Factsheets: Sleep and Posttraumatic Stress Disorder (PTSD)

A National Center for PTSD Fact Sheet.

By Pamela Swales, Ph.D.

Many people suffer from problems with their sleep. This can be especially true for those who have witnessed or experienced one or more traumatic events such as rape, military combat, natural disasters, beatings, or neighborhood violence. Some individuals exposed to traumatic physical or psychological events develop a condition known as Posttraumatic Stress Disorder (PTSD). It is well known that a problem with sleep is one of many problems for those with PTSD. Sleep problems, such as difficulty falling asleep, waking frequently, and having distressing dreams or nightmares, are common to those with PTSD. In fact, sleep disturbance can be a normal response to past trauma or anticipated threat.

What are the major reasons why people with PTSD have problems with sleep?

Severe psychological or physical trauma can cause changes in a person’s basic biological functioning. As a result of being traumatized, a person with PTSD may be constantly hyper-vigilant, or "on the lookout," to protect him- or herself from danger. It is difficult to have restful sleep when you feel the need to be always alert.

What are some sleep problems commonly associated with PTSD?

Difficulty falling asleep

• Basic Biological Changes: Actual biological changes may occur as a result of trauma, making it difficult to fall asleep. In addition, a continued state of hyper-arousal or watchfulness is usually present. It is very hard for people to fall asleep if they think and feel that they need to stay awake and alert to protect themselves (and possibly others) from danger.

• Medical Problems: There are medical conditions commonly associated with PTSD. They can make going to sleep difficult. Such problems include: chronic pain, stomach and intestinal problems, and pelvic-area problems (in women).

• Your Thoughts: A person’s thoughts can also contribute to problems with sleep. For example, thinking about the traumatic event, thinking about general worries and problems, or just thinking, "Here we go again, another night, another terrible night’s sleep," may make it difficult to fall asleep.

• Use of Drugs or Alcohol: These substances are often associated with difficulty going to sleep.
These substances are often associated with difficulty going to sleep.

Difficulty staying asleep

• Distressing Dreams or Nightmares:  Nightmares are typical for people with PTSD. Usually, the nightmares tend to be about the traumatic event or some aspect of it. For example, in Vietnam veterans, nightmares are usually about traumatic things that happened in combat. In dreams, the person with PTSD may also attempt to express the dominant emotions of the traumatic event; these are usually fear and terror. For example, it is not uncommon to dream about being overwhelmed by a tidal wave or swept up by a whirlwind.
  
• Night Terrors: These are events such as screaming or shaking while asleep. The person may appear awake to an observer, but he or she is not responsive.
• Thrashing Movements: Because of overall hyper-arousal, active movements of the arms or legs during bad dreams or nightmares may cause awakening. For example, if one were having a dream about fleeing an aggressor, one might wake up because of the physical movements of trying to run away.
• Anxiety (Panic) Attacks: Attacks of anxiety or outright panic may interrupt sleep. Symptoms of such attacks may include: 

• Hearing the Slightest Sound and Waking Up to Check for Safety: Many people with PTSD, especially combat veterans, wake up frequently during the night. This can be for various reasons. However, once awake, a "perimeter check," or a check of the area, is often made. For example, a Vet may get up, check the sleeping area, check the locks on windows and doors, and even go outside and walk around to check for danger. Then the Vet may stay awake and vigilant and "stand guard;" he (or she) may not return to sleep that night.

What can you do if you have problems sleeping due to PTSD?

Talk to your doctor

Let your doctor know that you have trouble sleeping. Tell your doctor exactly what the problems are; he or she can help you best if you share this information about yourself.

Let your doctor know that you have (or think you have) PTSD. It is not your fault that you have these symptoms. Tell your doctor exactly what they are.

Let your doctor know about any physical problems that you think are contributing to your sleep problems. For example, chronic pain associated with traumatic injuries can make it difficult to sleep.

Let your doctor know about any other emotional problems you have–these may also be contributing to your sleep problems. For example, depression or panic attacks can make it hard to fall asleep or to stay asleep.

There are a number of medications that are helpful for sleep problems in PTSD. Depending on your sleep symptoms and other factors, your doctor may prescribe some medication for you.

Your doctor may recommend that you work with a therapist skilled in dealing with emotional and behavioral problems. Psychologists, social workers, and psychiatrists fall into this category. They can help you take a closer look at, and possibly change, the variety of factors that may be preventing you from sleeping well. They can help you with PTSD and other problems.

Do not use alcohol or other drugs

These substances disturb a variety of bodily processes. They impair a person’s ability to get a good night’s sleep. For example, alcohol may help a person fall asleep, but it interferes with one’s ability to stay asleep.

If you are dependent on drugs or alcohol, let your doctor know, and seek assistance for this problem.

Other Strategies

• Limit substances that contain caffeine (e.g., soda, coffee, some over-the-counter medicines).
• Try to set a regular sleep/wake schedule:

• Make your sleeping area as free from distractions as possible:

• Consider a light nighttime snack:

• Avoid over-arousal for at least 2-3 hours prior to going to sleep:

• Don’t worry that you can’t sleep: