To sleep or not to sleep, that is the question : A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma

Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.



  • Two-level meta-analysis based on aggregated and individual participant data.
  • Comparison of the effects of sleep vs. wakefulness on intrusions of analog trauma.
  • For those who experience intrusions after trauma, sleep predicts fewer intrusions.
  • No effect on the occurrence of any vs. no intrusions and intrusion distress.
  • Future studies need to critically examine the clinical significance of this effect.


Sarah K. Schäfer, Charina C. Lüder, Kate Porcheret, Xiaoqing Hu, Jürgen Margraf, Tanja Michael, Emily A. Holmes, Gabriela G. Werner, Ines Wilhelm, Marcella L. Woud, Shengzi Zeng, Edith Friesen, Shilat Haim-Nachum, Johanna Lass-Hennemann, Klaus Lieb, Angela M. Kunzler, Benedikt E. Wirth, M. Roxanne Sopp | 2023
In: Behaviour Research and Therapy ; ISSN: 1873-622X | 167 | august | 104359
Assessment, Intrusive Thoughts, Meta Analysis, Posttraumatic Stress Disorder, Psychotrauma, PTSD (en), Sleep Behavior, Sleep Disorders, Systematic Review, Traumatic memories