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Sleep Problems When You Have PTSD

Information on the Types and Causes of Sleep Problems in PTSD

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Updated January 29, 2012

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It is very common for people with a diagnosis of PTSD to experience some type of problem sleeping. In fact, difficulty falling and/or staying asleep is considered one of the hyperarousal symptoms of PTSD, and studies have found that sleep problems are one of the most commonly reported symptoms reported by people with PTSD.

Types of Sleep Problems in PTSD

People with PTSD may experience a number of different types of sleep problems. Many people with PTSD have difficulties falling asleep as compared to people without PTSD. In fact, one study of Vietnam veterans found that almost half of those with PTSD said that they have trouble falling asleep at night, whereas only 13% without PTSD said that they have this problem.

In addition, PTSD may make it difficult to stay asleep during the night. In the same study mentioned above, 9 out of 10 veterans with PTSD said that they often have trouble staying asleep during the night. People with PTSD may wake up frequently during the night, have difficulty falling back asleep, or may wake up earlier than they intended. Also, even if sleep does occur, it is often not good, effective sleep (for example, there may be a lot of movement or talking/yelling during sleep).

Of course, nightmares are also very common among people with PTSD. Nightmares are considered one of the re-experiencing symptoms of PTSD. Among people with PTSD, nightmares may be about the traumatic event a person experienced or they may be about some other upsetting or threatening event.

Finally, because of these sleep problems, people with PTSD often develop fears about going to sleep. They may experience worries or thoughts of their traumatic event as soon as they go to bed. They may also fear acting out their nightmares while asleep or impulsively upon being woken up from a nightmare, leading them to sleep alone away from their partners.

What Causes These Sleep Problems

Sleep problems are often one of the more difficult symptoms of PTSD to treat and the exact causes of these sleep problems in PTSD is not really well known. However, there have been some ideas.

It has been suggested that the nightmares of PTSD (or the fear of having a nightmare) result in difficulties falling or staying asleep. As people experience more nightmares and resultant waking, the nightmares may actually begin to trigger waking in order to escape the arousal that goes along with having a nightmare.

Sleep problems among people with PTSD may also be the result of experiencing frequent symptoms of hyperarousal. Constantly being on guard, tense, and on edge may interfere with one's ability to fall and/or stay asleep. A person may be more sensitive to sounds while asleep, and as a result, be more likely to wake up even in response to minor sounds.

People with PTSD may also view going to sleep as a loss of control. The lack of awareness and control that comes with sleeping may be frightening for a person with PTSD, thereby further intensifying arousal and interfering with sleep. Finally, the sleep problems connected with PTSD may lead to a problematic cycle. Because of a lack of sleep during the night, a person may sleep more during the day, leading to greater difficulties falling asleep at night.

Getting Help

Sleep problems are important to address because poor sleep can lead to a number of other problems. A lack of sleep or poor sleep quality can be a factor contributing to stress and mood problems. Poor sleep can also have a negative impact on your physical health.

Changing sleep habits may be helpful in improving your ability to fall asleep. There are a number of things you can do to improve your sleep. Try some of the suggestions in this article and see if you can change any of your bad sleep habits. You can also learn more about how to cope with sleep problems from About.com Guide to Sleep Disorders.

It may also be important to obtain treatment for your PTSD. Given that many of the sleep problems experienced by people with PTSD are thought to result from the symptoms of PTSD, by reducing those symptoms you may also improve your sleep. You can find out more information about treatment providers in your area who might offer PTSD treatments through UCompare HealthCare from About.com, as well as the Anxiety Disorder Association of America. However, it is important to note that people sometimes find that their sleep problems remain even after the successful treatment of PTSD. Therefore, it may be important to also seek out assistant from doctors that specialize in sleep problems.

Source:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.

Epsie, C. A. (2002). Insomnia: Conceptual issues in the development, maintenance, and treatment of sleep disorders in adults. Annual Review of Psychology, 53, 215-243.

Harvey, A. G., Jones, C., & Schmidt, D. A. (2003). Sleep and posttraumatic stress disroder: A review. Clinical Psychology Review, 23, 377-407.

Inman, D. J., Silver, S. M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3, 429-437.

Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., et al. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder. Journal of the American Medical Association, 286, 537-545.

Lamarche, L. J., & De Koninck, J. (2007). Sleep disturbance in adults with posttraumatic stress disorder: A review. Journal of Clinical Psychiatry, 68, 1257-1270.

Mellman, T. A., Kulick-Bell, R., Ashlock, L. E., & Nolan, B. (1995). Sleep events among veterans with combat-related posttraumatic stress disorder. American Journal of Psychiatry, 152, 110-115.

Neylan, T. C., Marmar, C. R., Metzler, T. J., Weiss, D. S., Zatzick, D. F, Delucchi, K. L., et al. (1998). Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 155, 929-933.

Schreuder, B. J. N., Kleijn, W. C., & Rooijmans, H. G. M. (2000). Nocturnal re-experiencing more than forty years after war trauma. Journal of Traumatic Stress, 13, 453-463.

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