Grief is a biopsychosocial experience and anyone who has experienced grief and loss would recall
how it disrupted their sleep.
Intellectually you know you’re going to deal with grief and death someday, whether it’s a pet, family
member or friend. Those are easy for you to identify. Many people don’t often consider all of the
other grief and losses that you have to deal with. To experience grief or loss, somebody doesn’t have
to die, only a change needs to happen. Bereavement occurs after a major stressful life event. With
that lens, a divorce, a relationship breakup, a job loss or redundancy and an empty nest are also grief
or loss. So, there are many types of losses, and one of the things they all have in common is the
capacity to disrupt your sleep.
How grief affects sleep
Sleep problems are thought to be the most reported bereavement-related symptom and it’s
because there is a bi-directional relationship between sleep and grief. Grief has been shown to
impact your sleep in the first 6-9 months after a bereavement. Your sleep can be impacted in a range
of different ways, and these include poorer global sleep quality ‘insomnia’ complaints, trouble falling
asleep, problems staying asleep or low sleep efficiency and shorter sleep duration. Studies show that
in normal grieving, people experience a shorter sleep duration and poor sleep quality however it
usually improves over time. However, if you are struggling with your grief, sleep disturbances can go
on for 9 months or more putting you at risk of developing Complicated Grief Disorder (CGD).
How poor sleep predicts complicated grief disorder (CGD)
Poor sleep can accompany grief and it can also be a risk factor for developing complicated grief after
a loss. So, if you have poor sleep prior to experiencing grief, it is probable that your sleep will
worsen, and you will likely experience complicated grief. Research shows people who experience
poor sleep have an exaggerated stress response and a better memory for remembering negative
experiences. Poor sleepers have also been linked to less effective emotion regulation and longer
periods in negative mood states which impacts their ability to cope with stressful events. The coping
ability of poor sleepers combined with stressful events makes poor sleepers vulnerable to
developing complicated grief disorders.
What is complicated grief disorder (CGD)?
Complicated Grief Disorder (CGD) is also known as prolonged grief disorder (PGD). Approximately
10% of people bereaved by natural causes develop CGD. CGD is characterised by a persistent
yearning for the deceased yet avoiding any reminders of them, a preoccupation with the pain from
the loss, feeling they have lost a part of themselves and experiencing feelings of bitterness, with
difficulty in accepting the loss. They struggle to engage in social or other activities and these
symptoms last longer than six months. In summary, complicated grief occurs when your grief
remains unresolved, and it significantly impacts your day-to-day experience.
Interestingly people suffering from CGD report dreaming with family members, both alive and
deceased, playing characters in their dreams, more so than non-CGD grievers.
Complicated grief occurs when your grief remains unresolved, and it significantly impacts your day-
to-day experience.
3 Risk factors for sleep disturbances while grieving
The three risk factors for sleep disturbances while grieving are age, gender and relationship to the
deceased.
1. Age
The older you are, the more likely you will experience sleep problems because of bereavement. This
is in line with the sleep disturbance data that shows sleep disturbances increase with age. Other
studies found some differences amongst grieving populations, i.e., greater sleep disturbances with
younger widows than older ones; adolescents who lose a parent experience more sleep disturbances
compared to an adult grieving a parent. Parents who grieve older children report more sleep
disturbances than parents who grieve younger ones.
2. Gender
Women report more sleep disturbances than men during childhood, adolescence, and adulthood.
This also reflects the gender differences with sleep problems. Importantly, one study reported
that unresolved grief following the loss of a child is associated with a higher risk for problems falling
and staying asleep in fathers, but not in mothers. This reflects the data that sleep apnea is more
prevalent in men across the lifespan.
3. Relationship to the deceased
Studies show that losing a parent at a young age is associated with an elevated risk for problems
falling asleep compared to losing a grandparent. In adults, the loss of a spouse or child is recognised
to lead to sleep problems. These findings are further illustrated by the research that shows 51% of
mothers, 8 weeks after the death of their newborn baby still suffer from severe disturbed sleep. Half
the parents who grieve a child from Sudden Infant Death Syndrome (SIDS) suffer sleep disturbances
for two years or more.
How to deal with sleep disturbances brought on by grief
The oldest and most well-known theory of grief comes from Elisabeth Kübler-Ross (1926 – 2004), a
Swiss American psychiatrist. She set out her theory of grief in her book, On Death and Dying, which
discusses five stages of grief. Those 5 stages are denial, anger, bargaining, depression, and
acceptance. While she describes the stages as linear, they are not. The model allows for a circular
experience of the stages and multiple stages occurring simultaneously.
The 5 stages of grief
Overcoming sleep disturbances during grief and loss
Sleep disturbances can occur at any time during your grieving process and there’s no hard and fast
rule with how long your sleep disturbance will prevail. In order to overcome sleep disturbances as a
result of grief and loss, it is recommended you deal with both simultaneously.
Research shows that interventions solely focused on grief and loss do not sufficiently reduce sleep
difficulties among bereaved people. This suggests additional interventions, like CBT-i are needed in
addition to grief interventions to target sleep difficulties. This is certainly true in my practice.
When clients visit me for grief and loss or sleep disturbances relating to grief and loss, I have found
working with both to be most effective. However, I have also found working with sleep
disturbance helpful in supporting the client to start processing their grief. A client who came to see
me early on in my sleep practice for grief-induced insomnia was able to sleep through the night after
not sleeping like that since before her adult daughter was diagnosed with cancer.
Similarly, a client who came to see me about her insomnia had unprocessed grief around a number
of events in her life. Working with both, she was able to acknowledge her anger and start processing
her grief and start sleeping well again.
If you are struggling to sleep well and you’re grieving book in a confidential call and we can discuss
what strategies you can use to overcome your sleep disruption and start grieving your loss.
