Post-Traumatic Stress and Sleep Disorders: A Brief Overview

Trauma usually manifests as a consequence of a distressing or life-threatening event or series of events such as school shootings, natural disasters, sexual assaults or any period of extreme duress such as war. These symptoms can manifest either by directly experiencing or witnessing an event or indirectly learning that it happened to a close family member or friend. Even repeated exposure to details of traumatic events can elicit PTSD symptoms such as police officers who must hear stories of child abuse in great detail continuously.

The mental health disorder known as Post Traumatic Stress Disorder is categorized through a series of symptoms (defined through the DSM-5);

1. Re-experiencing the trauma through intrusive recollections such as flashbacks or nightmares.
2. Emotional numbness and avoidance of places, people, and activities which remind the person of trauma (triggers).
3. Increased arousal such as difficulty sleeping, concentrating, and/or being easily angered or ‘triggered’ (irritable/aggressiveness).  
4. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (“No one can ever be trusted” or “the world is completely full of s***”)
5. Persistent, distorted blame of self or others about the cause or consequences of traumatic events.
6. Inability to remember important details of traumatic event which occurred.
   1. Associated with repressing memories and thoughts.
7. Markedly diminished interest or participation in significant activities (avoidance).
8. Persistent inability to experience positive emotions.
9. Feelings of detachment or estrangement from others.

Although the association of PTSD is usually of war; the symptoms are common amongst victims of sexual abuse, childhood abuse, prejudice/discrimination and other forms of lasting trauma. It is important to differentiate stress and trauma for the purposes of seeking mental health.

Stress is a causal response system built into our neurological framework (through the release of cortisol), in reaction to events or situations that we feel are ‘out of our control’ or ‘too much to handle.’ We often feel stressed when things are piling up on top of each other or there is a deadline that we must reach. The common language of ‘feeling stressed out’ is part in partial to our daily lives as students, disgruntled family members, and members of society. In the context of a mental health disorder, it is important to understand that ‘impairment in daily functioning’ is usually the point of no return for a diagnosis. I may feel stressed for my finals, but after it is over, I am perfectly content to enjoy the rest of my summer without any traumatic associations to the days and days of laborious studying I endured.

Trauma is usually long-lasting and persistent. Stress in the context of repeated abuse, assault, discrimination, war or violence manifests differently from the common language we associate with ‘normal’ stress. The latter form is discussed with our friends casually and posted on social media as just another emotion we portray in context with missing a movie showing or being stuck in traffic. Trauma, as is the case with most mental health symptoms, is harder to understand on surface level. A close friend may stop texting or answering our Whatsapp messages (‘avoidant’ symptoms), or avoid mentioning details of a serious event they endured when we ask them how they are (‘inability to remember important aspects of trauma’ symptom) or show sleep dysfunctions (‘intrusive thoughts’ symptom).

All of these are extremely hard to pinpoint at first glance; it is in our human nature to dismiss the friend who has stopped answering our messages as a ‘(insert unsatisfactory adjective here)’, rather than understanding that what they may have been through ‘shook them up’ more than they let on or how we perceived it. Even smaller forms of trauma such as witnessing a car hijacking or being in a store when a fight breaks out may elicit distortions in perception that a person may need time to cope with. Many times I hear people say things like ‘if I was in that situation, I would have fought back or done this or that’ or ‘not panicked’ or some other fantasy tale that seeks to ultimately undermine the real-life situations people who have experienced trauma go through.

We have to disengage with this Fundamental Attribution Error that we erroneously place on situations we were not a part of and events we cannot ever understand. It is better always to listen humbly and seek to understand. As the Qur’an so eloquently states:

“He gives wisdom to whom he wills.”

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                (2: 269)

If we understand this verse through a psychological lens, then we know from a multitude of research that people who go through severe forms of trauma are usually more resilient.

What can we do to help?

As always it begins in shifting the culture of mental health awareness. Let us show humility, conscientiousness, and empathy when we hear of stress (the preliminary basis for trauma). Rather than letting our society co-opt the language of stress, let’s reclaim it through understanding and love. If your friend or family member casually says “I am feeling super stressed as of late”, don’t dismiss it. Reclaim it. Inquire as to his/her condition; what you can do to help them? Ask them whether this is temporary stress or persistent stress? What do they enjoy doing? Can you take a day off this weekend to take them for a bike ride, to a new restaurant or even a small 5-10 minute conversation on why they are stressed and whether this job is worth what they are enduring? Your friend or family member may even slightly hesitate or chuckle at your request; perhaps it wasn’t as serious as you thought. Perhaps they may take your words and inquire further on resources to help them cope with stress. Maybe they can even find it in themselves to understand their stress better by verbalizing it with you.

Ultimately, we have to drive this as the take-home message; your friend/family member/even you may need mental health services. Speaking about it informally is not a standardized treatment for traumatic conditions; it is within the purview of psychological interventions, that a person must clarify, understand, manage, cope, and possibly alleviate or live with their mental health disorders, including traumatic episodes and PTSD.  

I sat down with Simon Lau, a former U.S. soldier and current 5th year clinical psychology student whose research specializes on the intersection of sleep disturbances and traumatic episodes. The inception of Simon’s research began when he sought to understand why fellow soldiers, who were clearly distraught and unable to perform in combat, were still being thrust into war despite obvious psychopathological symptoms. Now Simon’s work helps to understand early interventions to cope with markers of trauma through the causal effects of functional sleep habits.

You can watch the full podcast below.