Post-traumatic stress disorder (PTSD) is a mental health condition that some people develop after experiencing or witnessing a traumatic event. PTSD can cause a wide range of symptoms, including problems with sleep.
What are the common sleep problems in PTSD?
There are several sleep disturbances that are commonly experienced by people with PTSD:
- Insomnia – Difficulty falling or staying asleep
- Nightmares – Distressing, vivid dreams that often relate to the traumatic event
- Sleep apnea – Interrupted breathing during sleep
- Restless leg syndrome – Unpleasant sensations in the legs accompanied by an urge to move them
- Bruxism – Grinding or clenching of teeth during sleep
Insomnia is one of the most frequently reported sleep problems in PTSD. Many people with PTSD struggle to fall asleep or stay asleep throughout the night. They may lay awake for hours, waking up frequently or waking up very early in the morning. Nightmares are also very common, with studies showing over 70% of people with PTSD experience frequent nightmares relating to their trauma. These nighttime symptoms can make it difficult to function during the day.
What causes sleep problems in PTSD?
There are several factors that are believed to contribute to sleep disturbances in PTSD:
- Hyperarousal – PTSD often involves increased arousal and anxiety, making it difficult to relax and fall asleep. The body’s fight-or-flight response system remains activated.
- Changes in brain function – Studies show there are differences in brain activity in PTSD that may affect sleep and circadian rhythms.
- Depression and anxiety – Many people with PTSD also have co-occurring depression or anxiety disorders, which commonly cause insomnia.
- Medications – Some medications used to treat PTSD symptoms can interfere with sleep.
- Alcohol and substance use – Some people use alcohol or drugs to cope with PTSD, which can disrupt sleep patterns.
The intrusive memories and heightened arousal seen in PTSD make it very difficult for the body and mind to relax into restful sleep. Nightmares often occur during periods of REM sleep, when dreaming is more frequent. Brain pathways involving fear and stress responses may be altered.
How does lack of sleep affect people with PTSD?
Sleep problems tend to exacerbate PTSD symptoms, creating a vicious cycle. Effects of poor sleep in people with PTSD include:
- Increased irritability and anger
- Difficulty concentrating
- Memory and cognition problems
- Lack of motivation
- Fatigue, low energy
- Depressed mood
- Greater sensitivity to pain
- Impaired immune system functioning
Sleep deprivation has major effects throughout the body. Ongoing lack of quality sleep takes a toll both physically and mentally. Some research indicates poor sleep can contribute to increased suicidality in those with PTSD. Getting adequate sleep is an important part of coping with PTSD and improving mental health.
What treatments help improve sleep in PTSD?
It’s important to address sleep problems early in PTSD treatment. Some therapies and medications that may help include:
- Cognitive behavioral therapy (CBT) – Helps modify thoughts/behaviors that affect sleep.
- Imagery rehearsal therapy – Focuses on changing nightmare content.
- Relaxation techniques – Quiets the mind and body before bedtime.
- Medications – Prazosin, tricyclic antidepressants, and sedating antidepressants can improve sleep.
- Light therapy – Resets circadian rhythms.
- Avoidance of screens – Reduces stimulation and blue light exposure before bed.
Developing good sleep habits is also very important. Having a regular relaxing bedtime routine, limiting caffeine, exercising during the day, and making the bedroom comfortable and tech-free can all promote better sleep.
What are the statistics on sleep problems in PTSD?
Studies have found very high rates of sleep disturbances among those diagnosed with PTSD:
- Up to 90% experience insomnia symptoms
- 71-96% have frequent nightmares
- About 50% meet the criteria for nightmare disorder
- 28-90% have clinically significant sleep apnea
- Restless leg syndrome is 2-3 times more common in PTSD
Problems sleeping are a core symptom of PTSD. However, the exact statistics vary widely between studies due to different populations and diagnostic methods. Overall, sleep disruptions affect the majority of those with PTSD.
What sleep stages are affected in PTSD?
PTSD mainly impacts REM sleep and non-REM sleep:
- REM sleep – Increased REM density but fragmentation of REM cycles.
- Light non-REM sleep – Higher proportion compared to deep sleep stages.
- Deep non-REM sleep – Reduced slow wave sleep duration and continuity.
People with PTSD spend more time in lighter non-REM sleep stages 1 and 2 rather than deep restorative stages 3 and 4. Frequent awakenings disrupt REM and non-REM cycles throughout the night. Poor sleep efficiency and shifting sleep architecture are common findings.
Do sleep medications help PTSD?
Sleep medications can temporarily improve sleep duration and reduce awakenings. However, they do not treat the underlying cause of sleep disruption in PTSD. Some concerns with sleep medication include:
- Only provide short-term relief
- Cause grogginess and impaired functioning the next day
- Can lead to dependence and tolerance over time
- Worsen symptoms like depression or insomnia when stopped
- Some increase risk of dangerous sleep behaviors like sleepwalking
Medications should be used cautiously and in conjunction with psychotherapy targeted at PTSD and sleep. They are not a cure on their own. Non-medication treatments should be tried first when feasible.
Can PTSD cause other sleep disorders?
Yes, PTSD increases the risk of developing a number of secondary sleep disorders:
- Sleep apnea – Linked to arousal disturbances that relax throat muscles.
- Restless leg syndrome – Associated with neurotransmitter imbalances caused by PTSD.
- Night eating syndrome – PTSD can increase appetite changes and cravings at night.
- Delayed sleep phase disorder – Circadian rhythm shifts make it hard to fall asleep earlier.
PTSD does not directly cause these conditions but raises susceptibility through various biological and behavioral mechanisms. Treating the PTSD can often help alleviate these secondary sleep problems as well.
Are there gender differences in PTSD sleep patterns?
Studies have found some gender differences in sleep disturbances seen with PTSD:
- Women tend to have more insomnia, non-restorative sleep, and body movement during sleep.
- Men experience more sleep apneas and are more likely to meet criteria for sleep apnea diagnosis.
- Women have more vivid, intense nightmares than men.
- Men with PTSD more often show blunted REM cycles and lack of dream recall.
However, both genders are significantly impacted by symptoms like insomnia, nightmares, and restless sleep in PTSD. More research is still needed on how gender influences sleep in PTSD.
Can PTSD cause sleep paralysis?
Sleep paralysis involves temporary inability to move when first waking up or falling asleep. PTSD is associated with an increased risk of experiencing sleep paralysis episodes. Possible reasons include:
- Disruptions between sleep stages from PTSD can trigger sleep paralysis.
- PTSD hyperarousal causes rapid transitions between wake and REM sleep.
- Nightmares and flashbacks create fear of going to sleep.
- Medications like SSRIs may contribute to sleep paralysis.
The immobilization and panic felt during sleep paralysis can be very disturbing for PTSD sufferers. Relaxation and grounding techniques can help short-circuit episodes.
Does PTSD increase risk of dementia and Alzheimer’s disease?
There is conflicting evidence on whether PTSD is linked to an increased risk of dementia. Some studies have found associations, while others have not. Potential mechanisms proposed include:
- Ongoing stress hormones like cortisol may damage the hippocampus over time.
- Reduced deep sleep from PTSD may fail to clear waste proteins in the brain.
- PTSD causes shrinkage and loss of volume in parts of the brain like the hippocampus.
However, there are many unanswered questions about the interactions between PTSD, sleep, brain changes, and dementia risk. More longitudinal research is needed. Managing PTSD symptoms and sleep problems may help lower any elevated risks.
Can service dogs or companion animals help with PTSD sleep issues?
Having a service dog or emotional support animal can provide comfort and security that helps some people with PTSD sleep better. Benefits may include:
- Lowering anxiety and hypervigilance at night
- Decreasing nightmares through their comforting presence
- Motivating people to stick to a sleep routine
- Waking PTSD sufferers from nightmares
- Stopping panic attacks or flashbacks by redirecting focus
The unconditional love and constant companionship of an animal can be healing. Their presence can buffer the fear response. However, animals may not work for everyone with PTSD.
What are the best sleeping positions for PTSD sufferers?
The best sleeping positions for people with PTSD include:
- On your back – Keeps airway open if sleep apnea is present.
- On your side – Reduces pressure points and risk of neuropathy.
- With head elevated – Can minimize sleep apnea breathing pauses.
- With a pillow between knees – Maintains spine alignment and prevents pain.
- In a comfortable, safe room – Minimizes hypervigilance and startle response.
Avoid positions that cause pain or breathing issues. Listen to your body’s feedback. Use extra pillows for support and keep room temperature cool for restful sleep.
What foods and drinks help sleep in PTSD?
Some foods and drinks that can aid sleep by increasing serotonin and relaxing muscles include:
- Warm milk – Contains tryptophan.
- Bananas – Contains melatonin and magnesium.
- Oatmeal – High in sleep-promoting carbs.
- Chamomile tea – Has apigenin that binds to GABA receptors.
- Kiwi – Rich in antioxidants and serotonin.
- Tart cherry juice – Contains melatonin.
Avoid heavy meals, sugary foods, caffeine, and alcohol too close to bedtime. Staying hydrated can also improve sleep quality.
Can light therapy help reset circadian rhythms in PTSD?
Light therapy exposes the eyes to bright, artificial light for a prescribed length of time each day. This can help synchronize circadian rhythms that regulate sleep. Benefits may include:
- Increased daytime alertness.
- Improved nighttime sleep quality and duration.
- Less depression and PTSD symptoms like flashbacks.
- Better mood and cognitive function throughout the day.
Light therapy is often used in the morning hours. It should be timed properly based on your body’s circadian rhythms for optimal effects.
What vitamins, minerals, or supplements help sleep with PTSD?
Some natural remedies that may aid sleep in PTSD include:
- Magnesium – Lessens anxiety and hypertension.
- Vitamin D – Regulates circadian rhythms.
- Calcium – Needed for melatonin synthesis.
- 5-HTP – Boosts serotonin production.
- Valerian root – Increases GABA neurotransmitter levels.
- Melatonin – Directly regulates sleep cycles.
Always consult your doctor before beginning supplements, especially if taking other medications. Dosage, drug interactions, and timing are important to review.
Can audio apps with nature sounds, ASMR, or mediations help sleep with PTSD?
Relaxing audio tracks can engage the parasympathetic nervous system to reduce hyperarousal and anxiety at bedtime. Benefits of listening to apps with nature, ASMR, or guided meditations include:
- Blocks out ambient noises that trigger reactions.
- Focuses the mind on something other than trauma.
- Decreases heart rate and blood pressure.
- Releases calming neurotransmitters like serotonin.
- Induces physical tingles and sensations that soothe the body.
The soothing voices and peaceful themes can quiet racing thoughts when trying to sleep. These should be played at low, comfortable volumes to aid rest.
Sleep disturbances are very common in people with PTSD. Problems like insomnia, frequent nightmares, and sleep apnea often create a vicious cycle by worsening PTSD symptoms. However, treatments such as cognitive behavioral therapy, medications, light therapy, and improving sleep habits can help improve sleep quality. Addressing sleep issues should be a key priority in PTSD management.