Excessive Sleep or Escape?

The 30-Minute Problem

You meet with a case who comes to your sleep clinic reporting they sleep many many hours a day. They're exhausted despite all that sleep. In a 30-minute consultation, what do you hear? Sleep apnea? Narcolepsy? Idiopathic hypersomnia? What you might NOT hear - what often doesn't surface until later sessions - is this: "My partner was violent." "I was abused as a child." "My partner monitors everything I do." "I feel safe when I'm asleep."

Sleep as Solution, Not Symptom

As a Clinical Psychologist in a sleep disorders service, I've witnessed an interesting pattern: what presents as "excessive" sleep is often the body's adaptive response to trauma and emotional flooding.

Emotional flooding is when the nervous system becomes overwhelmed by intense emotions - rage, grief, terror - often rooted in trauma. When you've spent years (or decades) in hypervigilance, monitoring threats, managing others' feelings, surviving abuse - your nervous system might learn that sleep is the only escape. The only place where you're not responsible, not monitored, not in danger. Sleep becomes not excessive, but necessary. Not a disorder, but a solution.

The Risk of Mis-Pathologising

Here's where it gets complex: How do we differentiate between...

• Hypersomnia as a sleep disorder requiring medical intervention?

• Hypersomnia as an adaptive trauma response requiring psychological safety?

Both involve excessive sleep and fatigue. But the treatment pathways are entirely different.

One requires a medical intervention (e.g. a wake promoting medication). The other requires trauma-informed care and psychological support.

Ideas of Questions We're Not Always Asking

What if, alongside our standard sleep assessment, we might also ask:

• "Has sleep been your escape, or is this new?"

• "Do you have times in your life when you felt you couldn't rest? Maybe you were not allowed to rest? Scared to rest? Would it be ok to explore this a bit together?"

• "What happens emotionally in the hours before you need to sleep?"

• "Is there anyone or anything you're trying to get away from when you sleep?"

These aren't standard hypersomnia questions. They are trauma-informed questions. And they matter.

Why Psychology Must Be at the Table

I was a bit disappointed to see the recent 'Optimal Sleep Pathways' paper published by the British Sleep Society (Read et al., 2025) listed the following Consultant Neurologist, Consultant Respiratory Physician, Consultant Clinical Scientist, Consultant Respiratory and Physician, Consultant Physician, and lastly, Consultant Physician Sleep and Respiratory Failure; Consultant Clinical Psychologist did not feature among the authors. Sleep is multidisciplinary, yes. But psychology brings something essential: an understanding that symptoms often carry meaning beyond biology. That "excessive" is subjective. That what looks like pathology might be adaptation.

The Power Threat Meaning Framework (Johnstone et al., 2018) asks: "What has happened to you?" before asking "What's wrong with you?" In sleep medicine, we MUST do the same.

A Call for Trauma-Informed Sleep Care

I'm not suggesting we abandon medical investigation. Sleep apnea is real. Narcolepsy is real. Medication has its place. But I am suggesting we make space for this question in every assessment and that medics in the sleep field access trauma education, integrate it into their practice and ask questions such as :

"Is this person sleeping excessively because something is wrong with their sleep... or because sleep is the only thing keeping them safe from what's not going well in their life?"

Sometimes, the most therapeutic thing we can do is not prescribe - it's to witness, to validate, and to help someone understand that their body isn't broken. It's surviving.

I do appreciate that when the NHS only provides a 30 minute window for a triage team in an assessment it is not easy to bring these sensitive and big topics into the room. But their formulation must take into account the person's lived experiences.

On Trauma & Hypersomnia:

1. Kalantar-Hormozi, B., & Mohammadkhani, S. (2024). Reported history of childhood trauma, mentalizing deficits, and hypersomnia in adulthood: A mediational analysis in a nonclinical sample. Brain and Behavior, 14, e3363. https://doi.org/10.1002/brb3.3363

2. Babson, K. A., & Feldner, M. T. (2010). Temporal relations between sleep problems and both traumatic event exposure and PTSD: A critical review of the empirical literature. Journal of Anxiety Disorders, 24(1), 1-15.

On PTSD & Sleep Disturbances:

3. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 170(4), 372-382. https://doi.org/10.1176/appi.ajp.2012.12040432

4. Brownlow, J. A., McLean, C. P., & Gehrman, P. R. (2016). Sleep disturbances in posttraumatic stress disorder: Updated review and implications for treatment. Psychiatric Annals, 46(3), 173-176. (Available in PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC5068571/)

5. Vandekerckhove M, Wang YL. Emotion, emotion regulation and sleep: An intimate relationship. AIMS Neurosci. 2017 Dec 1;5(1):1-17. doi: 10.3934/Neuroscience.2018.1.1. PMID: 32341948; PMCID: PMC7181893.

On Traumatic Brain Injury & Sleep:

6. Mathias, J. L., & Alvaro, P. K. (2012). Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: A meta-analysis. Sleep Medicine, 13(7), 898-905.

7. Sandsmark, D. K., Elliott, J. E., & Lim, M. M. (2017). Sleep-wake disturbances after traumatic brain injury: Synthesis of human and animal studies. Sleep, 40(5). https://doi.org/10.1093/sleep/zsx044

On Dissociation & Sleep:

8. Schenck, C. H., & Mahowald, M. W. (2021). Sleep-related (psychogenic) dissociative disorders as parasomnias associated with a psychiatric disorder: Update on reported cases. Journal of Clinical Sleep Medicine, 17(5), 1047-1059. https://doi.org/10.5664/jcsm.9048

9. Watson, D. (2001). Dissociations of the night: Individual differences in sleep-related experiences and their relation to dissociation and schizotypy. Journal of Abnormal Psychology, 110(4), 526-535.

On the Freeze Response:

10. Roelofs, K. (2017). Freeze for action: Neurobiological mechanisms in animal and human freezing. Philosophical Transactions of the Royal Society B: Biological Sciences, 372(1718). https://doi.org/10.1098/rstb.2016.0206

11. Hagenaars, M. A., Roelofs, K., & Stins, J. F. (2014). Human freezing in response to affective films. Anxiety, Stress & Coping, 27(1), 27-37.

The Power Threat Meaning Framework:

12. Johnstone, L., & Boyle, M. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. British Psychological Society.

The Optimal Sleep Pathway

13. Read, N., Andersen, K.N., Craig, S., Kendrick, A., Quinell, T., Steier, J., and Hare, A. (2025). The Optimal Sleep Pathway: towards better care for patients with sleep conditions: a practical guide to improving the sleep pathway. British Sleep Society. https://www.sleepsociety.org.uk/wp-content/uploads/2025/02/Optimal-Sleep-Pathway.pdf