Post-Traumatic Stress Disorder and Insomnia

Trouble sleeping can be a passing problem or a chronic condition. People who have experienced significant trauma, such as veterans, often have difficulty sleeping. Insomnia is a sleep disorder where people have trouble falling asleep or staying asleep.^1-9

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition. It can develop after a traumatic experience. People who have PTSD replay the traumatic event(s) in their mind. This can include experiencing war, domestic or military violence, natural catastrophe, sexual assault, among other life-threatening events. PTSD can affect daily function and cause distress. This can lead to nightmares, waking up in the middle of the night, and fear of sleep.^1,2,5,9

Symptoms of PTSD can include:¹

• Replaying the traumatic event through flashbacks and nightmares that cause distress
• Emotional distress: brought on by efforts to avoid reminders of the traumatic event, including people, places, and activities
• Hyperarousal: being hyper aware, having difficulty sleeping and concentrating, becoming easily agitated, irritated, and angered

What is insomnia?

Insomnia is defined as trouble falling asleep or staying asleep. It can be acute, lasting a limited time or chronic, lasting for months or longer. Insomnia develops more often in women and people with certain physical and mental health conditions.

How does PTSD affect sleep?

It is common for people with PTSD to have trouble sleeping. In fact, having trouble falling or staying asleep are common symptoms of PTSD. It can affect sleep by contributing to insomnia and triggering flashbacks and nightmares. Some people with PTSD are afraid to sleep. They may be hypervigilant; listening to every sound, feel tense or on edge, or fearful of being attacked. It is a common complaint of veterans. This contributes to poor quality sleep.^1,2,4,6,8,9

Studies report that up to 90 percent of people with PTSD report trouble sleeping. This can include insomnia, not enough restorative sleep, and nightmares. A common treatment approach is to take prescription sleep medications. These can produce undesirable side effects, especially for people with PTSD. Yet those who go undiagnosed or untreated may be at increased risk for poorer physical and mental health. This can make it harder to manage activities of daily living such as functioning at work, participating in family and social activities, and maintaining relationships.⁷

Trouble sleeping at night can cause increased daytime sleep. This, in turn, can make normal nighttime sleep even harder. It can lead to increased stress and other psychological problems. Poor sleep can make other symptoms of PTSD worse. More severe and prolonged PTSD can result in worse or more frequent nightmares. This can lead to increased insomnia.^2,4,8

Some who suffer from PTSD drink alcohol to manage their stress, potentially negatively impacting sleep. Limiting alcohol, caffeine, and nicotine can help improve sleeping.^8,9

Treatment options

Insomnia often goes undiagnosed and untreated. Treatment options for people with PTSD who have insomnia include good sleep habits, drugs, psychological counseling, and therapy.³

It is also important to treat any preexisting medical or mental health conditions such as anxiety, depression, panic disorder, or substance abuse which can also disrupt sleep.^1,2

Good sleep habits

Good sleep habits can help reduce insomnia and improve the quality and quantity of restful sleep.^1,2

• Use the bedroom just for sleeping
• Do not use electronics/screens before or in bed
• Keep the bedroom cool
• Minimize noise
• Practice relaxation techniques

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy. It requires a limited number of sessions which are focused on helping people to become aware of inaccurate or negative ways of thinking. It helps to give you a set of tools to identify and effectively respond to specific situations. It can be a short-term intervention with long-lasting results.^7,10

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is a specific psychological and behavioral approach to treating insomnia. It is an established treatment to effectively improve sleep in people with PTSD. CBT-I is a highly structured intervention. It uses core behavioral elements to manage:⁷

• Stimuli
• Sleep restriction
• Sleep hygiene
• Cognitive intervention of catastrophic beliefs
• Attitudes towards sleep
• Relapse prevention

It has also demonstrated benefits in managing nightmares, and other symptoms of PTSD, anxiety, depression, and general functioning ability. Various studies have used multiple reporting tools to measure positive outcomes including improved sleep quality, psychosocial functioning, and a decreased fear of sleeping.^5-7