Sleep and PTSD
Although this is a short film from the US much of what is said in the film is relevant also in the UK.
Many people have trouble sleeping sometimes. This is even more likely, though, if you have PTSD. Trouble sleeping and nightmares are two symptoms of PTSD.
Why do people with PTSD have sleep problems?
They may be “on alert.” Many people with PTSD may feel they need to be on guard or “on the lookout,” to protect himself or herself from danger. It is difficult to have restful sleep when you feel the need to be always alert. You might have trouble falling asleep, or you might wake up easily in the night if you hear any noise.
They may worry or have negative thoughts. Your thoughts can make it difficult to fall asleep. People with PTSD often worry about general problems or worry that they are in danger. If you often have trouble getting to sleep, you may start to worry that you won’t be able to fall asleep. These thoughts can keep you awake.
They may use drugs or alcohol. Some people with PTSD use drugs or alcohol to help them cope with their symptoms. In fact, using too much alcohol can get in the way of restful sleep. Alcohol changes the quality of your sleep and makes it less refreshing. This is true of many drugs as well.
They may have bad dreams or nightmares. Nightmares are common for people with PTSD. Nightmares can wake you up in the middle of the night, making your sleep less restful. If you have frequent nightmares, you may find it difficult to fall asleep because you are afraid you might have a nightmare.
They may have medical problems. There are medical problems that are commonly found in people with PTSD, such as chronic pain, stomach problems, and pelvic-area problems in women. These physical problems can make going to sleep difficult.
What can you do if you have problems?
There are a number of things you can do to make it more likely that you will sleep well:
Change your sleeping area
Too much noise, light, or activity in your bedroom can make sleeping harder. Creating a quiet, comfortable sleeping area can help. Here are some things you can do to sleep better:
- Use your bedroom only for sleeping and sex.
- Move the TV and radio out of your bedroom.
- Keep your bedroom quiet, dark, and cool. Use curtains or blinds to block out light. Consider using soothing music or a “white noise” machine to block out noise.
- Keep a bedtime routine and sleep schedule
Having a bedtime routine and a set wake-up time will help your body get used to a sleeping schedule. You may want to ask others in your household to help you with your routine.
- Don’t do stressful or energizing things within two hours of going to bed.
- Create a relaxing bedtime routine. You might want to take a warm shower or bath, listen to soothing music, or drink a cup of tea with no caffeine in it.
- Use a sleep mask and earplugs, if light and noise bother you.
- Try to get up at the same time every morning, even if you feel tired. That will help to set your sleep schedule over time, and you will be more likely to fall asleep easily when bedtime comes. On weekends do not to sleep more than an hour past your regular wake-up time.
Try to relax if you can’t sleep
Imagine yourself in a peaceful, pleasant scene. Focus on the details and feelings of being in a place that is relaxing.
Get up and do a quiet activity, such as reading, until you feel sleepy.
Watch your activities during the day
Your daytime habits and activities can affect how well you sleep. Here are some tips:
- Exercise during the day. Don’t exercise within two hours of going to bed, though, because it may be harder to fall asleep.
- Get outside during daylight hours. Spending time in sunlight helps to reset your body’s sleep and wake cycles.
- Cut out or limit what you drink or eat that has caffeine in it, such as coffee, tea, cola, and chocolate.
- Don’t drink alcohol before bedtime. Alcohol can cause you to wake up more often during the night.
- Don’t smoke or use tobacco, especially in the evening. Nicotine can keep you awake.
- Don’t take naps during the day, especially close to bedtime.
- Don’t drink any liquids after 6 p.m. if you wake up often because you have to go to the bathroom.
- Don’t take medicine that may keep you awake, or make you feel hyper or energized right before bed. Your doctor can tell you if your medicine may do this and if you can take it earlier in the day.
Talk to your doctor
If you can’t sleep because you are in pain or have an injury, you often feel anxious at night, or you often have bad dreams or nightmares, talk to your doctor.
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. There are also other skills you can learn to help improve your sleep.
Nightmares and PTSD
Nightmares are dreams that are threatening and scary. Nearly everyone has had a nightmare from time to time.
For trauma survivors, though, nightmares are a common problem. Along with flashbacks and unwanted memories, nightmares are one of the ways in which a trauma survivor may relive the trauma for months or years after the event.
How common are nightmares after trauma?
Among the general public, about 5% of people complain of nightmares. Those who have gone through a trauma, though, are more likely to have distressing nightmares after the event. This is true no matter what type of trauma it is.
Those trauma survivors who get PTSD are even more likely to complain of nightmares. Nightmares are one of the 17 symptoms of PTSD. For example, a study comparing Vietnam Veterans to civilians showed that 52% of combat Veterans with PTSD had nightmares fairly often. Only 3% of the civilians in the study reported that same level of nightmares.
Other research has found even higher rates of nightmares. Of those with PTSD, 71% to 96% may have nightmares. People who have other mental health problems, such as panic disorder, as well as PTSD are more likely to have nightmares than those with PTSD alone.
Not only are trauma survivors more likely to have nightmares, those who do may have them quite often. Some survivors may have nightmares several times a week.
What do nightmares that follow trauma look like?
Nightmares that follow trauma often involve the same scary elements that were in the trauma. For example, someone who went through Hurricane Katrina may have dreams about high winds or floods. They may dream about trying to escape the waters or being in a shelter that does not feel safe. A survivor of a hold-up might have nightmares about the robber or about being held at gunpoint.
Not all nightmares that occur after trauma are a direct replay of the event. About half of those who have nightmares after trauma have dreams that replay the trauma. People with PTSD are more likely to have dreams that are exact replays of the event than are survivors without PTSD.
Lab research has shown that nightmares after trauma are different in some ways from nightmares in general. Nightmares after trauma may occur earlier in the night and during different stages of sleep. They are more likely to have body movements along with them.
Are there any effective treatments for Post-Traumatic nightmares?
Nightmare symptoms often get better with standard PTSD treatment. If nightmares persist, there are treatments that can reduce how often they occur.
One treatment is Imagery Rehearsal Therapy (IRT). In IRT, the person who is having nightmares, while awake, changes how the nightmare ends so that it no longer upsets them. Then the person replays over and over in their minds the new dream with the non-scary ending. Research shows that this type of treatment can reduce how often nightmares occur.
Also, treatment for breathing problems that occur during sleep may reduce the nightmares that follow trauma. High levels of sleep-disordered breathing have been seen in trauma survivors. In one study, patients given a treatment to improve their breathing during sleep no longer had violent, scary dreams.