PTSD and Sleep: How Improved Rest Aids Recovery

Jun 27, 2025 | Anxiety+Stress, Blog, Health, Insomnia, Sleep Apnea, Sleep Disorders, Sleep Tips, Veterans

Most people who’ve experienced trauma struggle with sleep. In fact, up to 9 in 10 people with PTSD say they have trouble falling asleep, waking up often, or suffering nightmares (Jaeger, 2021). These sleep issues aren’t just a side effect of PTSD; they actually fuel it and keep it going (Miller et al., 2020). That means getting better sleep isn’t just about feeling rested at night; it also helps ease stress during the day and supports your overall recovery.

Common Sleep Problems in PTSD

  1. Insomnia: Lying awake at night or waking up too early, even when you’re tired.
  2. Nightmares: Repeated, upsetting dreams that often replay the trauma.
  3. Hyper-alertness: Always feeling “on guard,” so it’s hard to relax into sleep.
  4. Broken Sleep: Waking up many times, which prevents deep, restorative rest.

These problems make daytime symptoms, like anxiety, trouble concentrating, and mood swings, worse, and can even raise the risk of developing PTSD after a trauma (Miller et al., 2020).

Talk Therapy to Improve Sleep

  • CBT-I (Cognitive Behavioral Therapy for Insomnia)
    • Teaches healthy sleep habits, like going to bed and waking up at the same time.
    • Includes simple exercises to calm racing thoughts and limit time spent tossing and turning.
    • Proven to help people with PTSD sleep better and feel less afraid of bedtime (Talbot et al., 2014; Taylor et al., 2018).
  • Nightmare-Focused Techniques
    • Imagery Rehearsal Therapy (IRT): You rehearse a less scary ending to your nightmare while awake.
    • ERRT (Exposure, Relaxation, Rescripting Therapy): You write or talk through your worst nightmare, then practice changing its themes.
    • Both can cut down on bad dreams, though researchers are still figuring out exactly which parts work best (Pruiksma et al., 2018; Cook et al., 2010).

Medicines for Sleep

  • Sleeping pills (like benzodiazepines or “Z-drugs”) can help short-term but may cause daytime drowsiness or dependence if used too long (Miller et al., 2019).
  • Prazosin, originally for high blood pressure, can reduce nightmares in some, but not all, patients (Raskind et al., 2003; George et al., 2016).

Treating Sleep Apnea

Some people with PTSD also have pauses in breathing while they sleep—known as obstructive sleep apnea (OSA). These pauses wake you up over and over, so you never get deep, restful sleep. A common fix is a CPAP machine, which gently blows air into your airway to keep it open. When people use CPAP consistently, they not only breathe easier but often notice fewer daytime PTSD symptoms and less trouble with nightmares. Unfortunately, many find the mask uncomfortable or hard to keep on, so they stop using it. Finding ways to make CPAP more comfortable and easier to stick with is key.

Challenges in Getting Help

Many individuals seeking help for sleep apnea or other sleep disorders face lengthy delays before even seeing a specialist. Nationwide shortages of board-certified sleep physicians, overbooked testing facilities, and prolonged insurance authorization processes can stretch wait times out for several months. In the meantime, patients continue to endure daytime fatigue, impaired concentration, and elevated health risks.

Easy Steps to Better Sleep While You Wait

  • Keep a Routine: Go to bed and wake up at the same times every day.
  • Set Up Your Bedroom: Make it cool, dark, and quiet, and save your bed for sleep (and intimacy) only.
  • Unplug Early: Turn off phones, TVs, and computers at least 30 minutes before bedtime. Read a book or do gentle stretches instead.
  • Watch Your Drinks: Skip caffeine and nicotine after midday.
  • Learn to Relax: Try deep belly breathing, tensing and relaxing each muscle group, or picturing a peaceful scene in your mind to calm your body before sleep.

Learn More

Poor sleep can keep PTSD alive and even make therapy less effective. But improving rest often lessens daytime PTSD symptoms and boosts overall recovery. If sleep problems persist, talk with your doctor or therapist about CBT-I, nightmare therapies, or other options. Better sleep is within reach. Visit our website to learn more.

Sources:

  1. Cook, J. M., Harb, G. C., Gehrman, P. R., et al. (2010). Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial. Journal of Traumatic Stress, 23(5), 553–563. https://doi.org/10.1002/jts.20569
  2. Colvonen, P. J., Drummond, S. P. A., Angkaw, A. C., & Norman, S. B. (2019). Piloting cognitive-behavioral therapy for insomnia integrated with prolonged exposure. Psychological trauma : theory, research, practice and policy, 11(1), 107–113. https://doi.org/10.1037/tra0000402
  3. George, K. C., Kebejian, L., Ruth, L. J., Miller, C. W., & Himelhoch, S. (2016). Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), 17(4), 494–510. https://doi.org/10.1080/15299732.2016.1141150
  4. Harb, G. C., Cook, J. M., Phelps, A. J., Gehrman, P. R., Forbes, D., Localio, R., Harpaz-Rotem, I., Gur, R. C., & Ross, R. J. (2019). Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(5), 757–767. https://doi.org/10.5664/jcsm.7770
  5. Jaeger, B. (2021, September 16). PTSD and Sleep: Common Issues and How to Address Them. CPTSD Foundation. https://cptsdfoundation.org/2021/09/16/ptsd-and-sleep-common-issues-and-how-to-address-them/
  6. Miller, K. E., Brownlow, J. A., & Gehrman, P. R. (2020). Sleep in PTSD: treatment approaches and outcomes. Current opinion in psychology, 34, 12–17. https://doi.org/10.1016/j.copsyc.2019.08.017
  7. Orr, J. E., Smales, C., Alexander, T. H., Stepnowsky, C., Pillar, G., Malhotra, A., & Sarmiento, K. F. (2017). Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(1), 57–63. https://doi.org/10.5664/jcsm.6388
  8. Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological trauma : theory, research, practice and policy, 10(1), 67–75. https://doi.org/10.1037/tra0000238
  9. Raskind, M. A., Peskind, E. R., Kanter, E. D., et al. (2003). Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: A placebo-controlled study. American Journal of Psychiatry, 160(2), 371–373.
  10. Talbot, L. S., Maguen, S., Metzler, T. J., Schmitz, M., McCaslin, S. E., Richards, A., Perlis, M. L., Posner, D. A., Weiss, B., Ruoff, L., Varbel, J., & Neylan, T. C. (2014). Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep, 37(2), 327–341. https://doi.org/10.5665/sleep.3408
  11. Taylor, D. J., Peterson, A. L., Pruiksma, K. E., et al. (2018). Impact of cognitive behavioral therapy for insomnia disorder on sleep and comorbid symptoms in military personnel: A randomized clinical trial. Sleep, 41(3).