Nearly 7% of Americans will be diagnosed with post-traumatic stress disorder (PTSD) sometime during their lifetime. In any given year, 3.5% of Americans have PTSD. Many struggles with sleep problems like insomnia, sleep too, and nightmares. For people struggling with the trauma during the day, the night can feel like a battlefield that offers little respite from traumatic memories and troublesome thoughts.
Are Sleep Problems a PTSD Symptom?
The trauma changes the brain and these changes can also affect sleep. The Diagnostic and Statistical Manual (DSM) reports sleep disorders – such as insomnia, frequent awakening or nightmares – as one of the many possible symptoms of PTSD. In particular, in order to be diagnosed with PTSD, an individual must present at least two of the six "lesions in stimulation and activity". These changes include:
For some people, other stimulation symptoms play a role in sleeping problems. For example, a person who is restless and deplorable can be afraid too much to sleep, while a person with an increased response can awaken awake in every sound as he drives to sleep. This change in sleep may also aggravate other symptoms of PTSD. A chronically exhausted person may be more irritable or more difficult to concentrate.
Some research shows that sleeping problems are more than just a symptom of PTSD. Instead, they may be a key element of diagnosis. A research published in 1989 suggests that REM is a sign of PTSD that plays an important role in other symptoms of PTSD. Subsequent surveys produced mixed results. While some studies, including animals, find a pattern of REM-related PTSD disorders, others do not.
A review of the 2013 literature suggests that sleep disorders, especially REM sleep, may increase the risk of PTSD. Sleep problems can also aggravate the results in people with PTSD. The study further argues that sleep problems can reduce the effectiveness of many PTSD treatments and that targeted treatments for sleep problems can speed up recovery.
How Does PTSD Affects Sleep?
People with PTSD often find that their traumatic memories hamper their ability to sleep. Some common symptoms of sleep associated with PTSD include:
- It is unable to sleep due to anxiety or agitation.
- Difficulty sleeping due to frequent nightmares.
- Poor sleep quality due to nightmares. Some people say they wake up many times each night and struggle to fall asleep each time. This is called maintenance insomnia.
- Sleep problems related to drugs or alcohol. Some people with PTSD use alcohol or medication to deal with, which can cause sleep problems. Certain medicines for PTSD and anxiety can also cause sleep problems. For example, benzodiazepines may have difficulty waking up in the morning.
A study comparing insomnia without PTSD in people with PTSD and insomnia associated with the battle found significant differences in the two groups. These include:
- More recurring nightmares in people with PTSD. People with PTSD were more likely to say that their nightmares were having difficulty returning to sleep.
- More worries during the day for people with PTSD.
- More fatigue during the day between people with PTSD.
This suggests a feedback loop between sleep problems and other PTSD symptoms. Sleep problems can exacerbate PTSD symptoms during the day, which can make it difficult to sleep at night. People who feel anxious or tired during the day can more exterminate their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.
Sleep problems can exacerbate PTSD symptoms during the day, which can make it difficult to sleep at night. People who feel anxious or tired during the day can more exterminate their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.
Other sleeping problems and PTSD
Sleep problems are common, even in people without PTSD. A 2009 study found that about 30% of people experience insomnia in a given year. Some people also struggle with sleep too much or by not feeling rested after sleeping. This may be due to:
- Displacement sleep disorder, a situation that alters the "inner clock" of people working nights or unusual hours.
- Sleep deprivation, a disorder that affects breathing during sleep, forcing people to wake up often many times during the night.
- Sleep Disorder, which causes people to do unusual things while sleeping, such as sleepwalking, driving or eating.
People with PTSD who have a pre-existing sleep disorder may find their symptoms worse after a traumatic experience. Conditions that affect sleep can also combine the effects of PTSD, leading to depression, anger, difficulty in concentrating, and more PTSD symptoms.
Even when the symptoms of a sleep disorder are not directly related to PTSD, it is important to get help. Quality sleep is an important component of personal PTSD care.
PTSD related sleep problem strategies
Lifestyle changes can help some people who have PTSD to sleep more loudly. The National Sleep Foundation stresses that sleep is a habit, so the right changes can help the body to adopt healthy sleep patterns that offer better sleep. Try the following:
- Design a comfortable sleeping area with a stable and supportive mattress and a comfortable pillow.
- Develop a relaxing ritual for sleeping.
- Take care of the same sleep schedule every day, even on weekends or holidays.
- Avoid sleeping during the day if you have trouble sleeping at night.
- Exercise every day, but not before bed.
- Keep your bedroom cool, between 60-67 degrees Fahrenheit.
- Keep the bedroom quiet. Some people find that it helps a white noise engine.
- If you can not sleep, pick up and do something else.
- Use your bed only for sleep – not to play, read, or work.
- Eat a light snack 45 minutes before bed if you tend to wake up hungry.
- Avoid heavy meals, alcohol, caffeine and cigarettes before bedding. Some people find eating caffeine in the afternoon making it harder to sleep.
Stress and anxiety management strategies can be particularly useful for managing PTSD-related sleep problems. Some people find relief from meditation or yoga. Others find that guided pictures or positive mantras trying to sleep can help.
Medicines, including anxiety and sleep medication, can help some people. However, when the underlying PTSD symptoms remain, sleep problems are likely to return when you stop using medication.
Treatment can help with both sleep problems and PTSD. A compassionate therapist will help you work through your trauma in a safe, free judgment. Your therapist can help you set goals, cultivate new tools for stress management, help you understand how the wound changes the brain and work with your doctor to decide which drugs are appropriate.
PTSD may feel overwhelming. Some people become depressed because they think things will never change. Others are too exhausted to work or enjoy time with their family. It does not have to be this way. Contact a therapist who is specialized in the treatment of PTSD.
- Germain, A. (2013). Sleep disturbances as a feature of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176 / appi.ajp.2012.12040432
- Gradus, J.L. (2007, 31 January). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
- Healthy sleeping tips. (n.d.). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
- Inman, D.J., Silver, S.M., & Doghramji, K. (1990). Sleep disturbances in post traumatic stress disorder: A comparison with insomnia without PTSD. Journal of Traumatic Stress, 3 (3), 429-437. doi: 10.1007 / BF00974782
- Phillips, K. (2015, February 4). What are the types of sleep disorders? Complete list of sleep disorders. Retrieved from http://www.alaskasleep.com/blog/types-of-sleep-disorders-list-of-lear-disorders
- Sleep and PTSD. (2015 August 13). Retrieved from https://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
- Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . Hyman, S.E. (2015). Post traumatic stress disorder. Nature Reviews Primary diseases, 15057. Retrieved from https://www.nature.com/articles/nrdp201557#t1
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