Why Trauma Makes Sleep So Hard

Sleep is the time when we are at our most vulnerable. We must let our guard down in order to rest, which can seem impossible if our nervous system is stuck in survival mode due to trauma. So how does this happen?

When we boil it down to the basics, the #1 job of our brain is to keep us alive. When something traumatic has happened that challenges our sense of safety, our brain goes into overdrive, shooting alert signals throughout our nervous system to tell our body and our senses to remain on high alert to help us guard against any sign of future threat.

This may show up in a number of ways in our body, our behavior, and our thoughts:

Maybe you notice:

feeling jumpy or easily startled

becoming irritated quickly, staying “on edge”, or feeling like you just cannot relax
spending a lot of time worrying about negative things that could happen in the future

These reactions make sense and are experienced by most people after a trauma. For some people this shift into survival mode lasts for days or weeks, but for others our brain can get stuck and this high alert state can persist for months or even years.

This programming is powerful and difficult to override, even when we try to convince our brain that the danger has passed.

Your mind may know that you are safe.

Your body may not yet believe it.

Sleep is often one of the last things to improve after trauma, because our brain and nervous system need repeated experiences of safety to help convince them that it’s time to rest.

What Trauma-Disrupted Sleep Looks Like

Trouble Falling Asleep

After trauma, many people find it difficult to fall asleep. For some, the quiet that comes at night is the time their thoughts or unwanted memories are the loudest. For others, sleep only comes after hours of tossing and turning. Muscle tension, heart racing, surges of adrenaline can all leave you feeling “tired but wired.” Reassuring an overly-alert brain of safety can take many forms:

Safety-checking: Checking locks on doors/windows or ensuring no one is nearby
Sensory strategies: Distracting or regulating sounds (t.v., fan, white noise)
Safety/comfort objects: Keeping objects nearby to comfort you or in case you need protection
Positional/environmental adjustments: Sleeping sitting up or on a couch or chair if the bed feels too vulnerable
Chemical strategies: Taking medication or using alcohol or cannabis to try to bring calm

Trouble Staying Asleep (and Waking Too Early)

Some people wake up at night or too early in the morning and find it difficult or impossible to return to sleep. Wakenings like this can happen for many reasons. Some reasons are universal and correspond with natural changes in sleep as we age, and some are trauma-specific. The brain’s survival mode can amplify otherwise “normal” sleep disruptions or lead to new disruptions unique to trauma recovery.

Expected Physical or Environmental Interruptions to Sleep:

Feeling too hot or too cold
Pain or physical discomfort
Having to use the bathroom (increases with fluid intake and age)

Trauma-Related Hyperarousal:

Hearing a noise that triggers scanning or checking the environment
Light sleeping due to increased arousal
Dread, panic, or worry upon waking (can also be caused by general anxiety)

Trauma-Specific Content:

Waking after nightmares

This pattern is understandably frustrating and can leave you feeling discouraged and unsure of what to do.

Nightmares

Nightmares are distressing dreams that can take on the form of trauma recall, but can also involve more general upsetting content. Some trauma survivors experience the details of traumatic events played on repeat during sleep, while others have dreams involving general themes of threat or danger. The increased arousal people experience during trauma recovery may also show up in the form of dreams focused on everyday stressors such as work performance or relationship conflict.

Nightmares may lead you to wake feeling scared or confused, and you may or may not remember the content of your dreams. Some people do not wake at all.

You may be more likely to experience nightmares when your nervous system is hyper-aroused before sleep, or after a stressful or triggering day. Though nightmares can be very distressing, they occur because your brain is trying to process and make sense of what happened so it can continue to protect you. This is all part of the survival mode that comes after experiencing trauma.

Importantly, nightmares do not mean that you are going backward in your recovery and they are not a sign that you are doing anything wrong. Understanding why nightmares happen is the first step toward finding relief.

Steps To Help Your Nervous System Rest

Start with Nervous System Soothing

When your body and brain begin feeling safer during the day, improvements in sleep tend to follow.

Calming your nervous system before bed helps signal that it’s safe to rest. Helpful routines might include:

Consistent wind-down rituals
Sensory grounding (warm tea, a bath, soft lighting, gentle sounds or scents)
Quiet activities like reading or stretching
Breathing or mindfulness exercises
Emotional decompression (journaling, connecting with supportive people)
Comforting objects (soft or weighted blanket)

Progress is gradual and not always linear. Stressful days may lead to harder nights, but that doesn’t mean you’re failing.

Set Yourself up For Success

Sleep science supports a few simple habits that improve sleep quality:

Keep a consistent bedtime and wake time
Reduce caffeine and alcohol before bed
Limit daytime naps
Keep your sleep space cool and quiet
Use the bed only for sleep and intimacy

Rethink How You Respond to Nighttime Waking

Waking up at night is normal. Shifting how you think about sleep can reduce pressure and prevent escalation. Catastrophic thoughts like “I’ll never get back to sleep” or “Tomorrow will be ruined” actually increase arousal.

When you wake up, these strategies can help your nervous system settle:

Pause before reacting. Notice that you’re awake without immediately scanning the environment.
Orient gently. Look at one or two familiar items in the room to remind yourself you are safe and in the present.
Slow your breathing. Lengthen your exhale to signal calm to the nervous system.
Use grounding sensations. Light pressure from a blanket or placing a hand on your chest can help re-anchor your body.
Try a quiet activity. If you can’t fall back asleep, choose something calming (reading, coloring, knitting). Avoid phones and TV.
Reset sleep associations. If needed, move to a chair or another room briefly and return to bed only when sleepy to strengthen your brain’s connection between bed and sleep.

When to Seek Professional Help

Sleep difficulties often improve more quickly with support, especially when trauma is involved. It may be time to talk with a professional if you notice:

Sleep isn’t improving. Falling or staying asleep has been difficult for months, nightmares continue, or the pattern feels stuck.

Daytime functioning is affected. You feel chronically tired, have trouble concentrating, or notice increased irritability or emotional overwhelm.

Nightmares or nighttime panic feel overwhelming. You wake up terrified multiple times a week, avoid sleep, or feel afraid to be in your bedroom.

Safety behaviors are taking over. You’re checking locks or scanning your environment repeatedly, relying on someone else to feel safe, or rituals are disrupting rest.

You rely on substances to sleep. You’re using sedatives, alcohol, cannabis, or over-the-counter sleep aids, and need more over time. These often help short-term but can worsen sleep over time.

What Help Looks Like

Fortunately, there are great treatment options available. Ask your provider if they are trained in these approaches. If not, contact us at Science for Survivors, and we can help you connect with a trained provider near you who can meet with you in-person or via telehealth:

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is the gold-standard treatment for insomnia, and it involves no medication. Treatment typically involves meeting with a trained provider for 5-7 sessions to learn how to make changes to your habits around sleep in a way that will help your body and your brain reset. 70-80% of people who complete CBT-I will see improvement in their sleep quality. Learn more about CBT-I at this link.

Imagery Rehearsal Therapy (IRT) for Nightmares

IRT is an approach that helps to teach the brain how to replace distressing dreams with new content, to help lessen the frequency of both general and trauma-specific nightmares. 60-80% of people see improvement in the frequency of nightmares, and benefits can last for years. This approach typically involves meeting with a provider for 4-5 sessions and practicing the skills to help reduce nightmares before bed.

Trauma-Focused Therapies

If you are having other daytime symptoms related to past trauma it may be helpful to work with a mental health provider to address the underlying challenges that are keeping your brain and body in survival mode. If you are experiencing any of these daytime symptoms, it may be a sign that trauma-focused therapy could help:

You experience unwanted or intrusive trauma thoughts or memories
You’re finding it difficult to talk about what happened, or to visit certain places or do certain activities due to trauma reminders
You are overly alert or on guard, or find yourself easily jumpy or startled
You experience depressed mood, loss of interest in activities you used to enjoy, or you find it difficult to experience connection, love, or happiness

There are many great options to explore with a trained mental health provider, including

Trauma-Focused Cognitive-Behavioral Therapy (CBT)
Prolonged Exposure Therapy
Cognitive Processing Therapy
Eye Movement Desensitization and Reprocessing (EMDR)

Sleep Medicine Evaluation

Some people who struggle with falling asleep, staying asleep, or managing nightmares after trauma may also have medical sleep issues that need a different type of support. A sleep specialist can help identify and treat conditions such as:

Sleep Apnea: A disorder where breathing repeatedly stops and starts during sleep, leading to fragmented, unrefreshing rest. Treatment can significantly reduce health risks and improve sleep quality.

Restless Legs Syndrome / Periodic Limb Movements: Uncomfortable sensations or involuntary leg movements that make it hard to fall or stay asleep.

Circadian Rhythm Disorders: When your body’s internal clock is out of sync with your ideal sleep-wake schedule, leading to difficulty sleeping at the times you need.

Pain-Related Sleep Disruption: Chronic pain or nighttime discomfort from medical conditions (like arthritis or injury) can interrupt sleep and leave you feeling exhausted.

Medication Side Effects: Some prescription and over-the-counter medications can cause insomnia, vivid dreams, nighttime waking, or daytime sleepiness.

Hormonal or Metabolic Factors: Changes in hormones or metabolism, such as thyroid issues, menopause, blood sugar fluctuations, or cortisol irregularities, can contribute to disrupted sleep.

Medication Support

Medications can be a helpful option for some people. We know that medications are typically most effective when they are used short-term and are paired with therapy and behavioral strategies to address the underlying causes of sleep disruption. Medications may be helpful for some people and unnecessary for others.

Some medications may help make it easier to fall asleep, reduce nighttime wakenings, help stabilize mood or anxiety that worsens sleep, or reduce the frequency of nightmares. However, long-term medications may change the structure of your sleep and tapering may require support.

You should always talk with a medical provider before beginning any medications or over-the-counter supplements for sleep.

An Invitation to Rest

If sleep has been hard, you’re not alone. Trauma often disrupts the very systems meant to help us rest. If you’re struggling, it’s not a sign of failure. Your nervous system is doing the best it can with what it’s been through.

The good news is that sleep can improve, and support is available if you need it. Small shifts add up, and your body can learn to rest again.

Why Trauma Makes Sleep so Hard (and What Actually Helps)