Sleep Disturbances in Children with PTSD
If your child has experienced trauma and/or has been diagnosed with Posttraumatic Stress Disorder (PTSD), then you as a parent or a caregiver have most likely dealt with some of their sleep disturbances. Children with a history of trauma may be sleeping too little, or too much, suffer from insomnia, or have nightmares. These sleep issues typically don’t go away on their own, but rather get worse with time, and affect the child’s daily life and functioning across all areas. Trouble sleeping and nightmares are two of the most common symptoms of PTSD. In fact, in his book, Post-Traumatic Stress Disorder: A Clinician’s Guide, Matsakis says that “sleeping problems are perhaps the most persistent of PTSD symptoms.” (1)
According to Diagnostic and Statistical Manual of Mental Disorder, Fifth Ed. (DSM-5), children with PTSD often experience recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event. However, it may not always be possible to determine that the frightening content is related to the traumatic event.
Trauma leads to overstimulation of our autonomic nervous system. When we are hurt, scared, or stressed our bodies react in “fight, flight, or freeze” response.
This is normally a very healthy response; however, a trauma survivor is “stuck” in this high arousal response most of the time. When triggered, the child’s muscles get tense, his heart starts racing, his breathing speeds up, and his brain blocks out any rational thoughts of feelings. It is not surprising that being in a constant state of arousal then has significant negative impact on the child’s ability to sleep, control his emotions, focus and concentrate, and function in his daily environment.
If not treated, sleep disturbances in childhood continue further into adulthood. According to research, 70-91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling or staying asleep. Nightmares are reported by 19-71% of patients, depending on the severity of their PTSD and their exposure to physical aggression. Additionally, recent findings suggest that sleep disordered breathing (SDB) and sleep movement disorders are more common in patients with PTSD than in the general population and that these disorders may contribute to the brief awakenings, insomnia and daytime fatigue in patients with PTSD.
Overall, sleep problems have an impact on the development and symptom severity of PTSD and on the quality of life and functioning of patients. Use of psychotropic medication can be effective in reduction of sleep disturbances in patients with PTSD; however, the adverse effects of these medications cannot be ignored. On the other hand, safe, cognitive behavioral interventions for sleep disruption in patients with PTSD have demonstrated significant reductions in nightmares and insomnia. However, more studies are needed to confirm these promising findings. (2)
A growing body of evidence also shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be one of the core features. Thus, sleep-focused treatment should be incorporated into any standard PTSD treatment. (3)
Having your child properly evaluated and his treatment needs assessed is absolutely crucial. In most cases, your child will be referred for therapy with a trauma specialist who has a sufficient amount of training and experience in treating symptoms of PTSD in children. However, you as a parent/caregiver can make a significant difference in your child’s quality of life, healing, and recovery, by educating yourself and implementing simple strategies at home.
There are many ways to help your child relax and prepare for sleep as well as improve their sleep. However, for children with PTSD, the routines may be a bit trickier to establish and implement.
Listed below are simple strategies I recommend and I have seen being very helpful for many of my little clients and their families (4):
Remove any triggers from the child’s bedroom. The child should not see, hear, or think about anything that reminds her of the traumatic event (pictures, drawings, belongings). Make sure that the child feels safe in her room.
Encourage your child to be physically active during the daytime, but significantly limit physical activity before bedtime.
Play relaxing music for them while getting them ready for bed.
Practice breathing and relaxation techniques with your child. *
If you are a believer, pray with and for your child before saying good night.
Read your child a calming story, avoid any literature with dramatic conflict or ending.
Allow them to use a night light if necessary.
Set the thermostat to a comfortable, cool temperature.
Choose a regular bedtime to establish a good routine.
Allow your child gather whatever he wants to have in his bed with him (special blanket, stuffed animals, pets, etc.)
Give your child a warm bath a few hours before bedtime; as her body cools down after the bath, it may be easier for her to fall asleep.
Using a white noise machine may drown out any disruptive noises that can get in a way of sleeping.
Keep a record of the number of hours your child sleeps each day and how they feel in the morning to help you understand their sleep patterns.
Feed your child only a very light snack before bedtime and completely avoid caffeine.
Help her write down her hopes and dreams every night before she goes to sleep to help her freed up her mind.
I hope you find these techniques helpful and easy to implement. As always, please don’t hesitate to contact me with any questions you may have.
Matsakis, A. Posttraumatic Stress Disorder: A Clinician’s Guide. Oakland, CA: New Harbinger Publications. 1994a
Maher MJ,, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567-90. PubMed: 16800716
Spoormaker VI1, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008 Jun;12(3):169-84. PubMed: 18424196
The PTSD Workbook, Third Ed. Mary Beth Williams, PhD, LCSW, CTS; Soili Poijula, PhD. Oakland, CA: New Harbinger Publications. 2016