Grief and Sleep
At one point or another, virtually everyone encounters times of grief. It is a fundamental and universal emotional response. But the way that grief is experienced is full of nuance and individual variation.
The experience of grief can be profound and touch almost all aspects of our lives. As a result, it should come as no surprise that grief can affect sleep.
In this guide, we’ll analyze what grief is and how and why it can impact our sleep. We’ll also delve into how sleep influences grieving. For people dealing with grief, we provide tips for improving sleep and a list of resources to learn more about these complex topics.
What is Grief?
Stated simply, grief is an emotional reaction to loss, but the truth is that grief is far from simple. Every person experiences loss during their life and they can respond in particular ways. The most common ways that people experience grief are with sadness and emotional pain.
Even though grieving can be extremely individual, there are patterns of how it typically occurs. In the following sections, we’ll review the causes, symptoms, and stages of grief. We’ll discuss how long grief normally lasts and what separates normal grief from complicated grief.
What Are the Causes of Grief?
Loss of virtually any type can cause grief.
Bereavement is the term used to describe the time of mourning after the death of a family member or friend. Bereavement is one of the most well-known causes of grief. Grief may be more severe after a major loss, which is when a close loved one, such as a spouse, parent, or child passes away. The loss of a close companion, including a pet, can also induce bereavement and feelings of grief.
A person can feel grief from the loss of a person even if a person has not died. For example, being in a separate location or out of contact with a loved one may cause sadness. In addition, after the end of a relationship, a person may mourn the loss of that relationship or the loss of that person from their life.
Grief can occur when a person becomes ill. If someone has a terminal illness, they may mourn this loss of a healthy future. A person who becomes incapacitated or disabled may feel grief for the loss of their prior capabilities.
Major life changes can induce grief reactions. Moving to a new city, state, or country can cause grief. Job changes, including retirement, professional problems, changing jobs, or losing a job can provoke grief.
As this list demonstrates, there is no shortage of ways that we can feel a loss and subsequent grief. The diversity of causes is part of the reason why experiences of grief can be so distinct among people or even for the same person at different points in their life.
What Are the Symptoms of Grief?
Sadness is a frequent symptom of grief, and it may manifest in the form of crying or simply feeling emotional hurt. A grieving person may seem detached, dreary, and disoriented. Some people even have what is known as a hypnagogic hallucination in which, during moments of extreme drowsiness, they see or hear a person who has died.
All that said, remember that there is no simple summary of the symptoms of grief. Not all grieving people cry. They may not even appear sad at all.
Because of the diversity of grief reactions, people who study this topic have attempted to classify and better understand the ways that people are typically affected by loss. An outcome of these attempts is an understanding of grief as experienced in stages.
What Are the Stages of Grief?
Grief is commonly broken down into five stages: denial, anger, bargaining, depression, and acceptance.
- Denial may also be referred to as numbness or disbelief. During this phase, a person may block out the idea of their loss and try to stifle emotional reactions. Even though they may have been confronted with the truth, denial is a means of evading this reality.
- Anger is a frustration that manifests about loss. It can be an overall state of irritability or anger directed irrationally at others. In some cases, the anger, including that which is directed at oneself, may arise from a belief that the loss could have been prevented had someone acted or believed differently.
- Bargaining is a way of trying to cope with grief by making a “deal” to change the circumstances. For example, a person might think, “if only I am cured of this disease, I will start eating better and exercising.” Like anger, bargaining can be related to the idea, rational or not, that the outcome of loss was preventable.
- Depression is a significant sadness associated with the loss. This sadness can occur when a person is thinking about what they have lost or can be more generalized. Depression can be relatively minor and temporary, or it can become major depression, also known as clinical depression.
- Acceptance is the last stage and involves coming to terms with loss and identifying a path for moving forward despite the circumstances.
While these stages offer a useful way of understanding the elements of grief, they are not stages that a person necessarily goes through in a stepwise fashion. There is considerable fluidity in grief experiences, and people may oscillate between these stages. For this reason, some researchers emphasize that no stage theory can encapsulate how individuals grieve.
What Are the Health Risks of Grief?
Unfortunately, this process of grieving can have serious implications for a person’s well-being. In addition to the obvious impacts on mental health, grief can be detrimental to physical health. Grief can affect the immune system and hormonal function. In a study of people who had lost a spouse, researchers found that people who were still showing signs of traumatic grief 6 months later had elevated risks of high blood pressure, cardiac problems, cancer, and poor nutrition.
As someone experiences the range of emotions associated with loss, there may be effects on various parts of their life. Anger or sadness may affect relationships with friends and family. Feeling disconnected or depressed can pose a challenge for productivity and work obligations.
Taken together, the impacts of grief can be far-reaching and affect mental and physical health as well as a person’s social and professional life.
How Long Does Grief Last?
There is no standard timetable for how long grief lasts, and every individual may spend different amounts of time in various stages of grief. For many people, the most acute grief is experienced within the first two months. In general, “the emotional and cognitive stages of grief arise, peak, and dissipate within 6 months,” but milder feelings of grief frequently last for around a year.
Some people may rapidly appear to recover and show limited signs of loss. While this may give an impression that a person has already completed all of the stages of grieving, that may not be the full story. In some cases, it may be that they have simply repressed their feelings, which can lead to a “delayed and distorted” grief in the future.
What is Complicated Grief?
Complicated grief (CG) is when intense grief does not relent and a person has difficulty adapting to life after a loss. Complicated grief may also be referred to as traumatic grief, prolonged grief disorder, or persistent complex bereavement disorder. Estimates of the prevalence of complicated grief range from around 7% to up to 15% of people who suffer a significant loss.
Most of the negative effects of grief occur when a person has complicated grief. In this condition, a person may struggle with daily tasks and obligations. Habits of eating, sleeping, and exercising can change, and the use of drugs or alcohol may increase. Finding joy in pleasant things can be difficult, and relating to other people can become burdensome.
A person with complicated grief may try to avoid reminders of a lost loved one, or they might delve deeply into thoughts of that person, trying to maintain feelings of being close with them.
All of these elements can contribute to a sense of grief that is overpowering and precludes coming to terms with a future that does not include that which has been lost. This powerful and prolonged experience of grief separates complicated grief from “normal,” uncomplicated grief.
Complicated grief is more common among people who have a history of mood or anxiety disorders. It affects women more often than men. It is more likely when a loved one’s death is violent, unexpected, and/or affects a younger person.
How is Complicated Grief Diagnosed?
Health professionals use specific diagnostic criteria to determine if a person has complicated grief. Key determinants of this diagnosis include a “persistent and pervasive” grief response marked by “intense emotional pain.”
In some cases, complicated grief can be confused for depression. These two conditions can co-exist, but the key difference is that complicated grief involves continued longing for and thinking about a lost loved one as opposed to a more generalized sadness or lack of interest.
How is Complicated Grief Treated?
There are several avenues for treating complicated grief. One primary treatment is with psychotherapy, also known as talk therapy. A specific type of psychotherapy called complicated grief therapy (CGT) works to directly address the emotional reactions that are frequently associated with loss. It involves confronting the loss and identifying approaches for adapting to life after loss, and several studies have found that CGT can yield benefits for people suffering from complicated grief.
Support groups are another means of treating complicated grief, and they can often be utilized alongside CGT. These groups can boost a person’s social support while providing a context for facing, rather than repressing or avoiding, feelings of loss.
In some cases, medications, such as antidepressants, may be prescribed to treat complicated grief, especially if a person also suffers from depression, and may be used in conjunction with other treatments. Further research is necessary to better define the benefits, risks, and optimal role of medications in treating complicated grief.
What is the Relationship Between Grief and Sleep?
Grief can pose serious challenges for getting quality sleep. As a major life change accompanied by powerful emotions, it may interfere with normal sleep patterns. It can also provoke moods and feelings of anxiety that complicate the ability to fall asleep and stay asleep.
At the same time, sleep may have an effect on bereavement and grief because sleep-deprived people may be at higher risk of especially difficult or complicated grief.
How Does Grief Affect Sleep?
For the majority of people, suffering from grief makes it harder to get enough hours of quality sleep. Anecdotally, most people can tell you of experiences in which grieving made it harder to sleep at night. This effect has been confirmed in multiple research studies that have found sleeping problems to be common in diverse groups of grieving people.
Experts believe that there are two main ways that grief harms sleep. First, grief can disrupt regular habits and patterns around sleep. This is especially pronounced in late-life spousal bereavement (LLSB), which is the loss of a partner in older age. In this context, a person may have lost the person with whom they shared a bed for many years, making it so that going to bed amplifies their sense of absence and loss.
Second, grief can become a cause of major depression, and sleeping problems are among the most common symptoms of depression. Studies have found that of people who have lost a spouse, about 28% have major depression. Depression can cause people to sleep too little (insomnia) or too much (hypersomnia). People who already have a separate diagnosis of depression and have complicated grief tend to have even more pronounced sleep problems.
The feelings of sadness that are common with depression can make it harder to put the mind at ease and fall asleep. Similar feelings are common with grief, and studies have indicated that even if they do not rise to the level of diagnosable major depression, grieving and bereavement can still cause significantly impaired sleep. The more severe a person’s grief, the greater the risk appears to be to their sleep quality.
The influence of grief on sleep may be more pronounced in certain people. For example, people with bipolar disorder have been found in some research to be more prone to grief-related sleep disturbances. The effect can be to worsen symptoms of bipolar disorder, which may further exacerbate sleep problems.
How Does Sleep Affect Grief?
Though the underlying mechanisms are not completely understood, a lack of sleep may heighten the severity of a person’s grief response. Quality sleep may promote a more “normal” grieving process in which a person can, over time, effectively progress through the stages of grief and adapt their life to respond to loss. Other research studies have found that insomniacs suffer from more symptoms of complicated grief than non-insomniacs when facing bereavement circumstances.
Lack of sleep has been found in numerous epidemiological studies to be a risk factor for depression, and sleep is known to be directly connected to mood. As a result, this link between poor sleep and worsened grief response corresponds with the growing recognition of the importance of sleep in preventing and treating mental health problems.
How to Get Sleep When You Are Dealing With Grief
Research is increasingly pointing to a bidirectional relationship between grief and sleep and one that can be mutually reinforcing. This means that there are opportunities to focus on both aspects in order to improve overall wellness.
In this section, we’ll review some of the ways that people who are dealing with grief, whether it be acute or complicated grief, can try to improve their sleep.
Reach Out and Find Help
Because grief is normal, many people may feel it’s unnecessary to get help when they are dealing with loss. But we all need help sometimes, and it can go a long way to making things better. Help can come from many places, including from professionals, family, friends, and support groups.
Trained, professional help is especially important for people who are suffering from complicated grief, but people dealing with acute loss or whose grief may not be diagnosed as complicated can still benefit from working with a qualified doctor or counselor. In these cases, professional help may improve a person’s ability to understand and manage emotions to prevent complicated grief or major depression from occurring.
For some people, reducing the severity of grief symptoms may make it easier to get to sleep, but one study found that for many people, only focusing on grief symptoms was insufficient. Interventions focused on sleep were needed to help resolve sleep problems.
In this area as well, trained counselors can be of assistance. One type of talk therapy, known as cognitive behavioral therapy for insomnia, or CBT-I, is tailored specifically to address sleep disturbances and has proven results. It works to remove negative thoughts about sleep and to foster healthy habits to promote sleep. For people who may have a hard time with the logistics of frequent visits to a therapist for CBT-I, research indicates that online versions can also be beneficial.
Take Time to Improve Sleep Hygiene
Sleep experts almost universally agree that sleep hygiene is critical to resolving sleep disturbances and getting regular, quality sleep. This approach emphasizes that there are a variety of ways of preparing for sleep so that it’s faster and easier to get to bed each night.
Two critical aspects of sleep hygiene are the environment in which you sleep and your habits and routines related to sleep. People with grief who want to sleep better can take a number of steps to boost their sleep hygiene in these two areas.
The Sleep Environment: Setting the Stage for Sleep
Multiple environmental cues and factors influence how we sleep. Setting up your environment in the right way can facilitate both falling asleep and staying asleep, and the following section outlines some important components of your sleep environment.
- Ensure that your bed is comfortable and supportive: so much of your sleep relies on your bed. Start by choosing a high-quality mattress that fits your preferences for firmness and that provides cushioning for your pressure points. Keep your head and neck supported with a quality pillow.
- Select high-performance bedding: once you have a good mattress and pillow, turn your attention to your bedding. A set of nice sheets can help keep your bed cool, or a heated mattress pad can take away the winter chill. You can choose from several styles to pick a good comforter, or you can consider using a weighted blanket.
- Put down devices: electronic devices like cell phones, laptops, and tablets increase exposure to blue light that interferes with the body’s way of preparing for sleep. It’s best if you can not use these in bed and ideally not look at them for a half-hour or more before bedtime.
- Block out noise and light: distractions like sound and light can disrupt the process of falling asleep or can startle you awake during the night. For blocking noise, use a white noise machine or earplugs. For blocking light, use low-watt bulbs, install dark curtains over your windows, and/or sleep with an eye mask.
- Tend to your sense of smell: certain smells can encourage calmness, and essential oils can disseminate pleasant, relaxing smells.
- Set your bedroom thermostat: the ideal bedroom temperature is subjective, but most research points to the conclusion that a cooler bedroom offers the most benefits.
Building Strong Sleep Habits
In addition to your sleep environment, improving sleep hygiene requires thinking about your sleep-related routines. What works best for each person can vary, but these are some tips that are widely regarded as useful for creating healthy sleep habits.
- Keep a standard schedule: erratic timing for waking up and going to bed can wreak havoc on our internal clocks. Set a schedule for what time you will wake up and go to bed each day and stick with that schedule, even on weekends.
- Prepare yourself with a pre-bed plan: you can use your nightly routine to send cues to your mind and body that the time for sleep is approaching. Standardizing this routine, which can include things like brushing your teeth, stretching, employing relaxation strategies, showering, and having a sleepytime tea, can create consistency that promotes easier sleep.
- Learn relaxation techniques: there are a variety of ways to help calm the mind and put the body at ease. Many of these techniques are part of other therapies for improved emotional regulation. Relaxation techniques can include journaling, deep breathing, mindfulness meditation, listening to music, and progressive muscle relaxation to name a few. If you want tips for instilling calmness, check out the best smartphone apps for meditation.
- Limit alcohol use: alcohol may make you sleepy, but it can disturb sleep and can lead to alcohol dependence. Try to decrease or fully eliminate alcohol intake, especially close to bedtime.
- Limit caffeine and choose food wisely: caffeine is a stimulant that can keep you wired for hours. It’s best if you can avoid having caffeine late in the day. It can be helpful as well to avoid foods that may disrupt sleep such as very fatty or spicy foods.
- Restrict the use of your bed: if you have a comfortable bed, it’s natural to want to spend time there when eating, watching TV, or playing games on your phone. But experts advise against this; instead, your bed should be used only for sleeping and sex. In your mind, this helps associate going to bed with actually falling asleep.
- Don’t toss and turn: if you find that you can’t fall asleep, don’t stay in bed stewing on the problem. This just creates frustration and negative associations with being in bed. Most experts recommend getting up after 20 minutes of not falling asleep and doing something else calming -- like reading or relaxation techniques -- before trying to get back to sleep again.
- Get frequent exercise: studies demonstrate that getting regular exercise can improve sleep, but just be sure to avoid extremely vigorous workouts in the hour or so before bedtime.
Learn More About Grief and Sleep
- National Suicide Prevention Lifeline (1-800-273-8255). This is a completely free and confidential program to provide immediate help to people who are considering suicide or dealing with extreme sadness. Trained professionals are available 24 hours a day, 7 days a week, and 365 days a year. Online chat service is also available.
- Open to Hope. Open to Hope is a collaborative website where people can share personal stories around loss. There are user-generated articles and opportunities to contribute your own story. Open to Hope also has a podcast available.
- What’s Your Grief? This page, run by long-term mental health professionals, provides free articles about grief as well as more in-depth webinars and e-courses for purchase.
- National Widowers’ Association. This group, focused specifically on men who have lost a loved one, tries to correct the tendency of men to suffer alone. Resources include articles, videos, and support groups.
- The National Alliance for Grieving Children (NAGC). NAGC’s mission includes offering education, raising awareness, and advocating on behalf of children who are dealing with grief. Extensive resources are available through the organization’s website.
- The Compassionate Friends. This organization was founded with the mission to provide support to the loved ones of children who have died. There are over 600 chapters nationwide, and the group also offers considerable information on their website.
- Connecting Our Paths Eternally (COPE) Foundation. COPE’s emphasis is specifically on helping with the process of grieving the loss of a child. The organization has programs for parents and siblings including a support summer camp for children between 6 and 17.
- Tragedy Assistance Program for Survivors (TAPS). TAPS is a non-profit that works to provide care and support for those who have lost a loved one who was in the military. A 24-hour helpline -- 1-800-959-TAPS (8277) -- can connect survivors to resources. Other programs include peer mentorship, support groups, retreats, and more.
- Friends For Survival. This group focuses on helping bereaved people who have lost a loved one to suicide. They have a toll-free helpline (1-800-646-7322), support group meetings, and a resource library to provide compassionate assistance.
- Association for Pet Loss and Bereavement (APLB). Not all grief and bereavement comes from the loss of a person. The APLB has an array of programs, including support groups, training programs, and a regular newsletter to help people who are mourning the loss of a pet.
Other Grief Resources
- The Center for Complicated Grief. This organization, affiliated with Columbia University School of Social Work in New York, provides resources for the public and health professionals about grief. They conduct research and offer information about evidence-based ways to help assess and treat complicated grief.
- The American Society of Clinical Oncology (ASCO): Understanding Grief Within a Cultural Context. How people grieve can be shaped by their upbringing and culture. This article from ASCO reviews some of the elements of how culture influences grief and how to be culturally sensitive when interacting with those who are grieving.
- The American Hospice Foundation: The Bereaved Employee -- Returning to Work. This practical article gives tips for grieving people on how to prepare for a return to work after suffering a personal loss.
- “When to Treat Grief and Bereavement.” In this video, Sidney Zisook, M.D., Ph.D., and Professor at the University of California San Diego, reviews basic information about grief and covers when people may be helped by treatment focusing specifically on grief.
- “Complicated Grief: Q & A with Dr. M. Katherine Shear.” This video from the Center for Complicated Grief discusses what separates complicated grief from normal grief and other frequently asked questions about complicated grief.
- The U.S. National Institutes of Health (NIH): Coping With Grief - Life After Loss. This article gives an overview of how we can be affected by grief and how to try to cope after the loss of a loved one.
- Harvard University: Sleep Health and Education. For background information about the biology of sleep and how to sleep better, check out this page from Harvard’s Sleep Medicine program.
- The National Sleep Foundation (NSF). You can access a collection of articles about sleep and sleep disorders from the website of this national organization.
Cognitive Behavioral Therapy for Insomnia
- Psychology Today: Cognitive Behavioral Treatment for Insomnia (CBT-I) Defined. In this article, Allison Siebern, Ph.D., a Stanford professor and sleep psychologist, introduces the core elements of CBT-I.