What To Do If You’re Having PTSD Nightmares

Everyone has had a bad dream or nightmare at some point in their lives. However, if you have post-traumatic stress disorder (PTSD), you probably experience nightmares more often. Is it possible to stop PTSDA nightmares from happening so you can get a good night’s sleep again? 

PTSD and sleep 

PTSD¹ is a trauma-related disorder caused by a traumatic event you have experienced or witnessed. Like other anxiety, depression, or trauma-related conditions, it can also impact your ability to fall and stay asleep. 

A significant relationship exists between PTSD and sleep.² If PTSD is affecting your rest, you may notice:

• Sleep disturbance (waking up during the middle of the night)

• Difficulty falling asleep

• Nightmares

• Sleep avoidance (staying up late or leaving the lights on)

• Insomnia (inability to sleep)

• Daytime drowsiness

• Fatigue

• Reduced concentration or cognitive function

• Decreased physiological function

• Feelings of hopelessness

• Irritability 

Nightmares are a common symptom of PTSD. Researchers estimate that 72%³ of people with PTSD are affected by nightmares. 

What are PTSD nightmares? 

A nightmare is a scary or unpleasant dream, and bad dreams caused by PTSD are often related to the traumatic event that led to the development of PTSD. For example, while sleeping, you may feel that your physical or emotional safety is threatened because the dream is causing you to relive bad memories. 

Why does PTSD cause nightmares? 

Researchers cannot identify an exact reason why PTSD causes nightmares. However, a close relationship exists⁴ between nightmares and PTSD, as both show altered activity in the same brain regions. 

Researchers also believe that nightmares can accelerate the progression of PTSD⁵ if someone is experiencing them in the days or weeks following their trauma. Regardless, it’s still possible for someone to experience nightmares without developing PTSD. 

Additionally, it’s been acknowledged that PTSD nightmares are based on traumatic experiences. Therefore, it’s also been suggested that these dreams may help your mind process what has happened. Since dreams also support memory and learning,⁶ this is one plausible explanation. 

Despite an apparent link between PTSD and nightmares, no broad consensus on how they are caused has been established. No single reason for the occurrence of nightmares likely exists. 

Are PTSD nightmares the same as flashbacks?

A nightmare may feel similar to a flashback, but it is not the same. However, both are classified under the re-experiencing symptoms of PTSD since they can make it feel like you’re reliving your trauma. 

Flashbacks occur when you’re awake and are triggered by an external stimulus, such as a person or place. Your thoughts can also trigger flashbacks. 

In contrast, nightmares occur while you’re sleeping, and researchers aren’t entirely sure what triggers them. Dreams can feel as though you’re re-enacting the trauma. As a result, you may wake up feeling anxious and have difficulty going back to sleep. 

Can you manage PTSD nightmares?

While it may feel that dreams are spontaneous occurrences out of your control, it’s possible to manage PTSD nightmares. However, the problem has no quick fix, and it may take some time before you start noticing a significant improvement. 

That aside, the good news is that many treatments are available for you to try. Additionally, you can try more than one treatment if you prefer. Trying more than one treatment could increase your chances of noticing an improvement. 

Nonetheless, everyone has different experiences with PTSD nightmares. It’s always best to choose a treatment plan that suits you best. 

Treatments 

If you’d like to start a treatment, it’s best to see a doctor or healthcare professional for guidance. However, before doing so, it may help to create a list of all the sleep problems you have regarding PTSD. 

From this, your healthcare professional will have a better overview of your issue and might be able to recommend one type of treatment over another. 

Behavior therapy 

Behavioral therapy is an approach that aims to address PTSD nightmares or relieve symptoms by altering your behavior. This type of therapy may also address environmental factors that influence behavior. 

Some experts think PTSD nightmares may start as a means of processing your emotions around the event. But they could become a frequent occurrence or become a cycle that will be challenging to break out of through time. 

Therefore, behavioral therapy may help relieve nightmares because it is based on the idea that bad dreams are learned behaviors. Since they’re learned behaviors, you can modify them through behavioral intervention. 

Several types of behavioral therapies are available. These include:

• Imagery rehearsal therapy (IRT)

• Exposure, rescripting, and relaxation therapy

• Eye movement desensitization and reprocessing (EMDR)

• Cognitive behavioral treatment for insomnia 

Imagery rehearsal therapy 

Imagery rehearsal therapy (IRT) is based on the idea that the relationship between nightmares and sleep can be altered by the daytime rehearsal of an ideal dream script. Hence, the nightmare you keep experiencing is modified in the script to have a different outcome or end. For this to work, you must rehearse or imagine the new script daily so that your dream eventually changes. 

Exposure, rescripting, and relaxation therapy

Exposure, rescripting, and relaxation therapy⁷ involve education about nightmares, muscle relaxation, sleep hygiene, and nightmare rescripting. Hence, this therapy is like IRT, with some extras. It is usually divided into three sessions so you can master one concept at a time. 

Eye movement desensitization and reprocessing (EMDR) 

With eye movement desensitization and reprocessing⁸ (EMDR) therapy, you’re asked to recall distressing details of the trauma while moving your eyes from side to side. This motion is called bilateral stimulation. Doing so may reduce the vividness of the memories linked to the trauma and could ease nightmares. 

Cognitive behavioral therapy 

Another aspect related to nightmares is insomnia. Hence, if you’re experiencing insomnia alongside PTSD, then treating your insomnia may also help. However, while researchers believe cognitive behavioral therapy⁹ (CBT) needs further refinement to be more successful, the idea of simply addressing insomnia could help.

Medications

Some medications can also help ease PTSD nightmares. These medications include:

• Alpha-1-adrenergic receptor antagonists (Prazosin)

• Alpha-2-adrenergic receptor antagonists (Clonidine)

• Antidepressants (SSRIs, mirtazapine) 

These medications have different mechanisms, but each one can potentially reduce nightmares. They’re available via prescription only. If you choose this type of therapy, your doctor will select the best medication for you.

Sleep hygiene

Sleep hygiene refers to healthy bedtime habits. These habits can help improve the quality of your sleep. 

You can incorporate several habits into your bedtime routine. These include:

• Going to bed and waking at the same time every day

• Ensuring that your bedroom is a relaxing, quiet, and dark place

• Keeping your bedroom at a temperature that’s comfortable for you, but cooler temperatures are preferable for good sleep

• Keeping your bedroom free from electronic devices

• Maintaining regular physical exercise during the day so that you can sleep better at night

• Avoiding large meals before bedtime or eating dinner earlier in the evening

• Avoiding caffeine or alcohol before bed 

If you’re struggling to fall asleep, you may find it helps to get out of bed and do something quiet such as reading for a short while before returning to bed. Staying in bed and forcing yourself to sleep doesn’t help because this can lead to upsetting thoughts, which may keep you awake. 

Additionally, if you’re experiencing racing thoughts before your sleep, it might help to record these in a journal. Writing is an excellent way to get those thoughts out of your mind and help you identify which ones bother you the most. 

When to see a doctor

For any sleep-related problem, it’s best to see a doctor sooner rather than later. Therefore, if your PTSD dreams persist or worsen, ask your doctor for some guidance and treatment if necessary. 

The lowdown 

Nightmares are a common symptom of PTSD, and the underlying cause remains unknown. Despite the many unanswered questions about nightmares, several treatments are available, including behavioral therapy, medications, and improving your sleep hygiene. 

Frequently asked questions

How common are PTSD nightmares? 

Experts estimate that 72% of people with PTSD are affected by nightmares.

Are nightmares the same as flashbacks?

Nightmares and flashbacks are similar because both make it feel like you are reliving the trauma. However, flashbacks occur while you’re awake, whereas nightmares happen while you sleep. Flashbacks are usually triggered by your thoughts, places, or people. Nightmares appear to have no trigger. 

Can you manage PTSD nightmares?

You can try several approaches to reduce the frequency of nightmares. These include behavioral therapy, medications such as antidepressants or prazosin, and improving your sleep hygiene.