How PTSD Can Affect Sleep

Trouble sleeping can affect all aspects of day-to-day life, making even the most trivial tasks challenging. Optimizing your sleep is essential for your well-being, but it can be challenging if you’re experiencing disorders like PTSD. 

As well as other symptoms, PTSD can cause nightmares, insomnia, and disrupted sleep patterns that significantly decrease your quality of sleep.

PTSD: A brief overview

PTSD is a mental disorder that can sometimes affect you if you experience or witness a traumatic event at some point in your life. This can involve a life-threatening event, physical violence, or great suffering in any other shape or form.

Research¹ shows that 6-7% of US adults experience symptoms matching a PTSD diagnosis in their lifetime. There are many symptoms of PTSD, including:

• Intrusive flashbacks

• Nightmares about the traumatic event

• Avoiding anything that may trigger memories of the event

• Increased negative outlook or mood after the trauma, including:

  • Memory loss of parts or all of the traumatic event

  • An increased negative self-view or perception of the world in general

  • Feelings of isolation from others

• Irritability and severe mood swings

• Impulsive behavior that can be dangerous

• Difficulty focusing

• Hypervigilance

• Trouble sleeping

Treatment

Like symptoms, treatment for PTSD varies for each person. Options include therapy-based techniques or medication. In some cases, medication aids therapy. 

Treatment options include:

• Therapy:

  • Trauma-focused cognitive behavior therapy (TF-CBT)

  • Cognitive processing therapy (CPT)

  • Prolonged exposure therapy (PE)

  • Eye movement, desensitization, and restructuring (EMDR)

  • Narrative exposure therapy

• Medication:

  • Fluoxetine (Prozac)

  • Venlafaxine

  • Paroxetine

  • Alprazolam (Xanax) 

  • Sertraline

PTSD’s effect on sleep

Trouble sleeping and disturbing nightmares can be significant symptoms of PTSD and can cause frustration and exhaustion. Symptoms of PTSD can be increased by a lack of quality sleep, creating a vicious cycle that is difficult to break.

Reports² suggest that 70–91% of people with PTSD experience problems with falling or remaining asleep. Studies that include all severities of PTSD indicate that 19–71% of people with PTSD experience nightmares.

Research shows an increase in other sleep disorders in people with PTSD, such as ‘sleep-disordered breathing’ and sleep movement disorders. 

Interruptions in sleep can be one of the largest causes of fatigue. PTSD nightmares usually link to the trauma experienced, resulting in a panicked awakening, especially in veterans. Nightmares associated with trauma are more likely to cause awakenings than those which are non-trauma related. 

Sleep breathing disorders involve interludes of obstruction of the upper airway during sleep, causing you to wake up at night to reset your breathing pattern. These sleep interruptions significantly decrease the quality and amount of sleep. 

What can improve my sleep?

While treatment aims to reduce every symptom of PTSD, it is a great idea to target sleep quality specifically. A good night’s sleep can improve daytime symptoms significantly and help with overall recovery. 

Psychotherapeutic options

Psychotherapy, also known as talk therapy, involves treatment without medication with a trained psychologist or therapist. The most commonly recommended type is cognitive behavior therapy (CBT). Trained specialists can also target CBT toward insomnia, which is called CBT-I³. 

You can expect several things from this treatment, including careful prolonged exposure to things that may trigger traumatic memories to discuss and correct responses.

Your therapist may also use relaxation training, education on sleep hygiene, and other methods to ‘rewire’ your brain's approach to sleep. The aim is to reduce wakefulness, daytime symptoms, and fear of sleep. 

Therapeutic options for nightmares include:

• Imagery rehearsal therapy (IRT)⁴

• Exposure, relaxation, and rescripting therapy (ERRT)⁵

Medicinal options

While insomnia-specific cognitive behavior therapy has better results in the long term, doctors can also prescribe medication to reduce PTSD sleep symptoms. 

The most frequently prescribed drugs are benzodiazepines and non-benzodiazepine receptor agonists, otherwise known as ‘Z-drugs.’ These sedative and hypnotic drugs are helpful in the short term, but they can be addictive and do not solve the underlying issue. 

They’re not well-suited to PTSD-related insomnia, as these sleep issues are complex and continuous.

Currently, research cannot confidently recommend a specific drug to reduce PTSD nightmares. The most promising so far is prazosin. However, it depends on the individual as to how effective it is, and studies contradict each other in terms of effectiveness.

The lowdown

Lack of sleep can take a huge emotional and physical toll on you and the people around you. If you or a loved one have disrupted sleep due to PTSD, contact your medical professional and enquire about sleep-targeted therapy. 

Research shows that non-pharmaceutical therapy is typically the most effective for treating insomnia. However, everyone has different needs, and your doctor or psychologist can guide you through what treatment could mean for you.

FAQs

Can I improve my sleep without treatment?

Research⁶ shows that physical exercise can moderately improve your sleep, so it could supplement other targeted therapies. If you have PTSD, exercise will likely not be enough on its own, but every little bit can help improve your quality of life.

How do I know if I have insomnia?

Insomnia symptoms include:

• Difficulty falling/remaining asleep despite ample opportunity and lack of disruption

• Daytime fatigue

• Difficulty concentrating

• Moodiness

• Headaches

• Unusual gastrointestinal symptoms

How can I help my loved one sleep?

The best thing to do for a loved one is to support them throughout their treatment and ensure they have a safe and comfortable sleeping environment. Remember to be understanding and patient; no one is their best self with minimal sleep.