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.
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:
o Feeling your heart beating very fast
o Feeling that your heart is "skipping a beat"
o Feeling lightheaded or dizzy
o Having difficulty breathing (e.g., tight chest, pressure on chest)
o Sweating
o Feeling really hot ("hot flashes")
o Feeling really cold (cold sweat)
o Feeling fearful
o Feeling disoriented or confused
o Fearing that you may die (as a result of these symptoms)
o Thinking and feeling that you may be "going crazy"
o Thinking and feeling that you may "lose control"
- 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:
A consistent sleep schedule helps to regulate and set the body’s "internal clock," which tells us when we are tired and when it is time to sleep, among other things.
- Make your sleeping area as free from distractions as possible:
Aim for quiet surroundings; keep the room darkened; keep the television out of the bedroom.
- Consider a light nighttime snack:
A light snack after dinner may prevent hunger from waking you up in the middle of the night.
- Avoid over-arousal for at least 2-3 hours prior to going to sleep:
Try not to get your body and mind in "arousal mode." Things that may tend to do this are: heavy meals, strenuous exercise, heated arguments, paying bills, and action-packed movies.
- Don’t worry that you can’t sleep:
Remember, there may be a number of reasons for your sleep problems. The first step is to talk to your doctor.
Related Fact Sheets
Discussing PTSD
with your doctor
A useful checklist to help discuss traumatic stress symptoms with primary care
physicians
PTSD and physical health
An overview of recent research confirming that trauma and PTSD affect physical
health
What is PTSD?
Answers basic questions about the signs and symptoms of PTSD, who gets it,
how common it is, and what treatments are available
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