Sleep and Trauma: What we know and where we are headed

The Starry Night by Vincent Van Gogh
“The Starry Night” by Vincent Van Gogh

Aaron Harwell is a doctoral student in psychology. His article below was included in the May 2020 issue of the National Institute for Human Resilience newsletter.

In 2020, it seems as if we are more enlightened than ever about the importance of sleep. Yet, most of us still struggle to get the recommended seven to nine hours of quality rest each night.1 Growing evidence suggests that chronic sleep deprivation has become widespread throughout society2;. For trauma survivors, in particular, trouble sleeping is the most common and long-lasting complaint after experiencing a life-threatening event3.

This is concerning for many reasons. For one, sleep represents a critical physiological human need, much like food, water, and shelter. Without it, individuals commonly report worse mental health, physical health and quality of life4. Additionally, sleep plays a critical role in self-regulation, establishing memories, and managing emotions, all of which commonly become more challenging after enduring a trauma3. Though not as common, trouble sleeping is also associated with increased suicidality for some individuals.

Despite these concerns, sleep impairment represents what researchers call a modifiable risk factor. Essentially, impaired sleep is not permanent, but rather something that can be changed and improved. Recognition of sleep as a modifiable risk factor has led many researchers to investigate the dynamics of sleep. These investigations have led to an influx of knowledge that we are trying to use to our advantage. As you can imagine or perhaps experienced yourself, the amount of sleep you get varies from day to day. What we’ve found out more recently is that this variability, average amount day to day change, is related to; younger age, isolation, poor physical health, mental illness, and higher stress levels4.

The next step is to understand how exactly sleep relates to these factors and what mechanisms maintain their association. My interest is in studying daily sleep changes and how they may relate to daily changes in an individual’s perceived ability to cope with stressors (i.e., coping self-efficacy). I am also interested in investigating how these daily interactions inform long-term mental health outcomes (i.e., depression and posttraumatic stress disorder). Technological advances in how we can measure sleep and mental health (e.g., smartphones, Fitbits, Apple Watches, etc.) allow for more accurate and consistent assessment while reducing research participant burden.

Though the field has moved forward, many questions still remain related to sleep, trauma and mental health. For example, what is the impact of receiving one hour less of quality sleep compared to two hours less? Are changes in sleep after a trauma more linear or nonlinear in nature? Is sleep related to the experience of posttraumatic growth? If yes, how so? When after a trauma is the most ideal window of time to measure sleep? And for how long? These questions and many more remain to be addressed. Promisingly, our knowledge of sleep dynamics and traumatic recovery is expanding. Future research will hopefully clarify these questions and translate findings into practical and effective trauma interventions.


1(Hirshkowitz et al., 2015), 2(Rosekind, 2015), 3(Germain, 2013), 4(Baglioni et al., 2016; Cappuccio et al., 2008; Strine & Chapman, 2005), 5(Bei, Wiley, Trinder, & Manber, 2016)