Rest Interrupted: Sleep Sabotage, Intimate Partner Violence, and Health

Sleep is essential for our physical health, mental wellbeing, and ability to navigate daily life. Yet for some survivors of intimate partner violence, sleep becomes another tool of control. In this episode of Seeding Safety, we explore the emerging research on sleep and IPV, including sleep sabotage as a form of coercive control. Our guest, Dr. Karen Jakubowski, discusses how abusive partners may intentionally disrupt sleep, the impact chronic sleep deprivation can have on health and safety, and why this often-overlooked form of abuse deserves greater attention. We also examine what healthcare providers, advocates, and support systems can do to recognize sleep-related abuse and better support survivors on their path toward healing and safety. 

Trauma history and persistent poor objective and subjective sleep quality among midlife women

Acknowledgment: This podcast was made possible by Grant Number 90EV0529 from the Administration for Children and Families, Office of Family Violence Prevention and Services, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services.

Transcript

SPEAKER_00 0:05

Welcome to Seating Safety, a podcast on cultivating conditions for health, healing, and violence prevention from futures without violence. I'm your host, Kate VanderTeig. And on today's episode of Seating Safety, we are going to be discussing sleep coercion and sabotage as a form of abuse with Dr. Karen Jakobowski, who is a sleep and IPV researcher at the University of Pittsburgh. So welcome, Karen. It is so nice to have you here on Seating Safety today. I would love if you could start by just introducing yourself and briefly sharing a little bit about your work and how you came to focus on sleep and intimate partner violence.

SPEAKER_01 0:56

I'm super excited to be here, Kate. So thanks so much for having me. So I am a clinical psychologist by training and a faculty member in the Department of Psychiatry at the University of Pittsburgh. And throughout, how did I come to this work? When I was in my graduate training, I was doing a lot of work then on child male treatment and childhood adversity and sleep. And during that time, I was given a chance to volunteer at an amazing domestic violence shelter in Pittsburgh, women's center and shelter. And when I was volunteering, I was helping them do some sort of like program evaluation and started to realize as somebody who's interested in sleep, there wasn't a lot of good research or just not a lot of research out there at the time on sleep and cardiovascular health. And so when I sort of started my fellowship after getting my degree and my faculty position, that's when I really started digging into doing more research on IPV and cardiovascular disease. And since then, that's like changed the trajectory of my career. It's been amazing.

SPEAKER_00 2:15

Awesome. That's very cool to hear how it came about so organically and really from the needs of survivors. Yeah. And before we kind of dive into that intersection of sleep and violence and experiences of violence, I kind of want to take um maybe set the stage or look at the bigger picture of just the impact that sleep has on our health. Can you talk a little bit about that? Just the importance of sleep and the impacts it can have on health.

SPEAKER_01 2:48

Definitely. Sleep, you know, it's something that obviously has a very emotionally laden thing for think for people sometimes when we think about sleep. But it is vastly important to everything to we know now. And there's still, I mean, there's active research going on for all of these things. But if we don't sleep good, it's related to our physical health, it's related to our mental health. And even just thinking about when I say when we don't sleep good, sleep is like a multi-dimensional thing. So it's not only just how long you sleep, but also are you waking up during the night, the timing of when you go to bed and wake up, how do you feel about your sleep? Do you feel rested? Is it disrupted? Um, so there's all each of those sort of components of sleep, many of them have been related to things like cardiovascular disease, heart attacks, strokes, dementia, and cognitive health. Um, and obviously there's a huge amount of research that's been done on sleep and different mental health disorders like depression, anxiety, PTSD, you know, substance use, and a whole bunch of other things. So I could go on and on and like on that, and I'm happy to. Um, but it's there's sort of, I think, no end to the things that we keep finding that sleep is important for.

SPEAKER_00 4:21

That makes a lot of sense. I know for myself, you know, if I don't get good sleep, that definitely impacts my mental health. And then fight it's kind of a vicious cycle where if my mental health, I'm feeling really anxious, it's very hard for me to sleep. And so it's just kind of uh um play in with each other. Um, so kind of thinking more closely on the intersection, um how does, you know, getting good sleep impact healing? Um, or maybe the flip side of that would be kind of how for people who have survived violence and trauma, could they be impacted if they're not getting good sleep? How, you know, kind of how does chronic sleep deprivation or disturbance? Um, you know, what does that do to brain health, um, physical health, decision making, ability to stay safe? How is this impacting survivors on the day-to-day?

SPEAKER_01 5:27

Sleep definitely impacts all the things that you described. And it is, there is sort of like a two-way street, which you alluded to, where I think survivors who have experienced um different forms of trauma or violence that impacts their sleep. So maybe um for some individuals who maybe have post-traumatic stress disorder, they may be more vigilant. Um, sleep might not feel safe to them. There might be sort of different thoughts or feelings they have around just what it feels like to go to sleep. You know, there's obviously that link of safety with sleep. You sort of inherently have to be vulnerable to sort of shut down in a sense. Um and I think for survivors who have experienced trauma, whether it's during their sleep or just at other times, sleep can feel scary and not safe. And it can be very disrupted. And I think that intersects with people who um maybe feel like they have to protect themselves or others during that time. And then I think on the other side, we know that survivors um in general just tend to have maybe a harder time sleeping. So when they do sleep, it just doesn't feel as restorative, or maybe they sleep at times that, you know, they their sleep is shifted in different ways. A lot of that work, to be honest, I think is still ongoing. There's, well, not to be honest, it definitely is still there's a lot more that we need to look at to see all the different ways that the sleep of survivors is impacted. But we know if we don't sleep well, it's hard to focus our sort of memory or ability to sort of like put pieces of information together to regulate our emotions, all of those things are impacted. Sleep is also, you know, a period where our bodies are healing physically. And so I think when you put all of those things together, sleep is both driving, I think, some difficulties in terms of like physical and maybe emotional healing that survivors might have. And also there's just a lot of aspects of sleep that are hard for survivors to do.

SPEAKER_00 8:06

That makes a lot of sense. And I'm also, you know, kind of going off of what you were just saying, I'm also thinking about even beyond the immediate mental and physical health impacts of not giving good sleep and making healing harder. I'm also thinking about how not getting good sleep or adequate sleep would really potentially impact a survivor's financial well-being. It makes it harder to show up for work or school or be able to study, or, you know, maybe it makes it harder to take care of your kids in the way that you want to, things like that. I don't know if if that's something your work is is addressing.

SPEAKER_01 8:51

Absolutely. We've heard that a lot from survivors that sort of they've had to deprioritize their sleep, whether it's because an abusive partner told them their sleep didn't matter, or did not give them the space or the time to have good restful sleep. And then if that intersects with whether it's caregiving and there's just necessary demands that people have to do, or you know, employment, school, um, there's a lot of areas where I think people are just like, well, I just need to push through. And my sleep just keeps getting, you know, deprioritized and deprioritized. And at some point, like all of those things, it we can feel pretty bad physically and mentally, if we're just chronically getting insufficient sleep for all of those reasons.

SPEAKER_00 9:48

Yeah, that makes a lot of sense. And I, you know, I hadn't really, you know, uh trained as a domestic violence advocate many years ago. And in my training, you know, we definitely talked about the health impacts of abuse and all of the different kinds of abuse that are on the power and control wheel. Um, and, you know, a part of that is reproductive coercion or um coercive control, things like that. But I never heard of or thought of um the impact of sleep so explicitly or heard of the term sleep coercion or sleep sabotage until I came across your work. Um, and so could you talk a little bit about how you're defining those terms? What does um sleep coercion or sleep sabotage look like? And how does that fit into the broader pattern of course of control that someone might be um experiencing from their partner?

SPEAKER_01 10:48

Yeah, so that's sort of the um, I think a main part of my research now. So I started to come to this idea of sleep being a behavior that could be controlled, manipulated, um, abused, is something when I was putting together measures for another study I was doing on IPV and cardiovascular health. And I was making sure I was getting all the best measures that we have out there on physical abuse, emotional, coercive control, reproductive coercion. Um and because sleep is of interest to me as a clinician and research-wise, honestly, it just sort of struck me. I was like, sleep is a behavior that we, it's a biological need. It's something we have to do every day. You sort of can't opt out of sleep like you can, maybe certain other behaviors. And it's something that's so tightly linked to safety, to rituals, to routines. Yeah. Is this also something that could be controlled? And I've been doing some reading at the time on coercive control, and I think it just sort of struck me like, hmm, I'm not reading anything about sleep. I asked colleagues of mine who've been in the IPV research and advocacy field for a long time. And they were like, you know, we've heard of this from survivors, but we don't know that anybody's put a term to it. And we definitely don't think anybody has researched this. And when I started to look into the literature, I realized there was really no measure, no definition of it. Um, and so that struck me as a huge gap, as something that like advocates were saying, oh, definitely survivors tell us this is happening, but we also don't really know the best way to help them with it, to describe it. So we got some pilot funding and basically interviewed um across two different studies, over 40 survivors who all had a history of different types of IPV, but we didn't tell them that we were necessarily interested in their sleep. And then we started asking them about their sleep, using basically items from like a good clinical sleep interview. Tell us about your sleep. Has an abusive partner ever controlled your sleep, chosen when, where, and how you slept, purposefully abused or intentionally disrupted your sleep, monitored it. And we just started to hear these stories of this happening. And what we're still parsing through, I think to maybe loop back to your question, is sort of how much this um control around sleep and abuse overlaps with other forms of abuse that, like you said, economic um, you know, coercion or control, sexual abuse. What we think and what we're what I think is that there's a part of this that sort of overlaps with some of the types of abuse that we know widely are happening. And then there's some of this that really is specific to sleep, and that's intentionally done because sleep is something that has to happen and that involves this sense of safety and um sort of vulnerability. So we're still trying to see where those things overlap and where they separate. Um and I guess maybe to answer the other question that you had, it's interesting in the in terms of how we've been calling it. We initially started calling it sleep coercion, just sort of based out of all of the amazing work that was done around reproductive coercion, you know, control over somebody's behaviors and decisions and um abuse around that. In some of my research that we're doing now, when we've asked survivors, does this term sort of cover the range of experiences that you've had around your sleep? And we've gotten a lot of thoughts on that. And I think I think we're still deciding what exactly we want to sort of use to call this. But I think a lot of people um have shared that they feel like abuse should be part of the free because it the word coercion maybe doesn't fully cover the actual overt violence and abuse that can happen during this. So we're um we're still thinking on that and talking with people about that.

SPEAKER_00 15:40

Fascinating. Yeah. So kind of what I'm hearing from you is that there's two kind of different ways that people are experiencing abuse related to sleep. One is this less overt, less explicit, you know, the daily experience of walking on eggshells of being in an abusive relationship can be very disruptive to sleep even if nothing is happening between the hours of you know, 11 p.m. and 7 a.m. Um and also you're hearing from survivors that um their partners are taking explicit actions to um ruin their sleep or uh interfere in their sleep or sabotage their sleep um or do things that um, you know, make it so they can't sleep safely or for long enough. Um and so I kind of see it as this like indirect way that sleep is impacted by abuse, and then very direct, overt ways that partners may be um impacting someone's sleep. Um, and you kind of started to talk a little bit about your research projects that are um that you're engaged in around this intersection. Would love to hear more about those um and kind of what are some initial learnings you're seeing and maybe what are some directions you're exploring next.

SPEAKER_01 17:19

Yeah, so we um we have a couple of things going and a couple of things planned. And I think right now, to your point, we found in this initial series of like 41 um interviews that we did, there are like two sort of buckets. There's like the abusive, coercive behaviors and the impact of a lot of women describing fear, vigilance around sleep, sleep not feeling safe, not wanting to sleep. And that sort of led us to really want to understand both sides, both what's the behavior that's happening and what's the impact on sleep. And and so we have some work going to um we've done some focus groups, both with survivors and also with sleep clinicians, IPv advocates, other folks who are sort of knowledgeable on like the sleep and trauma practice and research area. And everybody has sort of universally described there's a need to understand this. I've seen this in various ways in my practice, but what I know from my work is our best sleep measures don't really address this type of like trauma that specifically weaponizes sleep. And our best like trauma or PTSD measures look at, you know, maybe disruptions to sleep, hypervigilance, um, different types of you know, interpersonal violence, but not specific to sleep, not trauma that we would say specifically occurred because somebody was sleeping or to impact someone's sleep. And so we realize that if you if we don't have a good measure of sleep coercion, sleep sabotage, sleep abuse, I think clinicians, researchers don't have a good language and even a good sense of how common this is. So, our our goal right now, we have a um a funded project to develop a patient-reported or survivor-reported measure of sleep coercion. So, in the same way that there's a lot of excellent, you know, self-report surveys on there on physical violence, sexual violence, this would sort of we hope, be another measure that clinicians, shelters, you know, advocates, researchers would use along with those other established measures of violence, sort of. And so we're hoping to make and really validate a good measure of sleep um coercion, sleep abuse, and then look at how common it is, because I think at least in the the work that we've done, all of the women that we interviewed described at least one type of sleep coercion. And it ranges. Some described overt deprivation, straight-up deprivation. Some women described, you know, and not to sort of um say that there's, you know, a hierarchy of these things, but some women describe more control over their routines, when they were able to sleep, where, how. Um, some women describe not being able to use an alarm clock to wake up in the morning. Um, and what we want to do is really give this sort of survey when we make it to a much broader group of people, even people who say that they don't have a history of intimate partner violence, because we're also wondering if there are some folks who don't necessarily identify their experiences with physical, sexual, other types of violence, but do have a history of this.

SPEAKER_00 21:21

Um I think we definitely found that in the research around reproductive coercion, where people would say, Oh, I've I'm not a, you know, I've never experienced intimate partner violence, but my partner does throw away my birth control. Yes.

SPEAKER_01 21:33

Yes. And until we give that sort of language to it, we've found in our studies that women have said, I never thought of my sleep, and I never actually realized the intersection of violence with my sleep until I was asked to put those things together. So I think there's like a really important piece of just making this known so that people can help have language. to to to really reflect on the experiences they've had.

SPEAKER_00 22:04

Absolutely. Yeah. Wow, that's very um that's gonna be really important to have. Thank you. Thank you. Um yeah, I feel like this is very this is a learning edge for for our field for sure. Um even though I'm sure we can all as advocates or healthcare workers point to uh an instance with a client or a patient where you know sleep has been a huge a huge issue for them. Um and as you were talking I was starting to think about um you know times in life where sleep is hard um because of the life the season of life you're in and I'm thinking particularly for pregnant birthing and parenting survivors just having to deal with the overlap of you know inherently having very disrupted sleep because you have a new infant and on top of that um potentially experiencing coercion and abuse and sabotage to your sleep um just how um harmful of the impact that might be for not just the individual survivor but also you know their kids their family. And I'm curious in in your research have you heard folks talk about that um or if you're if you're doing any thinking around that intersection?

SPEAKER_01 23:38

Both of those things we've definitely heard survivors talk about um while they were pregnant or maybe raising a newborn that sort of compounding or exacerbation of the sleep issues that you said that there's already sleep issues that we know happen to most individuals during those like reproductive transitions and then having even less control or perhaps violence or other impacts on their sleep how damaging that is especially during periods where people are already physically not feeling well maybe emotionally you know there's a lot that I think gets wrapped up in that we definitely plan to do more work um in those areas and there's some colleagues of mine where we hope to maybe take this construct, this idea that we're developing of sleep coercion, sleep abuse and talk more specifically with folks who are pregnant or postpartum to understand if there's anything that we're missing because we haven't specifically looked at it yet in those populations and there might be things about sleep coercion sleep abuse that are unique to those periods that we're not aware of yet. So we definitely want to ask about that and you know potentially have some other items or maybe even a more sensitive measure to understand those. Something that I another period of life that I've been really interested in my work is also menopause. And some of my research currently has looked at um intimate partner violence, not necessarily sleep coercion yet with women who are going through menopause or aging and that's another season of life where sleep totally totally already has tons of changes and and already there's not a lot of as much research as there should be on IPv and menopause. So I think that's a whole other period of a a whole other podcast.

SPEAKER_00 25:48

I know exactly happy to come back when we learn more but I think all of those stages it's sort of like the doors wide open to just better understand this throughout the life course yeah that um gosh wow yeah absolutely you're just making me think of you know better understanding all of these intersections for the purpose of what right um and I'm thinking about you know I referenced earlier training as a DV advocate now some like 15 plus years ago definitely you know and part of my job um as an advocate a few years after I trained was working in a shelter um where survivors come to sleep um and also you know working in uh more drop-in uh setting also on a hotline in schools and I'm just thinking about um you know ways that maybe domestic and sexual violence advocates could learn from your research in terms of not just how often um folks might be experiencing this form of abuse but what can we do as advocates as healthcare workers um to to kind of mitigate some of that harm and create opportunities for safer sleep or provide strategies to survivors um offer them strategies to to achieve safer and better sleep you know just kind of safety planning around sleep.

SPEAKER_01 27:29

Yeah I'm curious if you've had initial um initial findings or just you know your own personal thoughts around that I think a lot of this is probably some of my personal thoughts that I hope to to do more on a a big sort of next step that I have is to try to develop an intervention that's specific to sleep for domestic violence survivors, whether it's sort of how other types of abuse impact sleep and also sleep sabotage and coercion I think there's sort of all things to be known there. Yeah and and it's been interesting because the majority of the work that we've done we when I think about this, you know, sleep is a period of vulnerability and for somebody who is actively in a dangerous situation you know we would never say just like just you know meditate and you'll be able to sleep better. Right. You know like all of the strategies that I think that we use in other contexts to sort of work on sleep just throw the rules out the window when the situation is so dangerous. And so I think when somebody um is actively in a dangerous situation what they need to do to sort of find times of sleep whether it's sleep napping, you know, finding periods of rest maybe in at other times then we would maybe say, you know, it's not the normal hours that other people sleep. That might be how somebody has to do that. I've been really interested you know in the intervention I'd want to develop one part of it I've thought of is really for folks who are in a safe housing situation who are in who are now out of that relationship how we can help their sleep and then another spin-off of that I think would be how could we develop strategies for people to use in shelter? We've had a lot of folks advocates at shelters ask us what they could do. And they absolutely you know they've also said shelters are busy they can be noisy. Some people can feel unsafe just because it's an unfamiliar setting so there's I think tailoring that would have to be done just to give people sort of like you know acute catch up sleep in a sense you know like what what can we do to help you sleep while you're here even though we know this is not like a long-term solution. Um the big thing that I'm working on at least right now the intervention that I hope to develop is really taking the best of what we know from sleep interventions, trauma interventions, and sort of empowerment like what we know is already done in shelters because I the work I've done with other folks who don't have a history of of violence around sleep it's just different because they have a most people have a desire I can't sleep that makes me upset. How can I sleep?

SPEAKER_00 30:42

With survivors it can be sort of like I want to sleep I know I should sleep but I also feel unsafe when I sleep and so the And it may not be the priority it's like I'll sleep when I can deal with the situation I'm in the middle of and then I'll worry about my sleep. My gosh I can't even focus on that right now totally.

SPEAKER_01 31:02

And that's I think something that there's already not a good sleep provider like folks who are trained to do good psychological or behavioral sleep interventions. There's already not enough in general but then when you think of the folks who sort of understand the intersection with violence and there's even fewer so we need good strategies.

SPEAKER_00 31:21

Yeah I know I hope there will be many many more cheers to that yeah uh yeah I'm even just like you know um reflecting on my time doing direct service with survivors and just even thinking about some of the changes that would have been so easy to make I'm like you know I had a job working um in a DV drop-in you know drop-in advocacy uh setting and just like could we have made uh you know turned one of the break rooms into like a quiet resting space so that survivors could take a nap after their appointment um or thinking about in shelter just even normalizing kind of what you're saying even just having that conversation with survivors you know people come here and it can be really hard to sleep and if you're having a hard time sleep we have this quiet cozy room downstairs that has books and an iPad and a blanket if you if you're you know not feeling like sitting in your room or you know whatever it is um even the way shelters are set up I could see really impacting sleep if you're throwing all you know four family members into one room and hoping that you know good luck. I could see some structural changes there that would really um be important too. So it seems like you're kind of on the brink of really putting together um maybe strategies that advocates have already been adopting and some that are not even known yet and you'll you'll kind of be exploring and uncovering. So I think that's that's really exciting um given that this is kind of a a an intersection that hasn't been explicitly explored um thus far too much. So I think my final question to this very incredible conversation um is just you know thinking about our audience of healthcare workers and domestic and sexual violence advocates and other other helping people that survivors come into contact with what is one thing you would want listeners to take away hmm I think I would want people to take away just ask about sleep.

SPEAKER_01 33:51

And I've had folks be like well I don't know what to ask or you know it's it's its own area. What we found is when we ask people about their sleep they start talking about a lot and the women describe feeling so heard it was an area that a lot of healthcare providers don't often ask and maybe you know in in crisis settings there's so much going on it's something that I think a lot of people know is important but obviously there's sometimes like acute danger you know financial legal things that need to be addressed. And so even just the act of asking about it I think can be a tiny intervention in and of itself because people realize oh makes total sense it does matter. Like somebody cares and my goal is in the not too distant future we will have more things that can be implemented across a variety of settings to help people with sleep because if we found anything even folks who experienced violence decades prior and are now well out of the relationship still describe impacts on sleep. So there's sort of no bad time to ask and no bad way I think to ask.

SPEAKER_00 35:08

Totally well thank you so much Karen this has been an incredible conversation I'm so excited to follow along as you um kind of uncover learnings in your in your research projects and next steps. So really appreciate you coming on Seating Safety today.

SPEAKER_01 35:26

Thank you.

SPEAKER_00 35:27

It was such a joy to be here and I appreciate you having me you've been listening to Seating Safety for resources and information from the National Health Resource Center on domestic violence visit ipvhealth.org thanks for listening