Expert's opinion
The article is a subjective view on this topic written by writers specializing in medical writing.
It may reflect on a personal journey surrounding struggles with an illness or medical condition, involve product comparisons, diet considerations, or other health-related opinions.
Although the view is entirely that of the writer, it is based on academic experiences and scientific research they have conducted; it is fact-checked by a team of degreed medical experts, and validated by sources attached to the article.
The numbers in parenthesis (1,2,3) will take you to clickable links to related scientific papers.
PTSD Nightmares 2023: The Connection Between PTSD & Sleep

Post-traumatic stress disorder is a mental health condition that can profoundly affect a person’s life. The condition develops after experiencing or witnessing a traumatic event,[1] such as combat, assault, or accident.
The symptoms of PTSD include intrusive thoughts, avoidance, and flashbacks. The condition can also cause nightmares that are related to the traumatic event, as well as other sleep disturbances, or in severe cases, thoughts of suicide may eventually prevail. Keep reading to find out how PTSD affects sleep, as well as how to achieve better sleep and on treating nightmares.
Are Nightmares A Sign Of PTSD?
Distressing nightmares are a common symptom of PTSD. They affect up to 70% of PTSD patients. PTSD nightmares often involve reliving the underlying traumatic event. There are several ways to treat PTSD nightmares, including different forms of therapy. Supplements such as CBD also show promise. Methods for treating nightmares include exercise, meditation, and treating substance abuse.
How Does PTSD Affect Your Sleep?
Nightmares are common in patients with posttraumatic stress disorder. However, the condition can also disrupt sleep in other ways. Overall, PTSD affects sleep:
- Distressing nightmares: Around 70%-90% of posttraumatic stress disorder patients experience recurring nightmares.[2] These bad dreams often replicate the event that traumatized them or symbolizes the experience.
- Insomnia: Many PTSD patients experience insomnia,[3] a sleep disorder that makes it hard to fall asleep,[4] stay asleep, or both. Researchers think this occurs because patients develop a fear of sleep[2] and nightmares.
- Sleep apnea: Some PTSD patients experience sleep apnea,[5] a condition caused by the airway becoming blocked during sleep. In some cases, treating sleep apnea helps reduce PTSD symptoms.[6]
- Limb movement: The movement of limbs during sleep is common[7] among PTSD patients. Limb movement often involves jerking of various joints[8] as well as the head.
- Sleep paralysis: PTSD patients are at risk[9] of experiencing sleep paralysis. This experience happens either while falling asleep or when waking up. It involves becoming conscious but unable to move and hallucinations and breathing difficulties.
The Effect Of Nightmares On PTSD
PTSD increases the chances of a person experiencing recurring nightmares. However, the nightmares themselves can also worsen the symptoms[10] of PTSD, causing a vicious cycle. Nightmares can impact the development[11] of PTSD following a traumatic event.
The distress caused by nightmares can lead PTSD patients to avoid sleeping or leaving the lights on. Both of these behaviors can lead to insomnia.[10] Sadly, some people with PTSD also experience an increased risk[12] of suicidal ideation because of feelings of hopelessness and defeat.
PTSD nightmares examples include bad dreams about life-threatening events.[10] They also involve perceived harm to a person’s physical and mental safety.
Treatments For PTSD Nightmares
Treating nightmares involve several different approaches. These include medication prescribed by doctors, supplements, and professional help from a therapist. Below, we will dive into some of the most common treatment techniques. They include:
- Imagery rehearsal therapy.
- Exposure and relaxation therapy.
- Cognitive-behavioral therapy.
- Medications.
- CBD.
Image Rehearsal Therapy
Image rehearsal therapy, or IRT, can help to improve nightmare frequency, sleep quality, and post-traumatic stress disorder symptoms. Research shows that the positive effects of this technique can last for 6–12 months.[13]
Imagery rehearsal therapy involves writing dream narratives and sleep education. These stories include specific changes to a recurring nightmare. Imaging the new dream narrative daily also forms part of therapy sessions.
The mechanisms of imagery rehearsal therapy include releasing pent-up emotions and looking at nightmares in a new way. Ultimately, these changes lead to better sleep.
Exposure, Rescripting, And Relaxation Therapy
Exposure, rescripting, and relaxation therapy, also known as ERRT,[14] is a behavioral therapy designed to treat trauma-related nightmares. During the first several sessions, the therapist educates the patient[10] about trauma, nightmares, sleep, and muscle relaxation techniques.
The next block of exposure therapy treatment involves rescripting therapy, where they practice using a recurring nightmare while using a new relaxation skill. Patients are encouraged to practice their new skills daily. These include deep breathing, reviewing rescripted nightmares, and muscle relaxation.
The last block of treatment reviews the progress of the ERRT protocol. The therapist will also provide the client with ways to prevent relapse. Research shows that ERRT helps to reduce[10] severe PTSD symptoms and the severity of nightmares.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy, or CBT, is a talking therapy designed to change unhelpful thinking.[15] It helps patients to understand their thoughts, behavior, and emotions better. Patients learn to calm their minds and face their fears while developing new problem-solving skills.
Research shows CBT effectively treats post-traumatic stress disorder symptoms that cause daytime dysfunction. The therapy is also associated with improved sleep quality[16] and longer bouts of sleep.
Medications
Doctors may prescribe certain drugs to PTSD patients if therapy doesn’t work for them. Some patients also receive medication if they don’t want to go down the therapy route for personal reasons. These drugs[17] include certain types of antidepressants, sedatives, and antipsychotics. They help to treat PTSD nightmares in some cases, but each comes with its own set of side effects.
CBD
CBD has gained popularity as a non-psychoactive compound from the cannabis plant. CBD has shown potential for a range of conditions, including anxiety.[18] Research has found that CBD reduces PTSD symptoms[19] when used alongside standard psychiatric care. It also helps to relieve some patients who suffer from PTSD-related nightmares.
How To Prevent PTSD Nightmares
Now you’re aware of treatments for PTSD nightmares. But how to stop PTSD nightmares from occurring? Below, we’re going to cover some preventative approaches. These methods include controlling snacking, exercising, avoiding drugs and alcohol, and meditation.
Avoid Late-Night Snacking
Research links PTSD to emotional eating.[20] This form of eating can cause several problems, including weight gain[21] and weight loss. Consuming large amounts of food before bed might also contribute to the nightmares[20] experienced by a person with PTSD. Resisting snacking close to bedtime could help to curb the likelihood of experiencing distressing nightmares.
Address Drug And Alcohol Abuse
People living with PTSD often also experience substance use disorder.[22] Substance users take alcohol and drugs to avoid bad memories[23] and dreams. However, alcohol can worsen PTSD symptoms. Several psychoactive drugs, including cannabis and cocaine, can also cause distressing drug dreams.[24]
When it comes to how to stop trauma nightmares, cutting out drugs and alcohol could help. While these substances increase the odds of nightmares, you need to consult your doctor to come off them properly.
Alcohol withdrawal[25] can cause nightmares in some people. Withdrawal symptoms when coming off certain drugs, including opiates, can also cause bad dreams.[26]
Exercise Regularly
Physical exercise offers many benefits,[27] including improved brain health and weight management. Research has also found a link between exercise and better mental health.[28] But could lifting weights or going for a run also help to prevent PTSD nightmares?
Studies show that aerobic exercises, such as going for a run or a bike ride, can help to manage PTSD symptoms.[29] Combating stress can also help to reduce the likelihood of anxiety before bed, which can trigger[30] bad dreams.
Meditate
There are many different styles of meditation, including mindfulness, compassion, and walking meditation. While different, these techniques share a similar goal of reducing stress and negative looping thoughts.
Meditation offers people living with PTSD several benefits.[31] These include reduced PTSD symptoms and thoughts of self-blame. Research[32] suggests that some people who meditate experience less frequent nightmares than those who have never meditated.
Simply sitting down to meditate for several minutes each day could help to reduce distressing dreams. It’s a simple and cheap option that also comes with a bunch of other mental and physical benefits.
The Bottom Line
People living with PTSD are likely to experience distressing chronic nightmares. These bad dreams involve directly reliving traumatic events or experiencing them symbolically. Recurring nightmares can have a drastic impact on the quality of life.
There are several ways to treat PTSD nightmares. They include different forms of therapy that help people living with PTSD reduce the severity of their nightmares. Techniques such as imagery rehearsal therapy help patients to write new dream narratives. Supplements such as CBD also show promise in treating this mental health disorder.
There are also a handful of ways to prevent PTSD nightmares. Exercise, meditation, and avoiding drugs can all help to reduce the chances of experiencing bad dreams.
+ 32 sources
Health Canal avoids using tertiary references. We have strict sourcing guidelines and rely on peer-reviewed studies, academic researches from medical associations and institutions. To ensure the accuracy of articles in Health Canal, you can read more about the editorial process here
- Psychiatry.org. (2023). What is Posttraumatic Stress Disorder (PTSD)? [online] Available at: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd.
- Marike Lancel, Marle, van, Veen, van and Annette van Schagen (2021). Disturbed Sleep in PTSD: Thinking Beyond Nightmares. [online] 12. doi:https://doi.org/10.3389/fpsyt.2021.767760.
- Sinha, S.S. (2016). Trauma-induced insomnia: A novel model for trauma and sleep research. [online] 25, pp.74–83. doi:https://doi.org/10.1016/j.smrv.2015.01.008.
- Medlineplus.gov. (2018). Insomnia. [online] Available at: https://medlineplus.gov/insomnia.html.
- NHLBI, NIH. (2022). What Is Sleep Apnea? [online] Available at: https://www.nhlbi.nih.gov/health/sleep-apnea.
- Habibolah Khazaie, Mohammad Rasoul Ghadami and Masoudi, M. (2016). Sleep disturbances in veterans with chronic war-induced PTSD. [online] doi:https://doi.org/10.5249/jivr.v8i2.808.
- Shahla Mohsenin and Vahid Mohsenin (2014). Diagnosis and Management of Sleep Disorders in Posttraumatic Stress Disorder. [online] doi:https://doi.org/10.4088/pcc.14r01663.
- Journal of Clinical Sleep Medicine. (2022). Clinical and polysomnographic features of trauma associated sleep disorder | Journal of Clinical Sleep Medicine. [online] Available at: https://jcsm.aasm.org/doi/abs/10.5664/jcsm.10214.
- Wróbel-Knybel, P., Flis, M., Rog, J., Jalal, B., Leszek Wołkowski and Karakuła-Juchnowicz, H. (2022). Characteristics of Sleep Paralysis and Its Association with Anxiety Symptoms, Perceived Stress, PTSD, and Other Variables Related to Lifestyle in Selected High Stress Exposed Professions. [online] 19(13), pp.7821–7821. doi:https://doi.org/10.3390/ijerph19137821.
- El-Solh, A.A. (2018). Management of nightmares in patients with posttraumatic stress disorder: current perspectives. [online] Volume 10, pp.409–420. doi:https://doi.org/10.2147/nss.s166089.
- Saskia van Liempt, Mirjam van Zuiden, Herman G.M. Westenberg, Super, A. and Vermetten, E. (2013). IMPACT OF IMPAIRED SLEEP ON THE DEVELOPMENT OF PTSD SYMPTOMS IN COMBAT VETERANS: A PROSPECTIVE LONGITUDINAL COHORT STUDY. [online] 30(5), pp.469–474. doi:https://doi.org/10.1002/da.22054.
- Journal of Clinical Sleep Medicine. (2016). Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness | Journal of Clinical Sleep Medicine. [online] Available at: https://jcsm.aasm.org/doi/full/10.5664/jcsm.5592.
- Casement, M.D. and Swanson, L.M. (2012). A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress. [online] 32(6), pp.566–574. doi:https://doi.org/10.1016/j.cpr.2012.06.002.
- Kendall College of Arts and Sciences. (2022). ERRT. [online] Available at: https://artsandsciences.utulsa.edu/errt/.
- What is Cognitive Behavioral Therapy (2017). What is Cognitive Behavioral Therapy? [online] https://www.apa.org. Available at: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.
- Yan, F., Chan, C.S. and Kristen (2016). Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials. [online] 43, pp.90–102. doi:https://doi.org/10.1016/j.cpr.2015.09.005.
- Tomas, M. (2014). Treatment of sleep disturbances in post-traumatic stress disorder. [online] 4(2), pp.91–97. doi:https://doi.org/10.9740/mhc.n190104.
- Blessing, E.M., Steenkamp, M.M., Manzanares, J. and Marmar, C.R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. [online] 12(4), pp.825–836. doi:https://doi.org/10.1007/s13311-015-0387-1.
- Elms, L., Shannon, S., Hughes, S. and Lewis, N. (2019). Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. [online] 25(4), pp.392–397. doi:https://doi.org/10.1089/acm.2018.0437.
- Nielsen, T. and Powell, R. (2015). Dreams of the Rarebit Fiend: food and diet as instigators of bizarre and disturbing dreams. [online] doi:https://doi.org/10.3389/fpsyg.2015.00047.
- Frayn, M., Livshits, S. and Bärbel Knäuper (2018). Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns. [online] 6(1). doi:https://doi.org/10.1186/s40337-018-0210-6.
- Flanagan, J.C., Korte, K.J., Killeen, T.K. and Back, S.E. (2016). Concurrent Treatment of Substance Use and PTSD. [online] 18(8). doi:https://doi.org/10.1007/s11920-016-0709-y.
- American Addiction Centers. (2023). Post-Traumatic Stress Disorder (PTSD) & Addiction: Signs, Symptoms & Treatment. [online] Available at: https://americanaddictioncenters.org/co-occurring-disorders/ptsd-addiction.
- Aggarwal, A. and Lindegaard, V. (2020). The Use of Prazosin in Treatment of Drug Dreams in Adolescents with Substance Use Disorder: Two Case Reports. Psychopharmacology bulletin, [online] 50(4), pp.29–31. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511147/.
- Sandman, N., Valli, K., Kronholm, E., Antti Revonsuo, Tiina Laatikainen and Tiina Paunio (2015). Nightmares: Risk Factors Among the Finnish General Adult Population. [online] 38(4), pp.507–514. doi:https://doi.org/10.5665/sleep.4560.
- Shrivastava, D. (2022). Drugs That Affect Sleep. [online] pp.29–36. doi:https://doi.org/10.1201/9781003093381-6.
- CDC (2022). Benefits of Physical Activity . [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm.
- Chekroud, S.R., Ralitza Gueorguieva, Zheutlin, A.B., Paulus, M.P., Krumholz, H.M., Krystal, J.H. and Chekroud, A.M. (2018). Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. [online] 5(9), pp.739–746. doi:https://doi.org/10.1016/s2215-0366(18)30227-x.
- Hegberg, N.J., Hayes, J.P. and Hayes, S.M. (2019). Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation. [online] 10. doi:https://doi.org/10.3389/fpsyt.2019.00133.
- Stanfordhealthcare.org. (2017). Stanford Health Care. [online] Available at: https://stanfordhealthcare.org/medical-conditions/sleep/nighttime-sleep-behaviors/nightmares.html.
- Boyd, J.E., Lanius, R.A. and McKinnon, M.C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. [online] 43(1), pp.7–25. doi:https://doi.org/10.1503/jpn.170021.
- Tzioridou, S., Dresler, M., Sandberg, K. and Mueller, E. (2022). Nightmares, Mindfulness And Lucid Dreaming. [online] Available at: https://assets.researchsquare.com/files/rs-1303397/v1/03d27d2e-110c-437b-9819-acbee138294f.pdf?c=1675183594.