Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.
Those with chronic pain, substance abuse, traumatic brain injury, depression, or other medical problems face an additional barrier to getting quality sleep. Certain sleep medications also interfere with REM sleep, which is the sleep stage during which we dream and an important sleep stage for dealing with traumatic memories.
The most common sleep problems in PTSD can be summed up in three categories:
Insomnia: An estimated nine in ten people with PTSD suffer from insomnia. This is largely due to hyperarousal, in which the individual is unable to relax. It may also be a lingering effect of having been in a situation that required constant alertness at night. Insomnia in PTSD may also be self-perpetuating, as the stress of not being able to fall asleep eventually leads to maladaptive sleep behaviors such as daytime napping or substance abuse.
Nightmares and Night Terrors: Nightmares and night terrors plague a majority of people with PTSD, leading to nighttime awakenings and making it difficult to get back to sleep. The content of these vivid dreams is sometimes related to past trauma, with many PTSD sufferers reporting repetitive nightmares. Nightmares are sometimes treated with imagery rehearsal therapy, in which the patient “rewrites” the script of the dream with a less threatening version during waking hours.
Treating PTSD-related sleep problems, as well as co-existing disorders such as depression, is an important part of resolving overall PTSD symptoms.