The Connection Between PTSD and Sleep
Post-traumatic stress disorder, or PTSD, affects 1 in 11 adults or 3.5% of adults every year. PTSD is a psychiatric disorder that affects people who’ve recently experienced a traumatic event. These events vary in severity and type and may include military battles, sexual assaults, natural disasters, serious injuries, or terrorist attacks. Many people associate PTSD with military service members but the truth is, many people can suffer from this debilitating disorder.
The most common side effects include being startled easily, irritability, anger, self-destructive behavior, and difficulty focusing and sleeping. Many PTSD sufferers are on constant alert, looking for and expecting danger, which often develops into insomnia.
Here we’ll take a closer look at the many side effects and causes of PTSD, how this disorder interferes with sleep, and ways to combat PTSD-related insomnia.
How PTSD Affects Sleep
One of the main symptoms of PTSD is a heightened state of awareness and arousal. Many PTSD sufferers don’t even realize they have a problem until several symptoms present themselves at once, including insomnia. PTSD can occur immediately following a traumatic event but sometimes takes weeks, months, or even years to develop. This is one reason so many cases go undetected.
Nearly 70% of people who suffer from PTSD also have trouble sleeping. The two most common PTSD symptoms that affect sleep are hyperarousal and intrusion. Others include:
- Nightmares or flashbacks of the traumatic event
- Reminders of the trauma that cause a “flight or fight” response
- Irritability and trouble concentrating
- Negative thoughts and feelings of guilt or self-blame
In addition to these symptoms, PTSD disrupts sleep by reducing deep sleep and increasing moments of light sleep. It may also interfere with restorative sleep and REM (rapid eye movement) sleep. Other PTSD patients report difficulty falling and staying asleep and daytime fatigue, which are common symptoms of insomnia.
The Relationship Between PTSD, Sleep, and the Brain
The relationship between PTSD and sleep is a complicated one. While in most situations, PTSD is believed to cause insomnia, researchers are still determining if sleep problems may also precede PTSD. Some studies show that individuals who already have difficulty sleeping are more likely to develop PTSD following a traumatic event. The most common PTSD sleep issues include nightmares, fragmented REM sleep, and insomnia.
One study showed that individuals who experienced sleep disturbances including nightmares before heading to war were at greater risk of developing PTSD once they returned home. These conditions can worsen when individuals turn to drugs or alcohol to numb their pain and try to sleep better. While alcohol may offer a quick, momentary fix, it will actually cause a more fitful sleep. These self-healing methods are considered counterproductive and can aggravate other PTSD symptoms outside of sleep.
How PTSD and Insomnia Affect the Brain
Insomnia may also worsen PTSD symptoms. Lack of sleep interferes with the brain’s ability to process traumatic emotions and memories, slowing down the healing process. Sleep and memory are closely connected. During sleep, your mind organizes and processes thoughts and memories, specifically emotional or fear-inducing ones. This makes sleep an important part of the healing process following a traumatic event.
After a traumatic event, your brain also begins associating a certain stimulus with a negative response. For example, many war veterans have an aversion to loud noises after exposure to dangerous battles and gunshots. Simple things like fireworks or a car backfiring can cause someone with PTSD from war to panic or become agitated. While this reaction is common, the brain generally processes and quells this unnecessary fear during a process called extinction memory. During this time, the brain slowly dissociates the specific stimulus from the negative response. Emotional memory processing generally happens during the REM cycle of sleep which is why those with PTSD who also experience REM sleep disruptions may struggle to overcome traumatic events.
Sleep also helps facilitate learning. To overcome traumatic events, one must learn that recurring thoughts about the event don’t pose an immediate threat. Understanding this helps those with PTSD learn to feel safe again. Because sleep is required to process memories and learning, insomnia is considered a risk factor for PTSD.
Research also shows that several regions of the brain are impacted by both PTSD and insomnia. These include the amygdala, insular cortex, anterior cingulate cortex, and hippocampus. It’s these areas of the brain that cause recurring thoughts and nightmares, forcing trauma patients to relive the event through flashbacks, maintaining a state of alertness.
When your body goes into a “flight or fight” response, your heart rate increases and you’re more alert and agitated. Now your body is in a constant state of hyperarousal, making it difficult to fall and stay asleep. This is one reason why those with PTSD often report fragmented, less restorative sleep. Without adequate rest, many PTSD and insomnia sufferers experienced daytime sleepiness which can cause increased anxiety, inability to focus, and irritability. It may also cause those with PTSD to be more sensitive to external stimuli and triggers.
Common Sleep Disorders Associated with PTSD
There are three common sleep disturbances associated with PTSD. These are insomnia, obstructive sleep apnea, and nightmares. While some of these conditions can overlap, let’s take a closer look at how these sleep disorders impact people with PTSD.
9 out of every 10 individuals with PTSD also suffer from insomnia. The main reason is that they’re constantly in a state of hyperarousal and find it difficult to relax. Some patients that were once in a constant state of alertness at night, like soldiers and other military personnel, find it difficult to associate night with rest.
The worst part about insomnia is that the stress and anxiety over not being able to sleep often aggravate other symptoms, creating a vicious cycle. You may find yourself napping during the day, unable to focus, or turning to other means to achieve sleep including drugs and alcohol.
Obstructive Sleep Apnea
About 1 in 15 adults, or 18 million people, suffer from obstructive sleep apnea, or OSA. Research is ongoing as to why PTSD sufferers are at higher risk of developing this condition but evidence suggests underlying factors may be to blame. These include alcohol abuse and a chronic state of arousal. People with obstructive sleep apnea experience an upper airway obstruction that makes breathing difficult. Other symptoms include snoring and daytime sleepiness.
A common solution for OSA is the use of a CPAP machine. A continuous positive airway pressure device helps clear your airways, allowing oxygen to flow freely and opening any obstructions. Some patients who feel claustrophobic using the mask on a CPAP prefer a mandibular advancement device which is less cumbersome and more comfortable.
Nightmares and night terrors are the two most common sleep disturbances associated with PTSD due to the nature of traumatic events. Recurring flashbacks can happen without warning and often creep into your mind during sleep. Not only do these night terrors wake you up but make it difficult to fall back asleep. One way to overcome these intrusive thoughts is a technique called imagery rehearsal therapy. In order to “change the ending”, patients rewrite how the dream plays out, making it feel less threatening.
While there’s no known cure for either PTSD or insomnia, treating the related and co-existing conditions like depression and anxiety is one of the best ways to help overcome both disorders.
Tips for Sleeping Better with PTSD
As you navigate both PTSD and the above-mentioned sleep disorders, there are certain steps you can take to improve your sleep hygiene. By doing so, you may ease both insomnia and PTSD symptoms, bettering your chances of getting a quality night’s sleep.
Create a Safe, Comfortable Sleep Environment
It’s important for PTSD sufferers to feel safe at night. This starts by creating a safe and comfortable atmosphere. This may or may not be your bedroom. If you don’t feel comfortable in your bedroom try sleeping elsewhere like a den or living room. Some people prefer their room completely dark while others need light to feel secure. Invest in a nightlight or soothing string lights. A sound machine can help ease your mind, drown out external noises, and keep negative thoughts at bay.
When sleep evades you or you find yourself laying in bed awake for more than 20 minutes, get up and walk around. Lying awake with racing thoughts is common for those with PTSD as anxiety often spikes at night. Instead of staying in bed, get up and do something relaxing until you find yourself feeling tired enough to fall asleep. Doing so will help strengthen the mental connection between your bedroom and sleep.
Stick to a Bedtime Schedule
This may be difficult for some people but going to bed and waking each night and waking at the same time each day can help stabilize your body’s natural sleep cycle, also known as your circadian rhythm.
Perform other nighttime rituals like reading or journaling before bed. Avoid digital devices or screen time at least 2 hours before you go to sleep. Regular exercise during the day can also better prepare you for sleep and reduce stress. Avoid eating or drinking caffeine too close to bedtime. Taking a calming bath and practicing meditation or mindfulness can also help reduce stress and ward off negative thoughts associated with the traumatic event that triggered your PTSD.
Ask for Help
Don’t be afraid to ask for help when battling PTSD. Many people need help to overcome the long-term effects of a traumatic event. If your PTSD is also affecting your sleep it won’t take long for both situations to worsen. There are countless therapy options available that can help treat both PTSD and insomnia symptoms.
Sadly, victims of PTSD are at greater risk of developing a substance abuse problem. Studies show that 40% of men and women who have PTSD also meet the criteria for an alcohol use disorder. Avoid self-medicating or if you find yourself indulging in alcohol more often than not or your habit is interfering with your daily life, it may be time for an intervention.
Living a Productive Life with PTSD
Living a happy, healthy life with PTSD is possible. Even if that life includes trouble sleeping. Processing traumatic events aren’t easy and it may take more time for some people than others. Try to stay patient with yourself during the process. In addition, treating other underlying mental disorders like anxiety and depression may help accelerate the healing process.
If you’re struggling to achieve quality sleep, this may trigger even more PTSD symptoms. In turn, sleep troubles like nightmares prior to a traumatic event may make you more prone to developing PTSD. While this can’t be avoided, there is help available.
While you undergo therapy to overcome PTSD, you can simultaneously treat your insomnia. At Somnus, we’re focused on helping patients become more aware of and accept their sleep troubles. We offer a variety of therapies including sleep restriction, cognitive restructuring, and stimulus control. Patients also learn to reduce anxiety using mindfulness.
Are you ready to take back your life and start the healing process toward more blissful sleep. Click here to learn more about Somnus Therapy.