Childhood, adult trauma tied to worse sleep continuity, quality for midlife women
Key takeaways:
- Childhood trauma was tied to worse sleep continuity and adulthood trauma was tied to worse sleep quality.
- Consider sleep-related interventions for trauma survivors with poor sleep.
Trauma from childhood and adulthood were associated with worse measured uninterrupted sleep and worse self-reported sleep quality for midlife women, researchers reported in Menopause.
“Ultimately, it is still unclear whether trauma experienced at different points in the life course is related to self-reported and/or objectively assessed dimensions of poor sleep at multiple time points in midlife,” Karen Jakubowski, PhD, assistant professor in the department of psychiatry at the University of Pittsburgh, and colleagues wrote. “Additionally, there is a critical lack of data focused on women, particularly during midlife. Some trauma types, most notably interpersonal traumas, disproportionately affect women.”
Jakubowski and colleagues assessed whether trauma from childhood or adulthood was associated with persistent poor objectively and subjectively measured sleep for 167 women aged 40 to 60 years (mean age, 54 years). All women had objective and subjective sleep measured at two time points 5 years apart. At baseline, women self-reported childhood trauma, adult trauma, demographics, depressive symptoms, apnea symptoms and medical history; researchers also obtained physical measures. At both visits, all women completed 3 days of actigraphy to measure total sleep time and wake after sleep onset and self-reported sleep quality using the Pittsburgh Sleep Quality Index.
Fewer than half (45.1%) of women reported childhood trauma, with the most reported being emotional abuse (25.6%) followed by physical abuse (21.2%). In addition, 58.1% of women reported adulthood trauma, with the most reported being witnessing serious injury/death (21%) followed by sexual assault (19.2%).
Overall, 16.7% of women had persistent short actigraphy-assessed total sleep time, 59.3% had persistent high wake after sleep onset and 32.9% had persistent poor sleep quality at both baseline and follow-up visits.
After adjusting for health behaviors, experiencing any childhood trauma was associated with doubled odds of persistent high wake after sleep onset (OR = 2.16; 95% CI, 1.04-4.5; P = .039). In models adjusted for age, race/ethnicity and education and fully adjusted models, experiencing any adult trauma was associated with doubled odds of persistent poor sleep quality (OR = 2.29; 95% CI, 1.07-4.93; P = .034).
Trauma from childhood and adulthood was not associated with persistent short total sleep time.
In secondary analyses evaluating associations between trauma subtypes and sleep, sexual assault (OR = 3.01; 95% CI, 1.32-6.88; P = .009) and serious accident (OR = 3; 95% CI, 1.33-6.78; P = .008) were associated with persistently poor sleep quality. Witnessing serious injury/death was associated with persistent high wake after sleep onset (OR = 2.78; 95% CI, 1.12-6.88; P = .027). Researchers observed no other associations between other adult trauma subtypes, any childhood trauma subtypes or other sleep outcomes.
“Findings highlight the importance of considering trauma history in order to effectively understand and improve sleep health, and potential downstream health consequences of poor sleep,” the researchers wrote. “Findings further indicate the importance of considering sleep-related interventions for trauma survivors with poor sleep.”
Perspective
Back to Top
This study does a great job of demonstrating the correlation between sleep disturbances and how historical trauma can impact midlife women. As mentioned in the study, insomnia is one of the most common sleep complaints and one that may even be underreported by patients and fluctuate with age and other physiologic changes throughout the lifetime, such as during perimenopause. While total causality of insomnia can be difficult to determine, the correlation between a trauma history and sleep disturbance and insomnia is very evident from the data presented. In addition, while chronic insomnia is defined as symptoms persisting for at least 3 months, as evidenced by both the baseline and 5-year follow-up data, this is often much longer and can persist for years and decades.
Clinically speaking, chronic insomnia as defined by the American Academy of Sleep Medicine includes difficulty falling asleep, staying asleep or waking too early with some concomitant daytime symptoms such as decreased energy, concentration or fatigue. The classic Spielman’s model of chronic insomnia postulates that acute onset of insomnia can lead to chronic perpetuation of insomnia over longer periods of time due to both conscious and subconscious maladaptive factors. However, in many cases, trauma may be either a predisposing or even a precipitating factor of insomnia demonstrating the need for recognition and understanding of how events such as this may affect sleep throughout the lifespan.
Currently, treatment for chronic insomnia is centered on cognitive behavioral therapy. While this focuses on mainly recentering the maladaptive behaviors and reversing the effects of the perpetuating factors of insomnia, this study demonstrates the importance of not losing sight of the potential contributing factors that lead to the development of insomnia in the first place. The authors recognize this fact and, in doing so, bring attention to an issue that affects many women.
Collapse
Read more about