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How Does Post-Traumatic Stress Disorder (PTSD) Affect Sleep?

PTSD May Lead to Nightmares, Insomnia

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Updated October 03, 2012

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The initial symptoms associated with post-traumatic stress disorder (PTSD) may be triggered by an upsetting event, but the effects may linger for months or even years. The effects of PTSD on sleep may be profound, and range from insomnia to nightmares. What is PTSD? How does PTSD affect sleep? Learn about this condition and some of the treatment options.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a psychological condition that begins after a traumatic event and is characterized by recurrent, unwanted re-experiences of the event. The normal feelings that occur in response to the trauma - including fear, helplessness, and horror - may persist and lead to unwanted consequences.

In general, the inciting trauma of PTSD would be something that nearly anyone who experiences it would find greatly distressing. It may be life-threatening, such as a violent attack with physical injury, sexual assault, or serious car accident. In other cases, the event may be abruptly life-altering in other ways, such as the sudden death of a loved one. The episodes may be repeated events, such as exposure to harm in military combat or domestic violence.

As a result of these exposures, it is normal to briefly have anxiety, recurrent thoughts about the event, and insomnia. This may last for several days after the initial event. Sometimes the feelings persist, however. If the symptoms cause impairment in daily functions, such as the ability to go to work and take care of your family, as well as feelings of unreality or memory problems (something called dissociation), it may be called acute stress disorder. Many times these symptoms will lessen over weeks. If they last, as they do in 10-30% of people after a traumatic event, the resulting dysfunction and distress may be diagnosed as PTSD.

The symptoms of PTSD are categorized into three groups: re-experience, avoidance, and hyperarousal. Common symptoms include:

  • Re-experiencing symptoms: recollections, images, thoughts, perceptions, dreams, nightmares, reliving, illusions, hallucinations, or flashbacks.
  • Avoidance symptoms: avoidance of reminders of the trauma, including thoughts, feelings, conversations, activities, places, people, detachment, estrangement.
  • Hyperarousal symptoms: insomnia, irritability, angry outbursts, difficulty concentrating, hypervigilance, or increased startle response.

If these symptoms last from 1 to 3 months, it is considered acute PTSD. When they last longer than 3 months, they are considered chronic PTSD. It is estimated that PTSD affects 7-8% of people at some point in their lives. It occurs twice as often in women, mostly in the context of domestic violence and sexual assault. It commonly affects those exposed to combat situations. It may coexist with depression.

The Effects of PTSD on Sleep

There are clearly effects of PTSD on sleep. Some surveys suggest that 70% of people with PTSD have sleep complaints, most often insomnia and nightmares.

The disruptions that occur in sleep often relate to the underlying symptoms of PTSD. The hyperarousal that occurs may result in extreme hypervigilance and paranoia. For example, if you are afraid of being attacked in your sleep, you may sleep lightly and be aware of every creak in the house during the night. This anxiety may lead to persistent insomnia. It may also be associated with isolated sleep paralysis.

PTSD can also cause flashbacks and nightmares. These episodes consist of re-experiencing the traumatic event. They can be quite vivid, and often are recalled upon awakening. They may lead to movements or even actions during sleep and the transition to wakefulness. This may result in violent or even injury-provoking behaviors. There may be sleeptalking. In addition, hallucinations during the transition to or from sleep may occur.

Many people with PTSD use alcohol to cope with their distress. The use of alcohol may result in disrupted breathing during sleep, most commonly manifesting as sleep apnea.

When the sleep of people with PTSD is evaluated in a sleep laboratory, there are not significant abnormalities noted. There may be increased movements, sleep-disordered breathing, or fragmentation of REM sleep, but the findings are inconsistent and more study is needed.

Treatment of Sleep Problems in PTSD

There are effective treatments available for the symptoms of PTSD, including its effects on sleep. These may include medications as well as therapy.

As part of this, it is very important to treat any other psychiatric conditions. These may include depression, anxiety, panic disorder, alcohol or substance abuse. Effective medications for these problems may include selective serotonin reuptake inhibitors (sertraline, paroxetine), tricyclic antidepressants, and monoamine oxidase inhibitors. An especially useful for treatment for the nightmares associated with PTSD is prazosin. In addition, medications such as olanzapine, risperidone, and quetiapine may be employed.

Aside from the use of medications, psychotherapy with a psychologist or psychiatrist is an effective primary or complementary treatment.

If you suffer from sleep problems related to PTSD, you should speak with your doctor about your treatment options. It is clearly not a condition that you have to suffer with alone.

Sources:

"Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)." American Psychiatric Press, 4th edition, 1994.

Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, pp. 1481-1483.

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