A Guide on PTSD and Sleep

Disrupted sleep is a hallmark symptom of post-traumatic stress disorder, or PTSD. (2) Many people associate PTSD with soldiers in combat, but this mental health condition can affect anyone who experiences or witnesses a traumatic event. (8) 

“Traumas such as combat exposure, sexual assault, and severe accidents are particularly impactful due to their intense, life-threatening, and distressing nature, leading to a higher likelihood of PTSD development,” says Joel Frank, PsyD, clinical psychologist and neuropsychologist at Duality Psychological Services. (6) About six percent of people in the U.S. have PTSD, which, in addition to nightmares, intrusive thoughts, avoidance symptoms, and changes in cognition and mood, causes symptoms like irritability, being easily startled, difficulty with concentration, self-destructive behavior, and poor sleep. (8) (1)

PTSD and sleep work against one another by creating a cycle of worsening symptoms and inadequate sleep, and 70 percent of people with this diagnosis report sleep disturbances. (2) Below, we’ll explain how exactly this condition affects sleep and how to sleep with PTSD.

Note: This information is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately. 

How Does PTSD Affect Sleep?

For some, PTSD can cause sleep problems: both your ability to fall asleep and stay asleep, as well as the quality of your Zzz’s. (2) “Individuals with PTSD often face significant sleep issues that affect their well-being, including insomnia, nightmares, night sweats, and frequent awakenings,” says Frank. More on those below.

Insomnia 

Hyperarousal from PTSD — a constant state of vigilance that prevents the mind and body from relaxing — can make it difficult to relax and fall asleep, which paves the way for insomnia, says Frank. About 25 percent of people with PTSD have insomnia, a sleep disorder defined by having trouble falling asleep more than three nights a week for over three months. (2) (3) (9)

Nightmares and Night Terrors

More specific PTSD symptoms — like nightmares — can also rob you of Zzz’s. “Nightmares can vividly replay traumatic events, causing distress and disrupting sleep,” Frank says. For people with PTSD, they’re pretty common, too: nightmares are reported by 50 to 70 percent of those with PTSD. (2) These disturbing dreams can wake you suddenly from sleep and can keep you awake afterwards. (10) 

Then there’s night terrors. Night terrors are different from nightmares in that most don’t remember them after waking. Your sleeping partner may be most aware of your night terrors, which can involve the sudden appearance of waking, yelling, and thrashing. While a small number of adults do remember their night terrors, many fall back into a restful sleep without ever waking up. (11)

Periodic Limb Movement Disorder

Periodic limb movement disorder (PLMD) is a sleep disorder that causes involuntary muscle movement during sleep. (12) A less-common sleep disorder associated with PTSD, PLMD affects about one in three people with PTSD, and these random movements can wake you from your slumber throughout the night. (2) (12) 

Experts used to think if you treated PTSD, you’d solve any sleep problems, but now we know sleep disorders themselves can play a big part in PTSD development. (2) Now that experts know this, they can more effectively treat PTSD by treating sleep issues at the same time.

A Note About PTSD and Sleep Apnea

Obstructive sleep apnea (OSA) and PTSD often come as a package deal, although experts aren’t entirely sure why. (13) But, we know 40 to 90 percent of people with PTSD also have OSA, so the correlation is clear. (2) “Sleep apnea can significantly disrupt the sleep cycle, leading to increased daytime fatigue and overall poor sleep quality,” says Frank. 

What Is Sleep Apnea?

When you have obstructive sleep apnea, the tissues surrounding your throat block your airways while you sleep, pausing your breathing periodically throughout the night. (13)(14)

For people with PTSD, interrupted sleep from OSA can intensify symptoms like hyperarousal, anxiety, and mood disturbances, creating a cycle where poor sleep worsens PTSD symptoms. These heightened symptoms make sleep even more elusive, Frank says. (13) (2) It’s important to address OSA and PTSD with your healthcare provider to treat both for maximum improvement. (13)

The Brain, PTSD, and Sleep

PTSD’s connection to the brain isn’t fully understood, but some smaller studies show this disorder affects several brain regions, including the amygdala, hippocampus, and prefrontal cortex. (4) (5) But what on earth does that mean? 

Well, these brain areas help you decide what is a threat to you and what you can shrug off. So, when they’re not functioning quite right, it’s easy for your brain to register too many things as dangerous. (5)

These important areas of your brain assess perceived danger, and when you experience or witness a trauma, your body gets flooded with adrenaline, which elevates your heart rate, blood pressure, and prompts your brain to order the release of other stress hormones like cortisol. (7) And when you have PTSD, research shows your heart rate may stay high even while you sleep. (15)

Whether your day’s events jack up your heart rate or not, your brain helps you process your memories while you snooze. (16) But when your deep sleep gets consistently disrupted by nightmares or other symptoms of PTSD, you may not process the traumatic memories properly. (17)

When these memories don’t get processed correctly, your brain and body can learn behaviors that hurt your sleep. Behavioral habits have a lot to do with good sleep — good sleep hygiene teaches your brain that after certain things happen (like getting ready for bed), you should fall asleep. (18) 

But with PTSD, your brain learns to respond negatively to stimuli like sudden noises or changing in lighting, which conditions your behavior by pulling you from sleep or making it hard to fall asleep, says Frank. (7) PTSD has also been linked to changes in brain messengers like serotonin, a hormone which helps you make melatonin to signal your body that it’s just about time to get to bed. (7) (19) (20)

Do Sleep Issues Affect PTSD Symptoms?

“Sleep issues can indeed have a profound impact on PTSD symptoms, often creating a challenging cycle that affects overall well-being and recovery,” says Frank. Poor sleep quality for any reason can worsen PTSD symptoms like hyperarousal, anxiety, and mood disturbances, Frank adds. 

The mood disturbances that come along with sleep deprivation can also make it more difficult to treat PTSD. The positive side of this coin? When you treat sleep issues, you’re also treating your PTSD. (7)

How to Improve Sleep With PTSD

When you have PTSD, you can get better sleep by following your PTSD treatment, treating sleep disorders, and practicing good sleep hygiene habits. (2)

Treatment for PTSD

Treatment for PTSD usually involves psychotherapy with a trauma focus: talking to a mental health professional about what happened and developing a personal plan and coping skills to work through your trauma. (7) 

Therapies to treat PTSD and its related sleep problems include: (7)

• Cognitive behavioral therapy (CBT): Using techniques like relaxation, coping skills, and stress reduction, CBT helps you reorient the way you think about a traumatic event. Some research shows that CBT for insomnia can even help you have fewer nightmares with PTSD. (6)
• Exposure-based therapy: Often used to treat phobias, exposure-based therapy slowly introduces sounds or other stimuli that typically trigger a trauma response, re-training the brain to tolerate them. 
• Eye movement desensitization and reprocessing therapy (EMDR): Learning how to move your eyes in a specific (expert-led) movement pattern can make disturbing thoughts less intense. EDMR can help take the powerful feelings away from traumatic memories and help you cope with them better. 
• Supportive psychotherapy: This type of therapy is less well-defined, but may simply mean having a place to speak freely about what you’re feeling.
• Medications: Depending on your situation, your provider may recommend you try a selective serotonin reuptake inhibitor (SSRI) like sertraline (Zoloft) or paroxetine (Paxil). A newer medication on the scene, Prazosin may help specifically with nightmares from PTSD. (21) (22)

That may all sound great, but how can you find a therapist? If you’re a veteran, the Department of Veterans Affairs (VA) can help you find a therapist near you through their website. Not everyone with PTSD was in the armed forces, however, and the American Psychological Association (APA) points to two websites for locating a vetted therapist: 

• The Psychologist Locator is run by the APA and shows you therapists in your area, which insurances they accept, their telehealth capability, and if they’re accepting new patients.
• The National Register offers a curated list of therapists with the highest education and training, and can help you narrow down which area of expertise you need most, like PTSD and trauma.

Sleep Disorder Treatment

Treating sleep disorders can also help you not only sleep better, but experience fewer PTSD symptoms. (23) Sleep disorders can be very diverse, but here are some common sleep disorder treatments your provider may recommend: (24)

• CBT-I: Cognitive behavioral therapy for insomnia works much the same as the original CBT, but with a focus on thought patterns around your sleep. (25)
• CPAP: Use a CPAP (continuous positive airway pressure) machine if you have sleep apnea.
• Medication: For short periods, sleeping pills or natural supplements like melatonin can get your nighttime rest back on track.

When you address disturbed sleep, you may be able to process your emotions better, lessen your PTSD severity, and even help your PTSD treatment work better. (17) To find a therapist who specializes in CBT-I, you can plug your location into the National Register linked above. For other insomnia therapies, your healthcare provider can also be a valuable resource.

Good Sleep Hygiene

Sleep hygiene can help anyone sleep better, but when you have PTSD, some tweaks to your daily habits and rituals can set you up for nightly sleep success: (25)

• Create a quiet, dark, and cool sleeping area: If your bedroom has too much activity, noise, or light, you may not be able to rest well. Keep the temperature cool for optimal sleeping. Some people sleep better with a white noise machine providing constant background noise, which also helps to block out other sounds that can trigger a trauma response. 
• Curate a comfy bed: Research mattress reviews to find a mattress that fits your sleep needs and will help you stay comfortable all night long. Some people with PTSD also find weighted blankets improve their sleep. (26)
• Use your bedroom for sleeping or sex only: Don’t watch television or scroll social media in your bed, or your brain may start to associate your sheets with wakefulness. 
• Keep a bedtime routine and sleep schedule: Maintaining a sleep schedule with the same bedtime and wake-up time helps your body acclimate to this schedule. Develop a soothing bedtime routine to get your body ready to sleep. Taking a warm shower or drinking a cup of decaffeinated tea may help.
• Try to relax if you can’t sleep: If you can’t sleep, focus on relaxing instead. You could get out of bed and read quietly on the sofa until you feel sleepy; however, avoid watching television or using electronics because they could keep you up longer. Especially avoid any reminders of trauma in entertainment, which may make it harder to fall asleep. To try focused relaxation, imagine yourself in a peaceful setting, thinking about specific details that make you feel relaxed.
• Exercise daily: Exercise is important for overall health, but try to avoid exercising within two hours of bedtime.
• Spend time outdoors: Get out in the sunshine every day to help regulate your waking and sleeping cycles.
• Avoid sleep-stealing substances: Limit or avoid foods and beverages that contain caffeine, alcohol, or nicotine.
• Be careful with naps: Avoid napping during the day, especially in the late afternoon or evening.
• Limit fluids: Limit beverages after dinner so you won’t have to get up to use the bathroom.
• Avoid some medications: Some medications can make it difficult to sleep, like some anti-anxiety drugs, antidepressants, heart medicines, or asthma treatments. (27) Just be sure to ask your provider before you stop any regular medicines.

When you make changes, remember to stick with the changes for several nights to give yourself a chance to see improvement.

How to Help Someone with PTSD Sleep

If your loved one or sleeping partner deals with insomnia from PTSD, it’s easy to feel powerless to help, but you can do quite a lot to support them. Frank recommends these tips:

• Be patient and understanding: Approach your loved one with empathy and patience, recognizing that sleep disturbances are a common symptom of PTSD.
• Create a safe and calm sleep environment: Make their bedroom a sanctuary for rest with blackout curtains or a noise machine to create a peaceful atmosphere.
• Avoid sudden movements or loud noises: Sudden actions or loud sounds can trigger anxiety or flashbacks. Instead, keep your movements gentle and smooth and noise levels low, especially if your partner is already asleep or trying to fall asleep.
• Use open communication: Talk transparently with your partner about their sleep issues and how you can support them. This can include discussing their triggers and finding ways to mitigate them together.
• Support their treatment plan: Be supportive of their treatment plan, whether it involves therapy, medication, or other strategies. You can also offer to attend therapy sessions with them to better understand their condition and ways you can help.
• Encourage relaxation techniques: Do relaxing activities together before bed, like reading, deep breathing exercises, or listening to calming music. This can help signal to their body that it’s time to wind down and help them feel like they’re not alone in this.

PTSD symptoms can pose a challenge for the person experiencing them, but also their loved ones. Don’t forget to take care of yourself, too, by asking for help or reaching out to your support system of family, friends, counselor, or support group. (28) You can find support groups online or near you through the VA or the National Alliance on Mental Illness.

Support for PTSD

Dealing with Post-Traumatic Stress Disorder (PTSD) can be an overwhelming journey, but finding the right support can make a significant difference. Recognizing that each individual’s experience with trauma is unique, it’s crucial to have access to tailored resources that address specific needs. Whether you’re a survivor of domestic violence, racial violence, or other traumatic events, there are specialized organizations, helplines, and communities ready to offer support, guidance, and healing. Below, we’ve compiled a comprehensive list of PTSD resources catered to various groups, ensuring that everyone can find the help they need.

Support for Veterans and Active Duty Military

• US Dept of Veterans Affairs National Center for PTSD: Find a Provider 
• Wounded Warrior Project: Veterans and PTSD: Understanding Causes, Signs, Symptoms and Treatment
• Disabled American Veterans (DAV): What are the symptoms of PTSD? 

Support for Front Line Workers

• US Dept of Veterans Affairs National Center for PTSD: Resources for Healthcare Workers and Responders
• CDC: Resources for Emergency Health Professionals
• SAMHSA: A Guide to Managing Stress for Disaster Responders and First Responders
• First Responders Foundation: Coping Strategies for Trauma Among First Responders

Support for Those With Childhood Trauma

• The National Child Traumatic Stress Network: Get Help Now
• SAMHSA: Recognizing and Treating Child Traumatic Stress
• NIH: Helping Children and Adolescents Cope With Traumatic Events
• Child Help Hotline: Resources
• Stop It Now!: Get Help Now 

Support for Those Who Have Experienced Sexual Violence

• RAINN (Rape, Abuse & Incest National Network): Hotline & Resources
• National Domestic Violence Hotline: Resources
• The Enough Abuse Campaign: Resources For Survivors Of Child Sexual Abuse
• National Sexual Violence Resource Center: Find Help
• Sexual Assault Kit Initiative: Resources for Survivors

Support for Those With Racial Trauma

• Mental Health America: Racial Trauma Guide
• California State University: Racial Trauma, Resiliency and Ally Resources
• University of Georgia Dept of Psychology: Coping with Racial Trauma

Support for Those in the LGBTQ+ Community

• The Trevor Project: Resources for Mental Health Support
• American Psychiatric Association: Stress & Trauma Toolkit for Treating LGBTQ in a Changing Political and Social Environment
• SAMHSA: LGBTQ+ Trauma-informed Care
• The National Child Traumatic Stress Network: LGBTQ Youth
• Center of Excellence on LGBTQ+ Behavioral Health Equity: Resources

FAQs

The Last Word

PTSD and sleep may not do a lot for each other, but when you can break the cycle of symptoms and sleeplessness, you can head towards better sleep and overall health. Remember to ask for help from a healthcare provider if you wake up often through the night over several weeks, if you have building anxiety from nightmares or other symptoms, or if you feel excessively sleepy during the day, says Frank. (8) With help and support, you can work towards better sleep with PTSD.

*Abby McCoy is an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She has practiced nursing all over the world from San Fransisco, CA to Tharaka, Kenya. Abby loves spending time with her husband, four kids, and their cat named Cat.