Sophie Bostock, PhD
Sleeping after loss: how sleeplessness and grief are linked
Sleepless nights are a common consequence of grief, and yet this is rarely spoken about. Sleep problems can cause additional worry and fatigue, which can add to the burden of loss, and make it harder to cope. In this article I explore why sleep may be disrupted, some actions you could take to help improve your sleep.
What is Grief?
Grief is the way in which you respond to losing someone, or something, close to you. We may expect grief to include emotional suffering, but grief can affect every area of our lives, including our behaviour, cognitive and physical health. Grief does not follow a predictable path. We are all unique, and the way in which we respond will depend on what or whom we have lost, and our own individual experiences.
Some common aspects of grief can include:
Numbness and shock: death is often unexpected, but even after a long illness, it can cause a sense of numbness and detachment. In the immediate period following bereavement you may have to focus on practical arrangements, and much of the emotional processing might only happen after the funeral and other administrative aspects have been settled. It may look as though people don’t feel anything, but in fact, the feelings may be so overwhelming, that it is only by focusing their attention on immediate tasks, that they feel they can get through the day.
Pain, depression and sadness: Pain can be physical, and emotional. Depression, hopelessness and sadness can come in waves. One day, you may wake up feeling positive, only to experience a crushing wave of sadness. Grief is often described as an emotional rollercoaster.
Poor sleep and fatigue: Sleep problems often accompany intense emotions. Negative thoughts and emotions can activate the ‘fight or flight’ stress response, which leads to physical arousal. Signs of this include a racing heartbeat, sweating, muscle tension or pain. If your body feels alert, your mind is likely to be racing too. Thoughts associated with the person you’ve lost, or worries about how you will cope, can keep you awake. Nightmares are also more common in response to loss.
Emotional outbursts: Grief can make us more emotionally volatile, and prone to tears or outbursts of anger or anxiety. Sleep deprivation actually adds to this emotional imbalance, and makes it harder to control our emotions.
Relief, and/or guilt: It’s very common to feel relieved when a loved one dies after a long or painful illness. Sometimes this can also lead to feelings of guilt, as if this is not an appropriate reaction - although it’s perfectly normal. You may also feel guilty for actions or words said, or actions not taken or words not said, in the hours or days leading up to the bereavement, and may re-live scenarios in your mind.
Physical signs and symptoms that accompany grief may include palpitations, pain, headaches, GI upsets, increase or decrease in appetite, lethargy, dizziness and vulnerability to illness. Intense grief has been linked to an increase in cardiac events.
What is Grief Awareness Week?
Grief Awareness Week runs from 2-8th December 2022, and was established by the Good Grief Trust to raise awareness of the challenges faced following bereavement, and of the support available.
The festive period is a particularly important time to consider those who are missing someone. It may bring back strong memories of a loved one which trigger intense sorrow or yearning, which hasn’t been felt at other times of the year. The sharp contrast between the messages of happiness and joy, and a feeling of loss, may amplify feelings of despair, anger or anxiety.
Is it true that there are stages of grief?
The five stages of grief model was first proposed by psychiatrist, Elisabeth Kübler-Ros, in her book “On Death and Dying” in 1969. She wrote that terminally ill patients often experience five stages when facing their own death: denial, anger, bargaining, depression and acceptance. The theory is often applied to the grieving process, but most research has found that grief doesn’t necessarily follow these stages, and this is not a helpful map to navigate grief. It is not true that ‘acceptance’ causes a resolution of grief.
The charity, Sue Ryder, which supports people with a terminal illness, or who have lost someone, suggests that the ‘growing around grief’ model described by Lois Tonkin in 1996 is a more useful model to describe the way that grief evolves over time.
Draw a circle. This represents everything in your life that you’re experiencing. Now, shade in the area of the circle which represents your grief. Some people shade in the entire circle, because their grief feels overwhelming. In the following days, weeks and months, it is not necessarily that your grief will get smaller, rather, that the circle of your life will slowly and gradually get bigger. Learning to cope and adapt doesn’t necessarily mean that you will forget, or lose your grief. Over time, you will have new experiences, meet new people and find new moments of enjoyment which will enlarge your outer circle, and mean that grief no longer dominates your life.
What is complex grief?
Grief follows a different timeline for everyone. Responses including tearfulness, sadness and insomnia are seen as a natural reaction to grief, and are not usually something which are treated medically.
From a clinical perspective, acute grief is usually described as the reactions within the first 6 months after a bereavement. Where someone is still experiencing intense grief over a year later, which has a serious impact on their day to day functioning, they might meet criteria for complex or complicated grief, or prolonged grief disorder. This can include intense emotional pain, persistent preoccupation with the person they have lost, inner emptiness, no interest in life, and poor sleep. Research shows that a talking therapy approach called complex grief therapy, or CGT can be very helpful. This helps people to move forward in life by both honouring those who have died, and finding meaningful activities and supportive relationships.
What’s the relationship between grief and sleep?
Around 1 in 2 people develop sleep problems or insomnia following a bereavement (Aoyama 2020). One study of sleep patterns in middle-aged and elderly people found that the more grief symptoms a person reported, the longer they took to fall asleep, the fewer hours they slept, and the worse sleep quality they reported. Poor sleepers were more vulnerable to developing complex grief over the following 6 years (de Feijter 2021). A study of bereaved parents found that many still experienced insomnia 5 years later (Pohlkamp 2019).
Sleep and mental health are closely linked. Most people find it harder to sleep when they feel stressed, for example. Stress and negative emotions can evoke the ‘fight or flight’ stress response; a cascade of biological reactions which originally evolved to help us defend ourselves from predators. The stress response leads to the release of adrenaline and cortisol, more muscle tension, and an increase in heart rate and blood pressure. These physical responses make it much harder to fall asleep. Grief can act as a chronic psychological stressor, leading to over-activation of this stress response, more pressure on the heart, and feelings of fatigue.
Coping with grief actually becomes much more challenging when we’re short of sleep, because our brains need sleep to process emotion and memories. Good quality sleep also reduces levels of the stress hormones, and gives our heart and cardiovascular system a chance to rest and re-set. Sleep deprivation can make it much harder to switch off the stress response, making us feel more tense, anxious, irritable and tearful.
Positively, we know that the relationship between sleep and mental health is bidirectional. This means that as grief becomes less acute and less intense over time, most people will automatically see improvements in their sleep. In one study, effective treatment for complex grief led to improvements in sleep quality (Szuhany 2020). However, proactively making small improvements to improve your sleep quality is also likely to have benefits for emotional health, and make you more resilient to coping with difficult situations.
How can I sleep better after a bereavement?
While trying to cope with acute grief, it’s common not to have the energy to focus on self-care. Things which you used to take for granted, like going for walks, or visiting friends, may feel like an insurmountable effort because they bring back memories of the person you have lost. Unfortunately, some of the ways in which many people instinctively respond to grief, such as spending less time outdoors, sleeping during the day, being less physically active, or using alcohol to cope, can make sleep worse.
Fortunately sleep is likely to improve as a result of either focusing on positive sleep habits, or via steps you take to cope with grief.
1. Positive Sleep Habits
● If you just do one thing, try to get out of bed at the same time each morning. This can be very, very hard, especially after a bad night’s sleep, but will help to anchor your internal rhythms so that you feel sleepy at the same time each night.
● Only use your bed for sleeping, and intimacy, and nothing else. If you’re struggling with day to day activities, you may feel like retreating to your bed during the day. The problem is that the brain then unlearns that your bed is a place for sleep.
● Get outdoors into natural light every morning, ideally for at least 15 minutes. Our brains rely on light to set our internal clocks. If we stay indoors all day, we can lose this natural cue which can make us feel more alert, and happier.
● Protect at least 15 minutes to practice relaxation every day. What can you do that lowers your heart rate and reduces tension in your muscles? The aim is to help switch off your stress response. There are many different strategies such as listening to calming music, having a bath, a massage, yoga, stretching, breathwork, mindfulness or progressive muscle relaxation.. the right one for you will be something you look forward to. Repeat this activity every night in the last half hour before you get into bed.
● If you really can’t sleep, get out of bed. If you’re awake during the night, with your mind racing, and getting frustrated that you can’t sleep for more than 15 minutes, get out of bed. This avoids the brain learning that the bed is a place for anxiety and frustration. Go somewhere else in your home and read or do a distracting activity. If you start to feel sleepy again, get back into bed.
2. Strategies for coping grief, which could also help with sleep
Just as some grief follows a different path for everyone, the things that you find helpful may not be the same as anyone else. Some people find it useful to keep busy, while others need plenty of time alone. The suggestions below are just that.. ideas, not a prescription.
● Journalling: If you are overwhelmed by thoughts and feelings, regularly writing them down can be therapeutic. There is no recipe for what to write about - just write about what is on your mind. You might want to write what you want to say to the person you have lost. Over time, you may notice patterns occurring, or that the feelings become less intense.
● Learning about ways other people have coped with grief: Grief can feel incredibly lonely, and it can help to be reminded that other people have been through similar challenges. Bereavement Counsellors at Sue Ryder have provided a list of recommended books.
● Honouring the person you have lost: You could look into a memorial, taking part in a charitable event or making or buying a particular object to help you feel connected to the person you have lost, and to honour their memory.
● Support from other people: It can be difficult to know who to talk to, and what to say. You may not want to burden people you love who are also grieving, but it is often helpful to share memories, and to be open and honest about how you feel. Several charities provide access to online bereavement counsellors, online communities, and telephone support, which might be a helpful place to start.
● Plan strategies for coping with difficult times: Christmas, birthdays, anniversaries. Thinking ahead will hopefully make it easier to cope, and for you to be less likely to be surprised by intense emotions. Plan how you might build in time to remember a tradition you shared with the person you have lost, as well as a new activity that you could do with friends or family that you can enjoy, even if for a short time. Be open with others about how you feel, accept help - you don’t need to always be looking after others, let them look after you.
Where can I find more help to cope with grief?
The Good Grief Trust lists a number of helplines you can call at any time, including the Samaritans. A number of other charities which specialise in supporting people through grief, including Sue Ryder, AtaLoss and Cruse, which all offer online bereavement support.
This article was written for Bensons for Beds Sleep Hub, listed here.