Understanding post-traumatic stress disorder (PTSD) and nightmares

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after someone experiences or witnesses something traumatic. It can develop immediately after the traumatic event or, for some people, it can develop months or even years later. It can cause a whole range of symptoms, including flashbacks, anxiety, irritability, hypervigilance and nightmares. PTSD nightmares can be extremely vivid and intense, and cause people to relive their trauma as they sleep.

Here, we explore how nightmares can affect people living with PTSD, what causes PTSD nightmares and provide some practical tips for managing sleep.

How can PTSD affect sleep?

PTSD can have a negative impact on sleep patterns, which can make it difficult for people to achieve restful and rejuvenating sleep. PTSD can affect sleep in the following ways:

• Nightmares - one of the main ways that PTSD affects sleep is through nightmares and night terrors. These vivid and distressing dreams often involve reliving the traumatic event, causing people to wake up in a state of panic, anxiety, distress or disorientation. Waking up from a nightmare can sometimes create physical sensations, such as pain, sweating, feeling sick or trembling. Over time, the fear of having nightmares can cause anticipatory anxiety, which can make it hard for people to relax and fall asleep
• Hypervigilance - people with PTSD might struggle with hypervigilance, causing them to be ‘on edge’ all the time and constantly alert for potential threats. This can also make it difficult for them to wind down and enter into a relaxed state, ready for sleep
• Hyper-arousal - the hyper-arousal that’s associated with PTSD can also cause people to wake up a lot during the night, disrupting their natural sleep cycle and preventing them from achieving good quality sleep

As a result, people with PTSD often experience symptoms of insomnia. These sleep disruptions can make other symptoms of PTSD worse, creating a vicious cycle that further compromises a person’s mental health and wellbeing.

What causes PTSD nightmares?

PTSD night terrors and nightmares are usually triggered by the trauma that led you to develop PTSD in the first place. Experiencing or witnessing something traumatic can have a significant impact on how your brain processes information. Specifically, your brain’s natural mechanisms for processing and integrating traumatic memories can become disrupted when you have PTSD, leading to an inability to process and resolve the trauma.

As a result, your trauma remains unprocessed and the memories of the trauma can become deeply ingrained in your mind. This can lead them to resurface during sleep in the form of nightmares. These nightmares usually involve your subconscious mind replaying the traumatic event (or how you remember it), causing you to experience the distressing emotions and sensations that you felt at the time of the trauma. In some instances, the body can also recreate the physical sensations you experienced during the traumatic event.

Nightmares are complex PTSD

Nightmares can also be a part of complex PTSD (CPTSD). CPTSD is a type of PTSD that arises from prolonged or repeated trauma, particularly during childhood. Everyone’s experience is different. People with CPTSD may experience a range of symptoms, similar to those of PTSD, including nightmares. However, they may also experience additional challenges such as difficulties with emotional regulation, relationship problems and issues around identity or self-image.

The nightmares in CPTSD can be related to the traumatic experiences that the person has gone through over a long period of time, and may include themes such as powerlessness, betrayal or a loss of safety. Find out more about PTSD vs CPTSD.

How long can PTSD nightmares last?

The duration of PTSD nightmares can vary from person-to-person and can also fluctuate over time. For some people, PTSD nightmares may happen shortly after the traumatic event and persist for a relatively short period of time. Over time, they may decrease in frequency and intensity as the person receives treatment and uses effective coping strategies. However, for other people, PTSD nightmares can persist for months, years or even decades, continuing to disrupt their sleep and cause ongoing distress.

Factors such as the severity of the trauma, the presence of other mental health conditions, and access to support and treatment can all influence how long a person’s PTSD nightmares may last. The person’s ability to cope with and process the trauma can play a role in reducing the impact of nightmares on their sleep and overall wellbeing.

Ultimately, while PTSD nightmares can be persistent and challenging, with appropriate treatment and support, people can learn to manage their symptoms and experience improvements in sleep quality and overall mental health.

How to manage sleep when you have PTSD

It can be challenging to manage sleep when you have PTSD. However, there are strategies that can help you to create the best conditions for sleep and minimise potential triggers for PTSD nightmares. These include:

• Try to go to sleep and wake up at the same time every day, even at the weekend. This will help to regulate your body’s internal clock, making it more likely you’ll fall asleep and stay asleep throughout the night, reducing the chance of you having nightmares. Also, try to avoid sleeping in the day, if possible
• Create a relaxing bedtime routine that will signal to your body that it’s time to wind down. This could include taking a hot bath, practising relaxation techniques, or doing something that makes you feel calm, such as reading or listening to soothing music. By creating a sense of calm and tranquillity before bedtime, it’s likely that you’ll find it easier to transition into sleep without the intrusive thoughts and images of your trauma disturbing your dreams
• Make sure your sleep environment is comfortable and conducive to sleep. Try to keep your bedroom dark, quiet and cool, as these factors can promote relaxation and help you to feel safe and secure while you sleep. This sense of safety can reduce hyper-arousal and hypervigilance, which are common symptoms of PTSD that can contribute to nightmares
• Avoid stimulating substances and activities close to bedtime, such as caffeine, nicotine or electronic devices. This can help to stabilise sleep patterns and minimise disruptions in your sleep continuity
• Be kind to yourself; there will be good nights and there will be nights where sleeping feels difficult. Overthinking can become a real challenge when a person is ‘inactive’. Applying acceptance combined with self-care tools, which can be developed in psychotherapy, can help to manage those nights better
• Get professional help for your PTSD. Seeking support from a mental health professional, who specialises in PTSD, can provide you with valuable guidance and coping strategies for managing sleep disturbances and other symptoms of PTSD  

Treating PTSD

PTSD is a complex condition that usually needs professional support. Without help, it is possible that your symptoms could get worse and continue to have a destructive impact on lots of different areas of your life.

However, it’s important to understand that there are lots of effective treatment methods for PTSD and it’s possible for you to regain control your life. Getting professional help tailored to your wishes and needs, is essential for managing your symptoms and improving your wellbeing.

If you’re experiencing the symptoms of PTSD, such as nightmares, flashbacks or hypervigilance, it’s important to reach out for help. You could start by getting in touch with your GP, who can provide an initial assessment and referral to appropriate mental health services. Alternatively, you could contact a mental health treatment provider, such as Priory, to enquire about our treatment options.

Treatment for PTSD usually involves an approach that addresses both the psychological and physiological aspects of the condition. Some of the most effective PTSD treatment methods include:

• Eye movement desensitisation and reprocessing (EMDR) – EMDR is an evidence-based treatment for PTSD that involves reprocessing traumatic memories while engaging in rhythmic eye movements or other forms of bilateral stimulation. This therapy aims to reduce the emotional distress associated with traumatic memories, and alleviate the symptoms of PTSD
• Cognitive behavioural therapy (CBT) – CBT is another common and effective treatment for PTSD. This therapy helps people to identify and change unhelpful thought patterns and behaviours associated with their trauma. Exposure therapy, which is a type of CBT, helps people to gradually confront and process their traumatic memories in a safe and controlled environment to reduce their emotional reactions
• Complementary and alternative therapies – yoga, mindfulness, meditation, acupuncture and other complementary therapies can also be beneficial in managing PTSD symptoms and improving overall wellbeing. These therapies can help people to develop coping strategies, reduce stress and enhance relaxation, and can go hand-in-hand with your preferred trauma-focused therapy
• Medication – medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) may be prescribed alongside therapy, to help alleviate symptoms of depression, anxiety and sleep disturbances that are commonly associated with PTSD

Getting support from a qualified mental health professional is crucial for receiving the care and treatment you need to address your PTSD. We can help to develop a tailored treatment plan that addresses your unique needs and goals - you don’t have to face PTSD alone.