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Posttraumatic stress disorder, or PTSD, is a well-known psychiatric disorder that includes a long-term heightened state of arousal following a traumatic experience. The condition often gets worse with time or may develop insidiously, which makes it difficult to pick up both victims and experts. The disease is more prevalent among women but can hit anyone. Surveys suggest that approximately seven out of a hundred people will experience PTSD at some point in life.
When it comes to PTSD and sleep, both problems share a complex relationship. Sleep problems are a common part of many mental health conditions but are particularly common in people with PTSD. Out of the symptoms used to make a diagnosis of PTSD, two are directly related to sleep: intrusion and hyperarousal, which may manifest as nightmares and insomnia. While researchers continue to understand whether sleep-related issues precede PTSD or vice versa, it is imperative for people struggling with these issues to understand more about it and learn how to manage both.
Insomnia PTSD: Can Sleep Issues Affect PTSD Symptoms?
Among people who go through traumatic events, those who develop sleep-related issues are more likely to develop PTSD at some point. Sleep disturbance remains an early symptom of PTSD and often includes insomnia, nightmares, and fragmented sleep during the rapid eye movement (REM) cycle. [1]
Interestingly, experts have found that sleep issues that precede trauma can also play a role in PTSD development. Studies have found that individuals who reportedly experienced nightmares before going to the war were at a higher risk of developing PTSD after coming back. Once a person develops PTSD, the simultaneous presence of sleep-related issues seems to exacerbate its symptoms. Even after addressing PTSD, many people continue to struggle with insomnia.
PTSD sleep problems can easily interfere with a person’s ability to process emotions and memories while slowing down the brain’s recovery process following a traumatic event. Additionally, many people with PTSD turn to using alcohol or drugs to sleep better, which often worsens the issue while aggravating the PTSD symptoms simultaneously.
How Does PTSD Affect Sleep?
People who have PTSD often have issues falling asleep and may find it difficult to wake up easily. Some of them keep waking up throughout the night, while others report experiencing nightmares. These issues collectively lead to non-refreshing, frequently disrupted sleep. Those who suffer from additional co-occurring issues, such as traumatic brain injury, substance abuse, depression, chronic pain, and other medical problems often face an additional barrier in the way of getting quality sleep. Many of them start using sleep medications that further interfere with REM sleep, a stage imperative for the brain to deal with traumatic memories.
Following are some sleep-related issues triggered by PTSD:
- Insomnia: Approximately nine out of ten patients with PTSD experience insomnia, mostly due to hyperarousal, which makes it difficult for a person to relax. Moreover, many people with PTSD often have a lingering effect after being in a situation that requires constant alertness, even at night, which further disturbs sleep. PTSD and insomnia can often be self-perpetuating, as stress arising from not being able to sleep makes a person adopt maladaptive sleep behaviors, such as substance abuse or daytime napping.
- Night Terrors/Nightmares: Night terrors and nightmares continue to plague a lot of people who have PTSD, leading to nighttime awakenings and constant interruptions in sleep. The vivid dreams such people experience are often based on past traumas, and many become repetitive.
- Obstructive Sleep Apnea: Experts are not clear on what causes an increased prevalence of obstructive sleep apnea in people with PTSD—some people think it to be due to their alcohol use or chronic arousal. Regardless of the reason, sleep apnea can cause significant disruptions in sleep and make a person feel sleepy during the daytime.
PTSD Sleep Problems and the Brain: Finding the Connection
Researchers believe that many overlapping brain regions are implicated in both sleep issues and PTSD. [2] The most important ones include the anterior cingulate cortex, amygdala, insular cortex, and hippocampus. These brain regions can cause a person to revisit their traumatic experiences in the form of nightmares and flashbacks while promoting a state of hyperarousal.
Studies have also found that people with PTSD experience a faster heart rate while sleeping, indicating that they have a heightened fight or flight response. This response consistently keeps them in a state of hypervigilance, which, in turn, affects their sleep negatively. Some hallmarks of disturbed sleep due to PTSD include spending more time in stage one light sleep and less in the restorative slow-wave stage, in addition to experiencing fragmented REM sleep.
Another connection between PTSD and sleep lies in the way the brain processes memories that provoke fear. During a traumatic event, the brain learns to link a certain stimulus with a negative response. This association may become so strong that even long after the traumatic exposure, the brain responds violently whenever it comes across a similar stimulus.
In normal cases, this response’s attenuation occurs through extinction memory. The brain dissociates a trauma-provoking stimulus from the learned response during this process. The majority of this extinction process takes place during a stage of sleep called REM sleep, which is the first one to take a hit in people with PTSD. [3] Consequently, such people eventually lose the ability to process trauma efficiently. The sleep loss that follows for such people often leads to daytime sleepiness while interfering with their coping strategies, making people highly sensitive to triggers. This hypersensitivity increases their PTSD symptoms and a vicious cycle sets in, which reduces the quality of life.
Managing Insomnia PTSD: How to Sleep Better?
The best way to minimize sleep issues while suffering from PTSD is by improving sleep hygiene. For this purpose, keep the following tips in mind:
- Keep the bedroom dark, cool, and quiet.
- Set a fixed bedtime schedule and stick to it.
- Limit the bedroom for sleep and intimacy only.
- Have a hot shower or read a calming book before bedtime to relax the mind and body.
- Exercise regularly to tame hyperarousal.
- Avoid using any type of screen for at least one hour before the scheduled bedtime.
- Invest in a white noise machine, especially if you have a higher sensitivity to sound.
- Eat healthily and avoid using alcohol or caffeine close to bedtime.
- Minimize rumination through meditation and other techniques.
Always remember to sleep in a room that makes you feel secure and safe. If you feel too uncomfortable to sleep in pitch dark, get a nightlight to feel secure without exposing yourself to too much light. It is common for people with PTSD to hesitate to sleep as they worry about nightmares. Consequently, they may spend hours in bed with anxious thoughts and an inability to sleep. If you find yourself in such circumstances where you cannot sleep despite being in bed for 20 minutes, leave the bedroom, engage in something relaxing, and only return to your bedroom when you feel sleepy. This practice helps strengthen the mental relationship between sleep and your bed.
If you are struggling to fall asleep or often turn to alcohol or drugs to support yourself to sleep, consider talking to a doctor. A doctor can connect you with a therapist who may use PTSD-specific techniques and other therapies, such as CBT-I, imagery rehearsal therapy, etc., to manage the symptoms. They may also prescribe sleep medications if appropriate. Remember that learning to regulate the sleep cycle following trauma can take some time, so do not feel defeated or down if it does not happen overnight. Continue practicing healthy behaviors and work closely with a doctor to eventually feel better. Ongoing therapy is the best way to manage PTSD and sleep issues due to the close relationship both issues share.
Tips for Partners of People With PTSD
While most of the time, experts focus on helping people with PTSD and sleep issues, their partners are often ignored. The reality is partners of such people also face many issues regarding their sleeping routines, for example, due to their frequent awakenings during the night. To help these people, experts recommend investing in a mattress that can muffle movement and sound.
People who frequently experience night terrors and nightmares may feel scared and last out violently during sleep. While many people believe that they must be with them when such episodes happen, they must realize the importance of sleeping in separate rooms occasionally to ensure adequate sleep. Both parties must also consider exercising together during the day. Such healthy routines can improve sleep and bond both people while re-establishing a sense of security.
It is common for many caregivers to feel guilt or shame, while others may feel responsible for saving their partners. However, remember that pouring all energy into helping a person with PTSD sleep issues can lead to serious consequences for one’s mental health. Hence, caregivers of such people must also consider individual therapy, couples therapy, and support groups to manage themselves and navigate safely while helping their struggling partners.
FAQs
Can PTSD cause insomnia?
PTSD is very likely to cause insomnia through various complications, such as nightmares, frequent nighttime awakenings, and night terrors.
Can treating PTSD reverse insomnia?
Most people benefit from PTSD treatment in terms of their underlying sleep-related issues, with some experiencing a complete resolution. A small number of them, however, continue to experience these issues even when their PTSD is well-controlled
Reference
1 Pace-Schott EF, Germain A, Milad MR. Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory. Biology of mood & anxiety disorders. 2015 Dec;5:1-9.
2 van Liempt S, Arends J, Cluitmans PJ, Westenberg HG, Kahn RS, Vermetten E. Sympathetic activity and hypothalamo-pituitary–adrenal axis activity during sleep in post-traumatic stress disorder: A study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology. 2013 Jan 1;38(1):155-65.
3 Colvonen PJ, Straus LD, Acheson D, Gehrman P. A review of the relationship between emotional learning and memory, sleep, and PTSD. Current Psychiatry Reports. 2019 Jan;21:1-1.
