Sleep and PTSD


Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop after a traumatic event. While studies suggest that up to 90% of people (1) will experience at least one potentially traumatic event in their lifetime, less than 7% of people (2) will develop PTSD. PTSD is more common in women and those with little social support after the traumatic event (3).

During a stressful experience, the body releases hormones and chemicals (4) to shift into a fight-or-flight state. After the experience ends, most people recover as these hormones and chemicals return to normal levels. For people who develop PTSD, the body remains in fight-or-flight mode long after a traumatic experience has ended.

Sleep and PTSD

Sleep issues affect up to 90% of people with PTSD (5). Although researchers are still working to understand the complex relationship between PTSD and sleep, evidence suggests that sleep issues are a core feature of PTSD (6). Sleep appears to influence the development of PTSD, and poor sleep may be a driver of PTSD symptoms. Inversely, PTSD symptoms often interfere with sleep.

According to the American Psychiatric Association, PTSD is associated with four categories of symptoms (7):

  • Intrusive Thoughts: People with PTSD may feel like they’re constantly reliving the traumatic experience through intrusive thoughts and flashbacks during the day and/or nightmares at night. Nightmares can significantly reduce sleep quality and cause a person to wake up throughout the night.
  • Avoidance: A person with PTSD may begin to avoid the people, places, and situations that remind them of the traumatic experience. People coping with recurrent nightmares may even start to fear or avoid sleep (8).
  • Hyperarousal: After a traumatic experience, a person may become hyper-aware of potential danger and easily startled. When the body remains in a fight-or-flight state, it can be difficult to fall asleep. Approximately 41% of people diagnosed with PTSD have trouble falling asleep.
  • Negative Thoughts and Feelings: A person with PTSD may develop distorted beliefs about the traumatic event, themselves, or other people. These thoughts and feelings may leave the person feeling unable to enjoy activities that used to bring pleasure. Unhelpful beliefs and ways of coping with PTSD may increase insomnia.

Each of these symptoms may be considered healthy in the immediate aftermath of a traumatic event. A healthcare professional may assess for PTSD if symptoms last more than a month or cause impairment in a person’s ability to function. A mental health professional who has experience working with people with psychiatric disorders, like a psychiatrist or psychologist, can help diagnose PTSD (9).

PTSD Nightmares

Nightmares can be a particularly distressing symptom of PTSD and are often what leads people to seek treatment for their symptoms. Around 67% of people diagnosed with PTSD (10) experience regular nightmares. Half of the  people who have PTSD-related nightmares have dreams in which they relive the traumatic experience (11).

One approach to treating nightmares is Imagery Rehearsal Therapy (IRT). In IRT, a person turns their nightmare into a script or a story, then rewrites it with a new ending. Research shows that regularly rereading the new script with a non-scary ending can decrease the frequency of nightmares.

Untreated sleep apnea and other sleep-related breathing disorders may also increase nightmares and disturbing dreams (12) in people with PTSD. Research suggests that treating sleep-related breathing disorders can reduce nightmares by 50%. If you’re experiencing recurring PTSD nightmares, it may be helpful to talk to a doctor about potentially undiagnosed breathing disorders.

Treatments for PTSD

PTSD can be treated. Although the symptoms of PTSD can be debilitating, there are several evidence-based treatment approaches that may help, according to the National Institute of Mental Health:

  • Psychotherapy: Psychotherapy, also called talk therapy, involves talking to a mental health professional about a person’s symptoms. Talk therapy helps people learn ways of responding to the events that trigger their symptoms. There are many types of psychotherapy that are beneficial.
  • Medication: Medications may help reduce PTSD symptoms, including symptoms related to sleep issues and nightmares. Many people diagnosed with PTSD symptoms benefit from a combination of talk therapy and medications. Please speak to your psychiatrist to determine if medication is right for you.

Improving Sleep with PTSD

Getting sufficient sleep and improving sleep quality may decrease the symptoms of PTSD. Good sleep habits are an essential part of sleep health. Here are a few tips for improving your sleep habits.

  • Maintain a Consistent Sleep Schedule: Having a consistent sleep schedule can reduce the time it takes to fall asleep (13). Try sticking to your bedtime, even on the weekends.
  • Exercise Regularly: Physical activity may reduce PTSD symptoms (14). Getting enough exercise can also help people fall asleep faster.
  • Be Careful About Alcohol and Substances: Alcohol, caffeine, and other substances can all negatively impact sleep. Try stopping caffeine intake at least 6 hours before bedtime (15) and alcohol 4 hours before bedtime (16). If you find yourself using more alcohol or other substances after a PTSD diagnosis, or if substances are impacting your relationships, it’s important to talk to your doctor.
  • Relax Before Bedtime: Finding ways to relax can be a challenge for people diagnosed with PTSD. Try different methods to relax the body and mind before bed and find what works best for you. Many people find it helpful to turn off electronics and take a bath, read a book, or meditate before bed.

Tips for Loved Ones

PTSD can also be challenging for partners and loved ones. Symptoms of PTSD may negatively affect relationships (17), creating issues in closeness and communication. A loved one’s sleep may also be affected if their partner wakes up often during the night. Here are some ways you can take care of yourself and help your loved one with PTSD, from the National Center for PTSD (18):

  • Normalize Worries: It’s common to experience a variety of feelings about your loved one’s symptoms. You may feel scared, frustrated, angry, and worried about the future. All of these feelings are normal for people who have a loved one with PTSD.
  • Learn About PTSD: Learning about the effects of trauma can help you understand what your loved one is going through. It may also help to offer to go to medical appointments with your loved one so you can bring questions to their doctor.
  • Prioritize Self-Care: Experiencing the feelings that come with having a loved one diagnosed with PTSD can be draining. Taking care of yourself and getting sufficient sleep is vital to making sure you don’t burn out.
  • Find Support: Having a support system can help you feel less alone in coping with your loved one’s symptoms. Find people to talk to about what you’re experiencing. Doctors, counselors, and support groups may focus on supporting loved ones of those living with PTSD.

PTSD can be a scary diagnosis and the symptoms of this condition can affect a person’s relationships, health, and sleep. Fortunately, treatments are available for PTSD that can help survivors sleep better and reduce disruptive symptoms. While it may feel overwhelming to ask for help with PTSD symptoms, it’s an important first step to finding relief.



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