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The Link Between Sleep Disturbances & PTSD

The majority of trauma survivors suffer from sleep problems. About 70 to 90 percent of people experiencing PTSD report experiencing sleep disturbances, such as nightmares, insomnia and more.

In fact, the relationship between sleep and traumatic stress runs so deep that people who experience sleep disturbances before and/or shortly after a traumatic experience have an increased risk of developing PTSD. 


By understanding sleep disturbances and how they interact with PTSD, we can identify treatment opportunities, and feel downstream improvements to our other PTSD related symptoms.

What Happens During a Nightmare?

The most common sleep disturbance is nightmares, impacting about 50 to 70 percent of people with PTSD. 


Nightmares primarily occur during rapid eye movement (REM) sleep. About 90 minutes after we fall asleep, we enter REM, the stage in which our brains are the most active. Our heart rates and breathing speed up, and we experience dreams that are intense, detailed and lifelike.


For people with PTSD, nightmares are often more significant than just intense dreams. They manifest as either literal replications or symbolic versions of our traumatic experiences. These trauma-associated nightmares are extremely triggering, causing extreme distress and fear of sleep. 

Other Sleep Disturbances

Sleep issues are not limited to nightmares. When taking into account the four symptom clusters of PTSD, we can understand nightmares as re-experiencing symptoms, and other disturbances as hypervigilance symptoms. Disturbances such as insomnia, apnea, sleep paralysis and night terrors are all caused by our inability to feel safe and secure.

How to Get Better Sleep

Oftentimes, sleep disturbances are highly central in PTSD – nodes at the center of a symptom network have greater influence than less central symptoms do. Therefore, treatments that focus on improving our sleep can also alleviate our other PTSD symptoms.


One such treatment is CBT-I, a variant of cognitive behavioral therapy that focuses on treating insomnia. Insomnia often means a fear of sleep and/or a fear of losing control during sleep, which can lead to daytime fatigue. With CBT-I, we learn how to identify and re-frame the thoughts, feelings and actions that are linked to our insomnia. 


To help with re-experiencing symptoms such as nightmares, therapists use Imagery Rehearsal Therapy (IRT). This treatment approach helps us manage nightmares by imagining non-frightening endings to past nightmares and rehearsing those revised conclusions.


Even tools like continuous positive airway pressure (CPAP) machines and mouth guards that open up our airways are useful in treating PTSD related sleep issues.


If you’re struggling with disturbances from PTSD, you are not alone. With support from PTSD professionals and self-management tools, like the Mira app, you can find relief from your sleep issues and other trauma symptoms. For more information on PTSD, check out our blog!

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