There is evidence that people with with PTSD, including Veterans, often suffer from sleep problems and poor sleep, which can make it difficult to function and decrease quality of life.
Insomnia can be a significant challenge. Among active duty personnel with PTSD, research tells us 92 percent suffer from clinically significant insomnia, compared to 28 percent of those without PTSD.
Veterans with PTSD often suffer from nightmares, as 53 percent of combat Veterans with PTSD report a significant nightmare problem. In fact, nightmares are one of the criteria used to diagnose PTSD. Often, nightmares are recurrent and may relate to or replay the trauma the Veteran has experienced. They may be frequent and occur several times a week.
Sleep challenges can compound the effects of PTSD, and can lead to more negative effects, including suicidal ideation and behavior. Insomnia is associated with an increased risk of suicide, even independent of PTSD as a risk factor.
Prolonged or intense stress, such as that experienced during a trauma or in PTSD, is associated with a decreased level of serotonin. The serotonin system regulates parts of the brain that deal with fear and worry. Low serotonin production disrupts sleep and often leads to more significant sleep disorders, like insomnia.
Those with PTSD who experience these brain chemistry changes may be hyper-vigilant, even in sleep. This can make it difficult to fall asleep or remain asleep. Excess adrenaline can make Veterans feel wired at night and unable to relax and fall asleep. With elevated cortisol, there is a decrease in short-wave sleep, and increases in light sleep and waking.
Treating PTSD and sleep disorders
It’s important for Veterans to seek treatment for trauma-related sleep difficulties. With treatment, Veterans can work to improve sleep difficulties and get more restful sleep. Treatment for Veterans with PTSD may include:
- Psychotherapy: Psychotherapy is used to facilitate processing of a traumatic event. It may include therapies such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing. Although psychotherapy may not be directly aimed at sleep improvement, it can be effective in relieving PTSD, and in turn, the symptoms of sleep disruption from PTSD.
- Cognitive behavioral therapy: With cognitive behavioral therapy, Veterans with PTSD discuss their sleep habits and identify opportunities for improvement of sleep hygiene.
- Relaxation therapy: Often combined with meditation, relaxation therapy is used to promote soothing and a peaceful mindset before bedtime. Ideally, relaxation therapy can alleviate hyperarousal so that Veterans with PTSD can relax and fall asleep more easily.
- Light therapy: Light therapy uses exposure to bright light to realign the circadian clock. With exposure to bright light during the day, your brain is better able to understand that it’s daytime, and time to be alert. Patients of light therapy often fall asleep more easily and sleep later.
- Sleep restriction: Sleep restriction is controlled sleep deprivation, which limits the time spent in bed so that sleeping takes up 85 to 90 percent of the time spent in bed.
- Medication and supplements: Medications are typically considered a last resort for solving sleep difficulties due to their potential side effects. Supplements of melatonin, a natural hormone that regulates the sleep cycle can help patients sleep better. Medications including sedatives and hypnotics may be used if therapies and natural supplements are not effective.
Strategies and techniques to help PTSD-affected Veterans get to sleep
Treatment of PTSD and related sleep disorders is key. However, there are steps Veterans can take in addition to treatment that can alleviate the sleep disruption associated with PTSD. These include:
- Sleep in a comforting location: Your sleep environment should be a location where you feel safe, and free of any triggers that might cause you to relive trauma.
- Ask friends and family for support: Some with PTSD feel safer and more comfortable sleeping with a trusted friend or family member in the same room or a nearby room.
- Wind down in the evening: Spend time in the evening before bed winding down from the day to induce relaxation. If you take time to relax and maintain a consistent bedtime routine, you can signal to your brain that it’s time to sleep. This can be done by going through the same steps before bed every night, ideally relaxing activities such as playing soft music, meditating, practicing muscle relaxation, taking a warm bath, or reading a book.
- Setup the ideal sleep environment: A nightlight might make you feel more comfortable sleeping in a dark room. If your sleeping environment can be noisy or disruptive, consider playing soft music or using a white noise machine to block out sounds that can startle you out of sleep. Make sure to control the temperature of your room and keep it between 60-67 degrees fahrenheit. From your mattress to your bedding, make sure you know what keeps your spine in alignment and alleviates any pressure points or additional issues you might face.
- Give yourself enough time to sleep: Being rushed in the evening or morning can contribute to feelings of stress that may exacerbate sleep struggles for Veterans with PTSD. You shouldn’t feel like you don’t have enough time to sleep. Schedule enough time for adequate rest, leaving extra time if you often experience difficulty falling asleep or staying asleep through the night.
- Listen to your body’s sleep cues: Following trauma, you may need more sleep than you’re expecting. Listen to your body and go to bed when you feel ready to sleep. However, it’s important to avoid getting into bed too early and lying awake for long periods of time.
- Avoid activities that can interfere with sleep: Eating a large meal, drinking alcohol, consuming caffeine, or napping or exercising a few hours before bed can make it difficult to fall asleep. Avoid screen time late at night, including video games, TV, and mobile devices.
Keith Cushner is the founder of the sleep science hub Tuck. He’s a graduate of Whitman College and lives with Seattle, WA.