Explaining the links between traumatic childhood and sleep disorders.

Prevalence rates of child and adolescent posttraumatic stress disorder (PTSD) range from 0.5%-5%, while subthreshold PTSD and other trauma-related difficulties are relatively common among trauma-exposed children. Prevalence rates of sleep disturbances among trauma-exposed child samples vary considerably. Adverse effects of childhood trauma on sleep have been found immediately as well as years after. The following discussion explores the prevalence of these sleep disorders and attempts to explain the not so-well-understood underlying mechanisms.

Sleep is comprised of dynamic patterns and gradual stages that take place during the night. Insufficient sleep has been associated with impaired daytime functioning, excessive tiredness, fatigue, pain, elevated emotional dysregulation, aggression, anger, irritability, uneasiness, little frustration tolerance, high risk for developing substance use disorders, suicidal behaviors etc.

Against this background, it is important to understand that rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. It may lead to a number of physical and mental outcomes like PTSD, etc. Amidst the most prevalent general repercussions of stress and trauma are sleep disturbances, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness, appear to have a higher prevalence among children and adolescents.

Problem statement:

Adverse effects of childhood trauma on sleep have been found immediately as well as years after trauma, and can still be demonstrated in adulthood.

Nightmares are reported most commonly, (20.3%–80.8%). In fact, nightmares are prototypic symptom of PTSD. Recurrent distressing dreams and sleep disruptions (e.g., difficulty falling or staying asleep, or restless sleep) are listed among the intrusion symptoms and the marked alterations in arousal and reactivity, respectively.

Wamser-Nanney et al, in their study of 276 treatment-seeking children, showed that although sleep disturbances were common among trauma-exposed children, the type of traumatic event (e.g., sexual abuse, physical abuse, domestic violence, emotional abuse, neglect, etc.) and the nature of trauma (i.e., interpersonal vs noninterpersonal) or complex trauma were largely unrelated to sleep problems.

A study in 6132 adolescent survivors 3 years after a disastrous earthquake documented that older adolescents were at a significantly greater risk of sleep problems than younger children, and they had significantly higher risks of anxiety, depression, and PTSD.

In yet another study of 1573 adolescent survivors following a deadly earthquake found that the risk of sleep issues was significantly increased in older adolescents and in those who witnessed the tragic events directly.

A study on sleep quality among avalanche survivors at 16 years after exposure showed that those who were children when the disaster occurred were more likely to report PTSD-related acting out dreams in adulthood than their non-exposed peers, while those who were adults at time of the disaster had elevated risk of trauma-related nightmares.

In a study of 33 children treated for injuries after road traffic accidents, it was shown that children experiencing posttraumatic stress had a prolonged subjective sleep latency.

Probable mechanisms involved:

Over the period of time various mechanisms have come out by various researchers to explain the sleep disturbances caused by trauma, some of which are summarised in table 1.

The relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. For example, work is needed to understand the mechanisms by which sleep difficulties emerge and persist in the context of childhood trauma, and if sleep problems exacerbate other trauma-related symptoms. Additionally, the long-term course of sleep problems in children exposed to trauma have not been thoroughly reported.

Moreover, in view of the negative consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial. Thus, clinicians should be aware of sleep problems in childhood trauma victims. Trauma-focused interventions for children and adolescents may be beneficial not only for relieving child and adolescent traumatic stress but also for ameliorating adolescents' sleep problems, and could be complemented by tailored psychotherapeutic and pharmacological interventions targeting sleep disturbances.

Source: World Journal of Psychiatry: Giannakopoulos G, Kolaitis G. Sleep problems in children and adolescents following traumatic life events. World J Psychiatr 2021; 11(2): 27-34