Trauma and sleep are closely linked. After a frightening or overwhelming experience, the body's alarm system can stay switched on at night, which makes it harder to drift off, stay asleep or feel rested. The VA National Center for PTSD puts it plainly: "Almost everyone who has PTSD also has trouble sleeping." The good news: effective treatments exist for both PTSD and poor sleep.
Here is how post-traumatic stress disorder (PTSD) changes your nights, and what helps. The condition reaches far beyond military veterans.
Why is sleep important?
The VA says both how well and how much you sleep count. Poor sleep may lead to:
Slow reaction time
Trouble with learning and memory
Irritability and mood changes
Trouble thinking and concentrating
Thoughts of suicide or self-harm
Long-term sleep problems are also associated with physical and mental health conditions, from heart disease and diabetes to depression. The Sleep Foundation adds that, according to research, getting adequate sleep after a traumatic event "can reduce intrusive trauma-related memories and make them less distressing."
How trauma and sleep connect: the stress response
When the brain senses danger, it sets off what the Sleep Foundation calls "the stress response or the fight-flight-freeze response." The heart speeds up, muscles tense and breathing quickens. After trauma, this alarm can keep firing well after the threat is over, which is why learning to calm your nervous system is part of healing.
The VA notes that "it is difficult to have restful sleep when you feel the need to be always alert or are startled easily by noise." Pushing painful memories away during the day may also make worries worse at night and disrupt sleep. Some people avoid bed because bad dreams and flashbacks make the night feel unsafe.
How does PTSD affect sleep?
Disturbed nights are a core part of PTSD, and the VA notes other changes too: more arm and leg movement, talking in your sleep and getting up earlier than you want.
Nightmares and night terrors
Nightmares are vivid, frightening dreams that frequently wake you, and you usually remember them clearly. After trauma they are often "a replay of the traumatic event," says the VA, and they can make it hard to fall back asleep.
Night terrors are different. According to the Sleep Foundation, they happen in deep non-REM sleep. A person may sit up, scream, thrash or kick, is hard to rouse, and often has little or no memory of the episode. The Sleep Foundation calls them rare after trauma.
Insomnia from anxiety and hyperarousal
Trauma can leave you anxious and keyed up, a state called hyperarousal. The Sleep Foundation explains that "alertness and hyperarousal related to the effects of the body's trauma response often contribute to the symptoms of insomnia."
The VA defines it as trouble falling or staying asleep at least three nights a week for a few months or more, enough to cause trouble at work and at home.
What is the relationship between PTSD, sleep problems and substance use?
The VA notes that some people use alcohol, marijuana or other drugs to get to sleep, but over time these can harm sleep quality and overall health. It also links using them to cope with PTSD or poor sleep to a higher risk of suicidal thoughts and attempts. If you rely on a drink or a substance to switch off, tell your doctor.
What is the best treatment for sleep problems?
The VA names Cognitive Behavioral Therapy for Insomnia (CBT-I) as the best treatment, recommended over medication because it works better and has fewer side effects. It reports that the therapy "improves sleep in 7 out of 10 people who complete it" and also reduces nightmares and the distress tied to them.
For fragmented sleep, when you wake again and again in the night, this is the first option to ask about. If you snore or wake up exhausted, ask your provider about a sleep study for sleep apnea, and about treating PTSD itself.
How does CBT-I work?
This therapy focuses on the beliefs, feelings and behaviors that affect sleep. A trained therapist offers it one-on-one or in a group, usually over six sessions, in person or by video. You keep a sleep diary and practice changes to your sleep patterns, and the skills can be used for a lifetime.
Is sleep hygiene the same as CBT-I?
No. Sleep hygiene means everyday habits that support good sleep, such as limiting caffeine before bedtime or keeping screens out of bed. The VA explains that CBT-I is a more focused treatment for chronic insomnia, and sleep hygiene is often one part of it.
For people without a clinical sleep disorder, ColumbiaDoctors describes a 10-3-2-1-0 routine "that promotes relaxation and signals your body that it's time to wind down for the night":
10 hours before bed: no more caffeine.
3 hours before bed: no food or alcohol.
2 hours before bed: no work.
1 hour before bed: no screens.
0 times: how often to hit snooze in the morning.
The Sleep Foundation adds tips for after trauma:
Keep a regular schedule: go to bed and get up at the same time every day.
Make your bedroom feel safe: try a dim light, a phone within reach or someone nearby.
Try relaxing activities: relaxation exercises can help calm body and mind before bed.
Don't force it: after about 20 minutes of tossing and turning, get up and do something quiet.
A doctor, psychologist or counselor can help you set realistic goals for managing sleep issues.
What are the pros and cons of sleep medication?
Sleep medication is easy to take and usually provides quick, temporary relief. The VA lists downsides such as daytime drowsiness, dizziness and confusion. It is often recommended for 2 to 4 weeks only, tends to help less over time and does not address the underlying cause. Some prescription sleep drugs can cause serious side effects with long-term use, and benzodiazepines are not recommended for PTSD. Your doctor can help you weigh the options.
What other sleep problems affect people with PTSD?
Sleep apnea is common in people with PTSD, especially Veterans. It is a breathing condition that disrupts normal sleep, which can leave you unrefreshed and sleepy by day. A bed partner often notices the snoring first. Treatment may include lifestyle changes and a CPAP machine, which research suggests may also benefit PTSD treatment.
Getting help with trauma and sleep in Brentwood
If you have experienced trauma, you don't have to face sleepless nights alone. Dave Saunders, LPC-MHSP, NCC, sees adults 18 and up at his Brentwood office near Nashville. His training for trauma and PTSD includes EMDR and Brainspotting, plus Trauma-Focused Cognitive Behavioral Therapy. Read about Dave Saunders Counseling, then start with a free 10-minute consultation.
In a crisis, or if you are thinking about harming yourself, you can call or text 988.