Traumatic Events and Children's Sleep

Direct experience with a traumatic event can have a multitude of psychological consequences for children. Disrupted sleep may take the form of difficulty falling asleep, frequent nighttime awakenings, restless sleep, nightmares, anxiety dreams, and not wishing to sleep alone. With extensive national media coverage, even those children not directly affected may suffer from these problems. Following major traumatic events in the U.S., immediate and long-lasting effects on children have been studied, and we look to these studies to guide us in the wake of what happened in Newtown, CT on December 14. One of the best reviews of research was published by Dr. Avi Sadeh in the Journal of Child and Adolescent Psychiatric Clinics of North America, titled “Stress, Trauma, and Sleep in Children." A broader review focusing on both children and adults was published in the New England Journal of Medicine in 2001, shortly after the attack of September 11 that year, by Dr. Peretz Lavie titled “Sleep Disturbances in the Wake of Traumatic Events.”

Here are a few conclusions distilled from these reviews that may be helpful for the many children and families affected by last week’s event and the teachers, counselors, ministers, and others who are trying to comfort them.

1. Sleep disturbances have been reported by large numbers of children studied who were directly exposed to events including a terrorist attack, a fatal shooting by a sniper on a school playground, natural disasters (i.e. flood, earthquake, hurricane, tornado), accidents (e.g automobile), deaths of friends or family by any means, including suicide, acts of war, and abuse (psychological and physical).
2. Even those children indirectly exposed can have problems. Following the Space Shuttle Challenger disaster in 1986, more than half of children studied who were watching it on TV reported sleep problems as much as 5-7 weeks following. The majority of these problems had subsided 14 months later. Children who have followed extensive media coverage on television, the internet, Facebook, twitter, or other places are more likely to experience sleep problems.
3. A wide range of individual differences in responses of children is to be expected, and we also expect that children of different ages will react differently. Older children have developmentally more mature cognitive and emotional coping resources and may have fewer problems than younger children. We should also be aware that children of all ages may not manifest overt signs of distress even though they are having difficulties.
4. Poor sleep is a natural initial response to trauma, and sleep will usually gradually get better with time. Children who report troubled sleep many months after an event may need continued help, and some need professional attention.
5. Daytime problems of children following events such as emotional dysregulation, acting out, anxiety, and depression may be direct effects of the event, but they can also be caused by poor sleep. Accordingly, helping children attain better sleep can improve problems seen during the day.
6. Reinforcing good sleep habits is a good way of addressing problems without directly focusing on the event by other means (e.g. talking; comforting; counseling). Good practice regarding children’s sleep includes enforcing consistent bedtimes, providing ample time for sufficient sleep (earlier bedtimes), having a structured routine before bedtime, minimizing interpersonal conflict (between adults and between children and adults) especially near bedtime, avoiding or eliminating drinks with caffeine, and minimizing use of media before bedtime.

Lavie, P. (2011). Sleep disturbances in the wake of traumatic events. New England Journal of Medicine, 345, 1825-1832.

Sadeh, A. (1996). Stress, trauma, and sleep in children. Child and Adolescent Psychiatric Clinics of North America, 5, 685-700.