.org/10.1093/sleep/zsz087

2. Chapman DP, Wheaton AG, Anda RF, Croft JB, Edwards VJ, Liu Y, Sturgis SL, Perry GS (2011) Adverse childhood experiences and sleep disturbances in adults. Sleep Med 12:773–779

3. Nielsen T (2017) The Stress Acceleration Hypothesis of Nightmares. Front Neurol 8:201

4. Nielsen T, Carr M, Picard-Deland C, Marquis L-P, Saint-Onge K, Blanchette-Carrière C, Paquette T (2019) Early childhood adversity associations with nightmare severity and sleep spindles. Sleep Med 56:57–65

5. Wright LA, Roberts NP, Barawi K, Simon N, Zammit S, McElroy E, Bisson JI (2020) Disturbed Sleep Connects Symptoms of Posttraumatic Stress Disorder and Somatization: A Network Analysis Approach. J Trauma Stress. https://doi.org/10.1002/jts.22619

6. Poon CYM, Knight BG (2011) Impact of Childhood Parental Abuse and Neglect on Sleep Problems in Old Age. Journals Gerontology Ser B 66B:307–310

7. Association AP (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

8. Perlis ML, Giles DE, Buysse DJ, Thase ME, Tu X, Kupfer DJ (1997) Which depressive symptoms are related to which sleep electroencephalographic variables? Biol Psychiat 42:904–913

9. Peterson MJ, Benca RM (2006) Sleep in Mood Disorders. Psychiat Clin N Am 29:1009–1032

10. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Riemann D (2011) Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disorders 135:10–19

11. Rojo-Wissar DM, Davidson RD, Beck CJ, Kobayashi US, VanBlargan AC, Haynes PL (2019) Sleep quality and perceived health in college undergraduates with adverse childhood experiences. Sleep Heal 5:187–192

12. Dong L, Xie Y, Zou X (2022) Association between sleep duration and depression in US adults: A cross-sectional study. J Affect Disorders 296:183–188