People with post-traumatic stress disorder (PTSD) may experience a range of symptoms, including nightmares and difficulty sleeping. Researchers have also identified a link between PTSD and certain sleep disorders.
PTSD is a psychiatric disorder that can develop after a person experiences or witnesses a traumatic event.
This article describes how PTSD can affect sleep, how sleep issues can, in turn, affect PTSD symptoms, and when to seek help.
According to the Department of Veterans Affairs (DVA), people with PTSD may experience difficulty falling asleep or staying asleep and may have overall sleep quality issues. Factors that can affect sleep quality in PTSD include:
- sleep avoidance due to a fear of reliving past trauma through complex dreams and nightmares
- heightened levels of arousal, which may cause someone to startle easily in response to loud noises or sudden movements
- nighttime restlessness due to sleep talking or increased limb movements during sleep
- leaving the television or radio on during the night to help drown out uncomfortable or distressing silence
Researchers have also identified a link between PTSD and sleep disorders. According to a
- insomnia
- nightmares
- periodic limb movement disorder (PLMD)
- dream enactment
- sleep paralysis, often with hallucinations
- obstructive sleep apnea (OSA)
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The review adds that sleep disturbances occurring before or shortly after trauma can increase a person’s risk of developing PTSD. It also states that sleep quality issues during therapy for PTSD can reduce the effectiveness of the therapy.
As the DVA explains, sleep disturbances can also cause symptoms similar to those of PTSD. As a result, sleep disturbances can worsen PTSD symptoms, such as:
- problems with thinking and concentration
- issues with learning and memory
- mood disturbances
- suicidal ideation or self-harm
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Sleep disturbances and substance use
According to the DVA, sleep disturbances can also increase the risk of substance misuse since people may turn to alcohol, cannabis, or other drugs to help them sleep.
However, using alcohol or drugs can worsen PTSD symptoms and put additional strain on aspects of life that people with PTSD may already find challenging, such as:
- relationships with family or friends
- maintaining a job
- completing school or college
The table below lists some of the
| Sleep disturbance | Approximate percentage of people with PTSD affected |
|---|---|
| insomnia | 70% |
| nightmares | 50% to 70% |
| PLMD | 33% |
| dream enactment behavior | 40% |
| OSA | 40% to 90% |
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Cognitive behavioral therapy for insomnia (CBT-I)
CBT-I combines traditional CBT with the following therapeutic components to target specific sleep issues:
- education about sleep and sleep hygiene
- relaxation training
- behavioral interventions, such as restricting the amount of time spent in bed while not sleeping
People with PTSD may require additional therapy to overcome fears surrounding sleep or the sleep environment.
Image rehearsal therapy for nightmares
Imagery rehearsal therapy is a visualization technique that may help reduce the intensity and frequency of nightmares in people with PTSD.
This technique involves rescripting the nightmare to create a more positive ending and rehearsing the ending in the mind.
Treatments for obstructive sleep apnea
Treatments for OSA include continuous positive airway pressure (CPAP) and mandibular repositioning appliances. These treatments keep the upper airway open during sleep, helping reduce episodes of OSA.
The
Additional tips
People with PTSD may find that
- sleeping with a photograph of a loved one next to the bed
- sleeping in a dimly lit room
- playing low-level background noise, such as soothing music or white noise
- using a weighted blanket, except in the case of OSA
If the above measures do not help, a doctor may prescribe off-label treatments, including medications, such as alpha1-receptor antagonists, or sedating antidepressants and antipsychotics.
People need to contact a doctor if they experience PTSD symptoms following a traumatic event, especially if these symptoms last longer than
There are four categories of PTSD symptoms:
| Re-experiencing symptoms | • flashbacks, in which the person relives the traumatic event • recurring thoughts, memories, or dreams of the traumatic event • physical signs of stress, such as headaches or muscle tension |
|---|---|
| Avoidance symptoms | • avoiding places, events, or objects that remind a person of the traumatic event • avoiding thoughts or feelings associated with the traumatic event |
| Arousal and reactivity symptoms | • startling easily • feeling tense or on edge • irritability or aggressive outbursts • dangerous or destructive behavior • difficulty concentrating or sleeping |
| Cognition and mood symptoms | • difficulty remembering key aspects of the traumatic event • exaggerated feelings of blame toward oneself or others • negative thoughts or ongoing negative emotions • feelings of social isolation |
A doctor can refer someone to a licensed mental health professional, such as a psychologist or psychiatrist with experience treating PTSD.
Many people with post-traumatic stress disorder (PTSD) experience sleep disturbances. These may stem from hyper-arousal, nighttime restlessness, or a fear of reliving past trauma through flashbacks and nightmares.
Sleep disturbances can affect a person’s ability to process traumatic events, and this can worsen PTSD symptoms. Treatments, such as cognitive behavioral therapy (CBT) and image reversal therapy, can help promote sleep in people with PTSD, breaking this negative feedback loop.
Anyone with PTSD symptoms that interfere with their daily functioning or last longer than a month needs to contact a doctor for further help.