How PTSD Affects Sleep. Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.
PTSD and Sleep Written by Danielle Pacheco, Staff Writer Danielle Pacheco Staff Writer Danielle writes in-depth articles about sleep solutions and holds a psychology degree from the University of British Columbia. Read Full Bio Want to read more about all our experts in the field? Learn About The Editorial Team Medically Reviewed by Alex Dimitriu, Psychiatrist Alex Dimitriu Psychiatrist Dr. Dimitriu is the founder of Menlo Park Psychiatry and Sleep Medicine. He is board-certified in psychiatry as well as sleep medicine. Read Full Bio Want to read more about all our experts in the field? Learn About The Editorial Team Fact Checked Learn More Sleep Foundation Fact-Checking: Our Process At Sleep Foundation, we personally test every product featured in our reviews and guides. This hands-on approach allows us to provide accurate, data-driven recommendations for mattresses, pillows, sheets, and other sleep essentials. Guidelines for our testing methodology are as follows: We only cite reputable sources when researching our guides and articles. These include peer-reviewed journals, government reports, academic and medical associations, and interviews with credentialed medical experts and practitioners.
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Post-Traumatic Stress Disorder Trusted Source National Institute of Mental Health (NIMH) The NIMH is the lead federal agency for research on mental disorders. nimh.nih.gov (PTSD) is characterized by a chronically heightened state of arousal after a traumatic event. PTSD often gets worse over time or develops insidiously, so that people may not realize they have it until many months after the traumatic event. The disease is more common in women, though it can happen to anybody. An estimated seven people out of 100 will experience PTSD during their lifetime.
PTSD and sleep have a complex relationship. Though sleep problems accompany many mental health conditions, sleep problems in PTSD Trusted Source National Center for PTSD The mission of the National Center for PTSD is to advance the clinical care and social welfare of America's Veterans and others who have experienced trauma, or who suffer from PTSD, through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. ptsd.va.gov are actually considered part of the disorder. Among the symptoms used to diagnose PTSD, two are directly related to sleep: hyperarousal and intrusion, which can manifest as insomnia and nightmares. Researchers are still trying to understand whether sleep problems precede PTSD or whether PTSD causes sleep problems.
How Do Sleep Issues Affect PTSD Symptoms?
Among people who experience a traumatic event, those who suffer significant sleep problems appear to be more likely to develop PTSD in the future. In fact, one of the earliest signs of PTSD Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. pubmed.ncbi.nlm.nih.gov is sleep disturbance, which often encompasses nightmares, insomnia, and fragmented rapid eye movement (REM) sleep.
Interestingly, sleep problems that precede the traumatic event may also play a role. One study found that people reporting nightmares before going to war Trusted Source Wiley Online Library Wiley Online Library is one of the largest and most authoritative collections of electronic journals published by Wiley, as well as a vast and growing collection of reference works and other books. onlinelibrary.wiley.com were more likely to develop PTSD after coming back.
Once the disorder sets in, the presence of sleep problems appears to exacerbate PTSD symptoms Trusted Source Wiley Online Library Wiley Online Library is one of the largest and most authoritative collections of electronic journals published by Wiley, as well as a vast and growing collection of reference works and other books. onlinelibrary.wiley.com . And even after treating daytime PTSD symptoms, many people find that insomnia still persists .
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Sleep problems in PTSD interfere with the brain’s ability to process memories and emotions, slowing down the recovery process after a traumatic event. Moreover, many people with PTSD use alcohol or other substances to try to sleep better. Far from helping, these counterproductive coping mechanisms actually worsen sleep and can aggravate PTSD symptoms as well.
How PTSD Affects Sleep
Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.
Those with chronic pain, substance abuse Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. pubmed.ncbi.nlm.nih.gov , traumatic brain injury Trusted Source Eliserver Eliserver is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. linkinghub.elsevier.com , depression Trusted Source Oxford Academic Journals (OUP) OUP publishes the highest quality journals and delivers this research to the widest possible audience. academic.oup.com , or other medical problems face an additional barrier to getting quality sleep. Certain sleep medications also interfere with REM sleep, which is the sleep stage during which we dream and an important sleep stage for dealing with traumatic memories.
The most common sleep problems in PTSD can be summed up in three categories:
Treating PTSD-related sleep problems, as well as co-existing disorders such as depression, is an important part of resolving overall PTSD symptoms.
The Connection Between PTSD, Sleep, and the Brain
Researchers have found evidence that multiple overlapping brain regions Trusted Source Eliserver Eliserver is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. linkinghub.elsevier.com are implicated in both PTSD and sleep problems, most notably the hippocampus, the amygdala, the anterior cingulate cortex, and the insular cortex. These brain regions are likely responsible for causing the patient to revisit the traumatic event in flashbacks and nightmares, as well as for maintaining a state of hyperarousal.
Studies have found that individuals with PTSD have a faster heart rate Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. medlineplus.gov while sleeping, indicating an enhanced fight-or-flight response Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. medlineplus.gov that maintains the body in a permanent state of hypervigilance. Unsurprisingly, hallmarks of disturbed sleep in PTSD sufferers include more stage one light sleep, less restorative slow-wave sleep, and fragmented REM sleep.
Another significant connection between sleep and PTSD may lie in the way the brain processes fear-inducing memories. During a traumatic event, the brain learns to associate a certain stimulus with a negative response. Long after the traumatic event, this association may be so strong that the person suffers a violent reaction every time they are presented with a similar stimulus.
Normally, this response is attenuated during a process called extinction memory, during which the brain gradually learns to dissociate the stimulus from the learned response. A significant amount of emotional memory processing is done during REM sleep, and researchers believe the REM sleep disruptions Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. pubmed.ncbi.nlm.nih.gov seen in PTSD sufferers may indicate an inability to efficiently process trauma.
Sleep loss may also cause daytime sleepiness and interfere with coping strategies, leaving people anxious and hypersensitive to triggers. The good news is that improving sleep seems to have corresponding effects on PTSD.
How to Sleep Better With PTSD
Elements of proper sleep hygiene can go a long way toward reducing PTSD sleep problems. These include:
Keeping a cool, dark, and quiet sleep environment
Reserving the bedroom for sleep and sex only
Staying on a regular bedtime schedule
Eating a healthy diet and avoiding caffeine before bedtime
Getting regular exercise Trusted Source Eliserver Eliserver is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. linkinghub.elsevier.com
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Avoiding stressors before bedtime, including talking about your traumatic event
Having a warm bath or reading a calming book before bedtime
Turning off screens an hour before bedtime
Using a white noise machine if you are sensitive to sounds
Using meditation Trusted Source Wiley Online Library Wiley Online Library is one of the largest and most authoritative collections of electronic journals published by Wiley, as well as a vast and growing collection of reference works and other books. onlinelibrary.wiley.com rumination
You should sleep in a room that makes you feel safe, which may or may not be your bedroom. If you are uncomfortable sleeping in a dark room, a nightlight may provide a feeling of security.
People with PTSD are often afraid to go to sleep because they worry they will have nightmares. Unfortunately, this can lead to spending hours in bed with racing thoughts. If you have been in bed for 20 minutes and you can’t fall asleep, get out of bed, go to another room to do something relaxing, and only return to bed when you feel sleepy. This will help strengthen the mental association between your bed and sleep.
If you’re having trouble sleeping, or if you find yourself turning to substances such as drugs or alcohol to help you sleep, seek help from your doctor. They can help you find a therapist that provides cognitive behavioral therapy for insomnia (CBT-I), as well as PTSD-specific techniques such as imagery rehearsal therapy or exposure, relaxation, and rescripting therapy. They may also prescribe sleep medication, though this carries more risks and should be used with caution.
Learning to sleep soundly again after experiencing trauma may take some time, so don’t feel defeated if it doesn’t happen right away. Keep practicing healthy behaviors and working with your doctor, and you should eventually start to feel better. Because sleep and PTSD are so closely linked, ongoing therapy is extremely beneficial to those struggling with insomnia.
Sleep Tips for Partners of People With PTSD
While most efforts are focused on how to help someone with PTSD sleep, the partners of people with PTSD may also find it difficult to sleep soundly. For those with a partner who wakes up multiple times during the night, it may help to invest in a mattress that muffles sound and movement.
Nightmares and night terrors can be frightening and may cause your partner to lash out violently. Though you want to be there for your partner, you may find it necessary to sleep in a separate, nearby bedroom from time to time so you can get the restful sleep you need.
It may also be constructive to do exercise together with your partner during the day. In addition to improving sleep, developing healthy routines together can help you bond and help re-establish a sense of security for your partner.
Many caregivers struggle with feelings of guilt and a sense that they are responsible for “saving” their partner. However, pouring all your energy into helping another person can have a serious effect on your own mental health. Couples therapy, individual therapy, support groups, or a strong network of family and friends may help you manage your own thoughts and feelings to reduce the risk of burnout Trusted Source SAGE Publishing SAGE produces high quality educational resources that support instructors to prepare the citizens, policy makers, educators and researchers of the future. journals.sagepub.com .
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About Our Editorial Team Danielle Pacheco Staff Writer Danielle writes in-depth articles about sleep solutions and holds a psychology degree from the University of British Columbia. Alex Dimitriu Psychiatrist MD Dr. Dimitriu is the founder of Menlo Park Psychiatry and Sleep Medicine. He is board-certified in psychiatry as well as sleep medicine.
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