Grief is a universal response to anything that causes trauma with highly varied and unique responses. The grieving process is generally slow, takes time, and may look different for each individual. However, the majority of such people often complain of insomnia or sleep issues as one of the most common parts of the process. Since mental health and sleep share close ties, the painful toll of losing a loved one can wreak havoc on sleep, leading to issues that decrease the overall life quality.
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Understanding the relationship between grief and sleep can help minimize the consequential impacts and improve the overall quality of life.
Insomnia and Grief: The Effects on Sleep
Lack of sleep remains a common complaint in grieving individuals. People with more grief symptoms usually take much longer to fall asleep, spend a good portion of their time awake in bed instead of sleeping, and often wake up during nighttime. They also find it challenging to go back to sleep after waking up at night. All these issues are somehow tied to their underlying grief; for instance, some may struggle to fall asleep due to the thoughts of their lost loved ones, while others may wake up at midnight following a dream about the deceased.
Studies investigating individuals with poor sleep often use the Pittsburgh Sleep Quality Index or PSQI to assess the quality of their sleep.  To use this scale, participants use a self-administered questionnaire and score between 0 and 21 based on their answers. The lower the numbers on the scale, the better the sleep quality. In general, a PGSI score of 5 or above indicates poor sleep, and individuals with grief have been found to get more than double the score, i.e., 9.44 on average.
The Bidirectional Relationship
While poor sleep quality is not a diagnostic indicator of complicated grief, its presence heightens the risk of developing it. Multiple studies have suggested that sleep disturbances often co-occur with grief and that both issues share a bidirectional relationship. Up to 91 percent of people with complicated grief develop sleep issues, with 46 percent facing issues with sleep due to their grief at least thrice a week. At the same time, people with sleep struggles during bereavement, including trouble falling asleep, shorter sleep cycles, or frequent awakenings during nighttime, are more likely to acquire complicated grief.
In simpler words, grief not only interrupts sleep, but poor sleep can also make the grieving process more difficult. For instance, a study focusing on bereaved college students concluded that those with a loss had a higher prevalence of insomnia than their peers with no grief history.  More than one out of five such individuals experienced insomnia compared to one out of six of those with no grief. Among the grieving participants, those with insomnia had more intense symptoms of grief than those with no sleep disruptions.
Spousal Bereavement and Sleep
Studies suggest that more than 800,000 senior citizens in America lose their partner every year. Such individuals often experience poor sleep quality, whose severity is directly proportional to their sleep quality. Losing a partner is remarkably impactful on sleep as a widow or widower has been sharing their bed with their loved one for years. When their partner departs, everything about sleep, such as bedtime routines and the bedroom, may feel empty, different, or less safe. Consequently, the body finds it difficult to fall asleep or maintain it.
Losing a partner later in life also comes with additional risks, such as the risk of medication use and placement in a nursing home. Women who lose their spouse are up to two times more likely to consume hypnotics to cope with sleep issues. When someone going through bereavement due to the death of a spouse develops complicated grief, their risk of getting high blood pressure or cancer during the next two years greatly surges.
Remember that poor sleep is strongly associated with poorer health outcomes regardless of age. For older adults, however, it can double the risk of mortality.
Comorbidities & Sleep
Approximately one in four people who lose a loved one develop significant depression, which may persist for up to two years following the incident. Such people often develop complicated grief while battling comorbid depression and are at a heightened risk of experiencing poorer sleep quality as both psychiatric issues independently predict it. Grief is also associated with changes in physical health, which further exacerbates sleep issues and intensifies the overall grieving process. For instance, up to half of those individuals experiencing grief lose their appetite during the process.  Being in a poor physical state can also heighten the risk of developing complicated grief and consequent depression, which further exacerbates sleep issues.
Due to stress following the loss of a loved one, some people may develop increased levels of inflammation in the body than non-bereaved individuals. Such inflammation can put them at an increased risk of developing cardiovascular diseases. Stress due to grief can also cause drastic changes in a lifestyle, such as the loss of safety or financial security, which further disrupts the quality of sleep. It is also common for grieving individuals to exercise less and isolate themselves from social activities, both of which are not good for their sleep quality. A sedentary lifestyle that most people adopt during grief is also a predictor of poor sleep.
Grief and Sleep Issues: What Treatment Can Include
Poor sleep can significantly worsen the outcomes for a person with grief. On the other hand, getting good sleep can help them get through the grieving process quickly and successfully. Handling both issues together is imperative, and various approaches can be adopted.
Therapeutic Treatments Targeting Grief
As grief lies at the center of all sleep-related issues, addressing it can be an excellent way to manage the consequent insomnia. Treatments for grief can include a mix of medication and psychotherapy. Many people going through grief and trauma benefit from hypnotic medicines to manage their mood and sleep. However, this approach may be riskier in older adults as it can put them at significant risk of falls and injury.
Antidepressants are another type of medication commonly prescribed to manage grief, particularly in combination with specific therapies like complication grief therapy (CGT).  As a part of CGT, a therapist applies particular procedures to help individuals regulate their grief-related emotions. People who undertake CGT, in addition to using an antidepressant, have been found to experience better sleep than those relying on the latter alone. Some studies suggest this combination can reduce the percentage of people struggling with sleep due to trauma from 49% to 15%.
In terms of therapy, both interpersonal psychotherapy and cognitive behavioral therapy have been indicated to relieve symptoms of grief. However, the resolution of grief due to these therapies may not always resolve the underlying sleep issues. Some studies suggest that more than 50 percent of people receiving one or more of these psychotherapies may still complain of more sleep issues than an average person. Hence, to tackle both problems together, experts often recommend additional treatments, such as cognitive behavioral therapy that explicitly targets insomnia.
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy has been an important treatment modality to manage mood and behaviors for a long time. However, one of its subtypes, known as cognitive behavioral therapy for insomnia or CBT-I, has been emerging as a potential treatment to address sleep-related issues due to emotional disturbances. CBT-I involves up to eight weeks of sessions, each lasting 60 minutes. Each session takes place under the supervision of a trained therapist and allows patients to unpack and unload their unhealthy behaviors and thoughts around sleep while replacing them with newer, healthier ones. As a part of this psychotherapy, patients also learn how to adopt better sleep hygiene habits, such as the following:
- Exercising daily
- Avoiding caffeine and alcohol past early afternoon
- Limiting naptimes during the day
- Avoiding the use of electronics at least 60 minutes before bed
- Keeping the bedroom cool, dark, and quiet
CBT-I revolves around two important aspects, including sleep restriction and stimulus control. These aspects have proven to be particularly effective for grief and sleep issues.
- Stimulus control: This aspect of CBT-I focuses on helping a person associate their bedroom with relaxation and sleep only. Experts teach their clients to use bedrooms for sleeping only and to leave immediately if they cannot fall asleep within 10 minutes of lying down.
- Sleep restriction: This technique includes maintaining a strict daily sleep schedule based on how much time a person sleeps. For instance, a person who gets six hours of sleep must only stay in bed for 6.5 hours. This technique helps reinforce the idea that the bed is only a place to sleep while adjusting the body to a consistent sleep schedule.
Grieving often takes a lot of time to get through, but there is always help available. If your grief and sleep issues are getting worse, consider talking to a doctor to get more tailored advice.
Can grief cause insomnia or sleeplessness?
Grief can be complicated, but it is a normal process that an individual develops after going through some kind of loss such as grief. Different people may respond to grief differently, such as through sadness, anxiety, denial, shock, and insomnia. While insomnia can have multiple causes, grief can often trigger it due to the stress it brings along.
How long does grief insomnia last?
Insomnia secondary to grief may last for a variable time, from a few days to multiple weeks. In some cases, victims of grief may develop chronic insomnia once they start struggling to get sleep for three nights per week for three consecutive months.
How does grief impact sleep?
Grief and sleep have multiple associations, depending on how a person responds to the former. Understanding the source of grief can help a person decide on a management plan. Following are some reasons that accompany grief and can contribute to sleeplessness:
- Intrusive images, particularly associated with traumatic grief
- Mental rumination or excessive worry
- Biological response to grief due to severed physical attachment
- Getting frequent reminders, such as an empty bed after the death of a loved one
- Loneliness following bereavement
- Yearning for someone you lost
- Wake-time coping behaviors, such as excessive use of caffeine or alcohol
Why is grief worse at night?
Nighttime is typically associated with gloom and darkness, which can trigger memories and exacerbate feelings of grief. Moreover, there are fewer distractions as a day passes by, giving a person enough time to keep thinking and ruminating about their traumatic experiences.
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2 Hardison HG, Neimeyer RA, Lichstein KL. Insomnia and complicated grief symptoms in bereaved college students. Behavioral sleep medicine. 2005 May 1;3(2):99-111.
3 Utz RL, Caserta M, Lund D. Grief, depressive symptoms, and physical health among recently bereaved spouses. The Gerontologist. 2012 Aug 1;52(4):460-71.
4 Wetherell JL. Complicated grief therapy as a new treatment approach. Dialogues in clinical neuroscience. 2012 Jun 30;14(2):159-66.