PTSD Related Conditions Sleep Problems When You Have PTSD By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on September 17, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Peter Glass / Design Pics / Getty Images Table of Contents View All Table of Contents Sleep Problems in PTSD Causes Nightmares Hyperarousal Sleep Apnea Loss of Control Coping and Getting Help Stick to a Schedule Pay Attention to Your Eating and Drinking Habits Healthy Sleeping Habits Try to Relax A Word From Verywell 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 pressureBe overweightSmokeHave diabetes or other physical health problemsAbuse 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. 21 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Koffel E, Khawaja IS, Germain A. Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment. Psychiatr Ann. 2016;46(3):173-176. doi:10.3928/00485713-20160125-01 Neylan TC, Marmar CR, Metzler TJ, Weiss DS, Zatzick DF, Delucchi KL, et al. Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry. 1998;155:929-933. doi:10.1176/ajp.155.7.929 Sareen J. Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. Can J Psychiatry. 2014;59(9):460-7. doi:10.1177/070674371405900902 Khazaie H, Ghadami MR, Masoudi M. Sleep disturbances in veterans with chronic war-induced PTSD. J Inj Violence Res. 2016;8(2):99-107. doi:10.5249/jivr.v8i2.808 El-solh AA. Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nat Sci Sleep. 2018;10:409-420. doi:10.2147/NSS.S166089 Paul F, Schredl M, Alpers GW. Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study. Borderline Personal Disord Emot Dysregul. 2015;2:3. doi:10.1186/s40479-014-0023-4 Nappi CM, Drummond SP, Hall JM. Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence. Neuropharmacology. 2012;62(2):576-85. doi:10.1016/j.neuropharm.2011.02.029 Colvonen PJ, Masino T, Drummond SP, Myers US, Angkaw AC, Norman SB. Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND Veterans. J Clin Sleep Med. 2015;11(5):513-8. doi:10.5664/jcsm.4692 American College of Cardiology. Sleep Apnea and High Blood Pressure: A Dangerous Pair. Farr OM, Sloan DM, Keane TM, Mantzoros CS. Stress- and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments. Metab Clin Exp. 2014;63(12):1463-8. doi:10.1016/j.metabol.2014.08.009 American Sleep Apnea Association. Sleep Apnea Treatment Options. Pruiksma KE, Taylor DJ, Ruggero C, Boals A, Davis JL, Cranston C, Jason C. DeViva JC, Zayfert C. A Psychometric Study of the Fear of Sleep Inventory-Short Form (FoSI-SF). J Clin Sleep Med. 2014;10(5):551-558. doi:10.5664/jcsm.3710 Fernandez-mendoza J, Vgontzas AN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep. 2013;15(12):418. doi:10.1007/s11920-013-0418-8 LeWine H. Harvard Health Publishing. Does exercising at night affect sleep?. Todd CL. SELF. Is Late-Night Snacking Really So Wrong?. Cleveland Clinic. Why You Should Limit Alcohol Before Bed for Better Sleep. National Sleep Foundation. Debunking Sleep Myths: Does Napping During the Day Affect Your Sleep at Night?. National Sleep Foundation. Electronics in the Bedroom: Why it’s Necessary to Turn Off Before You Tuck In. Ong J, Sholtes D. A mindfulness-based approach to the treatment of insomnia. J Clin Psychol. 2010;66(11):1175-84. doi:10.1002/jclp.20736 Lie JD, Tu KN, Shen DD, Wong BM. Pharmacological Treatment of Insomnia. P T. 2015;40(11):759-71. Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res. 2018;20(12):e10124. doi:10.2196/10124 Additional Reading Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry. 1995;152:110-115. doi:10.1176/ajp.152.1.110 Schreuder BJN, Kleijn WC, Rooijmans HGM. Nocturnal re-experiencing more than forty years after war trauma. Journal of Traumatic Stress. 2000;13:453-463. doi:10.1023/A:1007733324351 By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.