Mastering the Art of Good Sleep After a Burn Injury

Written by Sheera Lerman Zohar, PhD  on May 21, 2024

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Integrative Healing

Sleep is an essential biological state that allows our bodies and minds to rest and recharge. During sleep, important processes take place in multiple systems, including immune function, hormonal regulation, memory and learning, and physical restoration. Most adults require at least seven hours of sleep every night, and maintaining continuous and uninterrupted sleep is just as important as how long you sleep.

Quality of sleep is sensitive to changes in our health and psychological factors, such as stress. Not surprisingly, the stress of a burn injury can have a significant impact on sleep for survivors and their loved ones. Sleep disturbances—such as difficulty falling asleep, difficulty staying asleep, and nightmares—are extremely common after a burn injury. They can be present in the initial stages of recovery and persist for years after the injury. Symptoms of pain, itch, and anxiety, which many survivors experience, can be particularly detrimental to restful and refreshing sleep. Poor sleep for prolonged periods can have negative consequences for physical and emotional health and well-being, which can complicate the recovery from a burn injury.

Sleep and Anxiety

We’ve all experienced sleepless nights during stressful times of our lives. Even the best sleepers can have a hard time sleeping from time to time. When you experience stress or anxiety, it triggers the body’s stress or ‘fight or flight’ response, which is designed to keep us awake and alert. By definition, anxiety is incompatible with sleep. Stressful events, such as an upcoming surgery, a test, or an important presentation at work can lead to difficulty falling asleep. Unfortunately, worrying about how bad the next day will be because we didn’t get enough sleep can make it even harder to fall asleep. Instead, try telling yourself that it’s normal to have trouble sleeping sometimes. This can take the pressure off, reduce anxiety, and make it easier to fall asleep.

Sleep and Pain

Pain is an unfortunate reality for most burn survivors at some point during their injury or recovery. Sleep and pain can become a vicious cycle where one makes the other worse. Getting a good night’s sleep can help us feel less pain the next day and also provide the energy to utilize helpful coping skills to better manage pain.

Sleep and Itch

Itch is part of the natural wound healing process. It’s commonly experienced after a burn for weeks to years after the initial injury. Chronic itch can cause significant psychological distress and interfere with sleep at night.

Sleep and Nightmares

Nightmares are a form of sleep disruption frequently experienced after a traumatic event and can be one of the symptoms of posttraumatic stress disorder (PTSD). There are effective and evidence-based treatments for nightmare disorders, which include both medication as well as psychological interventions such as Imagery Rehearsal Therapy (IRT).

If pain, itch, or nightmares are interfering with your sleep, talk to your healthcare provider so they can help you find solutions to help improve your rest.


Fatigue during the day is commonly experienced after a burn injury, often caused by different medical conditions or medication side effects. Many burn survivors report feeling fatigued even after getting sufficient sleep at night, making it difficult to engage in important and meaningful activities such as rehabilitation, exercise, work, hobbies, and spending time with friends and family. The following strategies can help in managing fatigue:

  • Pace your day by breaking activities down into smaller parts and resting in between.

  • Conserve your energy. For example, sit down for activities when possible, like cooking and getting dressed.

  • Don’t overdo it, even on good days.

  • Allow yourself to rest by taking breaks and scheduling downtime before you become exhausted.

General tips for improving sleep

  • Use your bed only for sleep and intimacy. Keep all other activities outside your bed or bedroom.

  • Get in bed only when you are sleepy.

  • Don’t stay in bed unless you are asleep.

  • Create a consistent sleep schedule by waking up at the same time every day, seven days a week.

  • No clock watching. Remove the clock from your bedroom and set an alarm for the time you want to wake up.

  • Create a relaxing bedtime routine. Help your mind and body get ready for sleep by winding down before bed and using a nightly practice of relaxation strategies such as breathing meditation or guided imagery when you get in bed. This will help you feel more relaxed, give you something to focus on if you are having anxious thoughts, and help you fall asleep faster.

When to contact your healthcare provider?

  • The problem persists for more than three months

  • Poor sleep impacts your daytime function and quality of life

  • You wake up gasping for air or snore loudly at night

You deserve to get good and refreshing sleep. This is not a privilege, but something we should all prioritize to improve our overall health and well-being. There are many different treatments for sleep disorders, one of which is Cognitive Behavioral Therapy for Insomnia, an effective and evidence-based psychological intervention that is recommended as the first line of treatment. Achieving good sleep might require some initial effort to understand the combination of causes for your sleep difficulties, but the results will be well worth the effort.

Sweet dreams!

Dr. Sheera Lerman Zohar is a licensed clinical psychologist and director of the Burn Psychology Service at the Johns Hopkins Adult Burn Center in Baltimore, MD. She is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine. Dr. Lerman Zohar works with burn survivors in the continuum of care from their inpatient admission to the outpatient setting. She is passionate about helping patients alleviate their physical and emotional suffering and assisting individuals in coping with trauma, anxiety, changes to their appearance and function, grief, and loss. She also specializes in teaching patients non-pharmacological pain management strategies to assist with acute and chronic pain and in the treatment of sleep disorders such as insomnia and nightmares. Dr. Lerman Zohar has many scientific publications, and her current research focuses on the complex relationship between pain and sleep in relation to burn injuries.

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