Sleep Problems When You Have PTSD

Young woman lying on her bed
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It is very common for people with a diagnosis of PTSD to experience some type of problem sleeping. In fact, difficulty falling and/or staying asleep is considered one of the hyperarousal symptoms of PTSD, and studies have found that sleep problems are one of the most commonly reported symptoms reported by people with PTSD.

Sleep Problems in PTSD

People with PTSD may experience a number of different types of sleep problems. Many people with PTSD have difficulties falling asleep as compared to people without PTSD. In fact, one study of Vietnam veterans found that 44% of those with PTSD said that they have trouble falling asleep at night, whereas less than 10% of combat veterans without PTSD said that they have this problem.

People with PTSD may wake up frequently during the night, have difficulty falling back asleep, or may wake up earlier than they intended. Also, even if sleep does occur, it is often not good, restful sleep.

Of course, nightmares are also very common among people with PTSD. Nightmares are considered one of the re-experiencing symptoms of PTSD. Among people with PTSD, nightmares may be about the traumatic event a person experienced or they may be about some other upsetting or threatening event.

Finally, because of these sleep problems, people with PTSD often develop fears about going to sleep. They may experience worries or thoughts about their traumatic event as soon as they go to bed. They may also fear acting out their nightmares while asleep or impulsively upon being woken up from a nightmare, leading them to sleep alone away from their partners.

Causes

Sleep problems are often one of the more difficult symptoms of PTSD to treat and the exact causes of these sleep problems in PTSD are complex.

Nightmares

It has been suggested that the fear of falling asleep and having nightmares affects the quality of sleep for people with PTSD.

Hyperarousal

Sleep problems among people with PTSD may also be the result of experiencing frequent symptoms of hyperarousal. Constantly being on guard, tense, and on edge may interfere with one's ability to fall and/or stay asleep.

A person may be more sensitive to sensory stimuli, even while asleep, and as a result, be more likely to wake up even in response to minor sounds.

Sleep Apnea

Emerging research is examining why people with PTSD may be more likely to develop sleep apnea. People with PTSD will often show many sleep apnea risk factors.

For example, they may be more prone than people without PTSD to:

  • Have high blood pressure
  • Be overweight
  • Smoke
  • Have diabetes or other physical health problems
  • Abuse alcohol

Sleep apnea is a common and treatable condition.

Loss of Control

People with PTSD may also view going to sleep as a loss of control. Fear of sleep may play a significant role in sleep problems in PTSD.

Finally, the sleep problems connected with PTSD may lead to a problematic cycle. Because of a lack of sleep during the night, a person may sleep more during the day, leading to greater difficulties falling asleep at night.

Coping and Getting Help

Sleep problems are important to address because poor sleep can lead to a number of other problems. A lack of sleep or poor sleep quality can be a factor contributing to stress and mood problems. Poor sleep can also have a negative impact on your physical health.

Pharmacologic interventions are sometimes necessary for the sleep problems that accompany PTSD, however changing sleep habits may also be helpful in improving your ability to fall asleep. Fortunately, there are a number of things you can do to improve your sleep.

Stick to a Schedule

Sleep problems can be avoided by exercising during the day. However, make sure to avoid rigorous exercise within one hour of your bedtime because that can keep you awake late at night. With that in mind, it's also important to stick to a regular sleep schedule, so you're accustomed to going to bed at the same time every night.

Pay Attention to Your Eating and Drinking Habits

Avoid eating heavy meals before going to bed; however, make sure that you do not go to bed hungry. Either move can disrupt your sleep schedule. You should also reduce the amount of caffeine and nicotine that you consume during the day. Avoid drinking caffeine after lunchtime, and do not smoke before going to bed. Avoid consuming alcohol within a few hours of your bedtime as well.

Healthy Sleeping Habits

According to the National Sleep Foundation, the best time to nap is between 1 and 3 p.m. when the body's circadian rhythms naturally drop. Forcing yourself to fall asleep will never work. If you are having a hard time falling asleep after 20 to 30 minutes, get up out of bed and try to do something relaxing (for example, drinking herbal tea, reading a book). Do not return to bed until you feel drowsy.

Try to make your bedroom a relaxing place, and try to limit your activities in the bedroom. For example, do not eat, watch television, check email on your laptop or talk on the phone in bed. Your bedroom should be associated with sleep.

Try to keep your bedroom at a cool and comfortable temperature. Use a white noise machine, earplugs, or an eye mask to help block out any distracting noises or light.

Try to Relax

Practice relaxation exercises before bed to release muscle tension and slow down your breathing. Many people experience worry when they go to bed at night. Practice mindfulness to separate yourself from these worries.

Use medications for sleep cautiously and only under a physician's recommendation. Find ways to express and process unpleasant emotions and thoughts. Some sleep problems may be due to a person not adequately coping with stress. Journal or seek out social support to limit the amount of stress that you carry into your sleep.

A Word From Verywell

It may also be important to obtain treatment for your PTSD. Given that many of the sleep problems experienced by people with PTSD are thought to result from the symptoms of PTSD, a reduction of those symptoms may also improve your sleep.

You can find out more information about treatment providers in your area who might offer PTSD treatments through the Anxiety and Depression Association of America, or if you're a veteran, check out the Wounded Warrior Project. However, it is important to note that people sometimes find that their sleep problems remain even after the successful treatment of PTSD. Therefore, it may be important to also seek out assistance from doctors that specialize in sleep problems.

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