Trauma commonly causes trouble falling asleep, light sleep and recurring nightmares, and the best-supported approach is to protect sleep with a fixed routine, avoid alcohol as a sleep aid, plan what to do after waking from a nightmare, and, for repeating nightmares, rehearse a changed version of the dream during the day. That imagery rehearsal has trial support, mostly from clinician-guided delivery.
Sleep disturbance after trauma includes insomnia, fragmented sleep and distressing nightmares that often replay or echo the event.
Sleep Is Both A Symptom And A Cause
Alertness keeps the body ready for danger, so it resists sleep, and nightmares make sleep something to dread. Lost sleep then lowers the ability to cope, increases irritability, and makes triggers hit harder. Improving sleep often improves everything else, so it is worth the effort. The general principles are in Rest & Sleep Discipline and Sleep Hygiene Without Electricity.
Routine
- Fixed times for waking and, as far as possible, sleeping.
- A quiet wind-down before bed: no intense conversations, no arguments, no scary stories; gentle activity, slow breathing.
- Dark, cool, quiet space, with a way to see the door if that reassures.
- Daylight and activity during the day.
- Keep stimulants (strong tea, coffee, tobacco) to the early part of the day.
- Do not use alcohol to sleep. It can bring sleep on faster but it fragments sleep later in the night, and it is a route into dependence; see Why Addiction Increases After Collapse.
- Never sleep in a closed space with a smouldering fire or coals, which can poison with carbon monoxide.
When A Nightmare Wakes You
- Orient: where you are, the date, that it was a dream.
- Sit up, feel the feet on the ground, drink water.
- Do a grounding exercise; see Grounding Techniques.
- Do not lie there replaying it. Get up, move to another place or light a lamp for a short while, then return to bed when calm.
- Tell the buddy if nightmares are frequent.
Waking Someone During A Nightmare
A person woken from a violent nightmare may lash out. Wake them from a distance by calling their name quietly and repeatedly, not by shaking or grabbing. Say where they are and who you are. Sleep arrangements for people with severe nightmares should keep weapons, tools and fire hazards away from the bed, and the person who shares the space should know what to do. A “night companion” who sleeps nearby can help.
Imagery Rehearsal For Repeating Nightmares
Imagery rehearsal therapy is a technique with positive trial results in people with trauma-related nightmares, delivered by clinicians in the studies I know of (cited from recollection). The idea is to write down or tell a recurring nightmare, change it in any way that feels better, such as a new ending, and rehearse the changed version in the imagination during the day for a short period.
If done without a clinician:
- Start with a less intense nightmare, not the worst one.
- Do it by day, not at bedtime.
- The person chooses the change; it need not be realistic.
- Stop if rehearsing is distressing, and use grounding.
- Expect partial results. The parent guide gives an effectiveness figure of 60 to 70 percent; I can cite no source for it and have not repeated it.
Common Mistakes
- Treating nightmares as weakness.
- Napping long in the day, which lowers the pressure to sleep at night.
- Forcing the person to talk about the dream.
- Assuming a person who has not mentioned sleep is sleeping. Ask.
What’s Next
- Learn next: Trigger Management — daytime work that often reduces night-time disturbance
- Combine with: Hypervigilance & Startle Response — the alertness that blocks sleep