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.

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.

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