Breaking the Vicious Cycle of Sleep Problems and PTSD

Woman sits on the floor at the foot of a bed with her head in her hands.Nearly 7% of Americans will be diagnosed with posttraumatic stress (PTSD) at some point during their lives. In any given year, 3.5% of Americans have PTSD. Many struggle with sleep problems such as insomnia, sleeping too much, and nightmares. For people struggling with trauma during the day, nighttime can feel like a battleground that offers little respite from traumatic memories and intrusive thoughts.

Are Sleep Problems a Symptom of PTSD?

Trauma changes the brain, and these changes can also affect sleep. The Diagnostic and Statistical Manual (DSM) lists sleep disturbances—such as insomnia, frequent waking, or nightmares—as one of many potential symptoms of PTSD. Specifically, to be diagnosed with PTSD, a person must show at least two of six “alterations in arousal and activity.” Those changes include:

For some people, other symptoms of arousal play a role in sleep problems. For instance, a person who is anxious and hypervigilant may be too afraid to fall asleep, while a person with a heightened startle response may startle awake at every sound as they drift off to sleep. This change in sleep can also exacerbate other PTSD symptoms. A chronically exhausted person may be more irritable or have greater difficulty concentrating.

Some research suggests that sleep problems are more than just a symptom of PTSD. Instead, they may be a core component of the diagnosis. Research published in 1989 suggests that disturbances in rapid eye movement (REM) sleep are a PTSD hallmark that play a key role in other PTSD symptoms. Subsequent research has yielded mixed results. While some studies, including of animals, find a pattern of REM disturbances associated with PTSD, others do not.

A 2013 review of the literature argues that disturbances in sleep, especially REM sleep, may increase the risk of PTSD. Sleep issues may also worsen outcomes in people with PTSD. The study further argues that sleep issues can decrease the effectiveness of many PTSD treatments and that targeted treatments for sleep issues may speed recovery.

How Does PTSD Affect Sleep?

People with PTSD often find that their traumatic memories intrude on their ability to sleep. Some common PTSD-related sleep symptoms include:

  • Being unable to fall asleep because of anxiety or agitation.
  • Difficulty staying asleep because of frequent nightmares.
  • Poor quality sleep because of nightmares. Some people report waking up many times each night and struggling to fall back asleep each time. This is called maintenance insomnia.
  • Sleep problems related to drugs or alcohol. Some people with PTSD use alcohol or drugs to cope, which can cause sleep problems. Some medications for PTSD and anxiety may also cause sleep problems. For example, benzodiazepines may make it difficult to wake up in the morning.

A study that compared people with insomnia who did not have PTSD to those with combat-related PTSD and insomnia found important differences in the two groups. Those included:

  • More repetitive nightmares in people with PTSD. People with PTSD were more likely to say their nightmares made it difficult to go back to sleep.
  • More anxiety during the day in people with PTSD.
  • More fatigue during the day among people with PTSD.

This suggests a feedback loop between sleep issues and other PTSD symptoms. Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Other Sleep Problems and PTSD

Sleep issues are common, even in people without PTSD. A 2009 study found that about 30% of people experience insomnia in a given year. Some people also struggle with sleeping too much or with not feeling rested after sleeping. This may be due to:

  • Shift work sleep disorder, a condition that alters the “internal clock” of people who work nights or unusual hours.
  • Sleep apnea, a disorder that affects breathing during sleep, causing people to briefly wake many times during the night.
  • Sleep behavior disorder, which causes people to do unusual things while sleeping, such as sleepwalking, driving, or eating.

People with PTSD who have a pre-existing sleep disorder may find their symptoms get worse following a traumatic experience. Conditions that affect sleep can also compound the effects of PTSD, leading to depression, anger, difficulty concentrating, and more trouble coping with PTSD symptoms.

Even when the symptoms of a sleep disorder are not directly related to PTSD, it’s important to get help. Getting quality sleep is an important component of PTSD self-care.

Strategies for Coping with PTSD-Related Sleep Problems

Lifestyle changes can help some people with PTSD sleep more soundly. The National Sleep Foundation emphasizes that sleep is a habit, so the right changes can help the body adopt healthy sleep habits that offer better sleep. Try the following:

  • Design a comfortable sleeping area, with a firm and supportive mattress and comfortable pillow.
  • Develop a relaxing bedtime ritual.
  • Stick to the same sleep schedule every day, even on weekends or vacations.
  • Avoid napping during the day if you have trouble sleeping at night.
  • Exercise every day, but not right before bed.
  • Keep your bedroom cool, between 60-67 degrees Fahrenheit.
  • Keep your bedroom quiet. Some people find that a white noise machine helps.
  • If you can’t fall asleep, get up and do something else.
  • Use your bed only for sleeping—not to play, read, or do work.
  • Eat a light snack 45 minutes before bed if you tend to wake up hungry.
  • Avoid heavy meals, alcohol, caffeine, and cigarettes before bed. Some people find drinking caffeine in the afternoon makes it harder to sleep.

Stress and anxiety management strategies can be especially helpful for managing PTSD-related sleep problems. Some people find relief from meditation or yoga. Others find that guided imagery or positive mantras as they try to sleep can help.

Medications, including anti-anxiety and sleeping medications, may help some people. However, when the underlying PTSD symptoms remain, sleep problems will likely return when you stop using medication.

Therapy can help with both sleep issues and PTSD. A compassionate therapist will help you work through your trauma in a safe space, free of judgment. Your therapist can help you set goals, cultivate new tools for managing stress, help you understand how trauma changes the brain, and work with your doctor to decide which, if any, medications are appropriate.

PTSD can feel overwhelming. Some people become depressed because they think things will never change. Others are too exhausted to work or enjoy time with their family. It doesn’t have to be this way. Reach out to a therapist who is highly skilled at treating PTSD.


  1. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176/appi.ajp.2012.12040432
  2. Gradus, J. L. (2007, January 31). Epidemiology of PTSD. Retrieved from
  3. Healthy sleep tips. (n.d.). Retrieved from
  4. 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(3), 429-437. doi: 10.1007/BF00974782
  5. Phillips, K. (2015, February 4). What are the types of sleep disorders? A full list of sleep disorders. Retrieved from
  6. Sleep and PTSD. (2015, August 13). Retrieved from
  7. Yehuda, R., Hoge, C. W., Mcfarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . . Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 15057. Retrieved from

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Silvester

    May 21st, 2020 at 2:32 PM

    Let us change the worries of the past into the thinking and planning beforehand!

  • Carolyn

    October 2nd, 2020 at 4:08 PM

    I am now in the final stages of divorce from a 28-year abusive marriage from a man with Narcissist Personality Disorder. I am experiencing high levels of PTSD and insomnia, and I am having trouble moving forward. The level of betrayal (mostly financial – he stole all of the profits that we earned together in the business that we ran for 18 years), along with his abusive behaviors of screaming or attacking out of nowhere and in a heartbeat, the silent treatments that could last anywhere from a full day to two full weeks, the gaslighting, the smear campaign — you name it! It is all now rising to the surface, and it so much interferes with my concentration on anything and everything. Thankfully, my soon-to-be-ex no longer lives in the house with me; we made our financial decisions through mediation, and since he never ever paid a dime towards the house mortgage, household needs, or the children, this was a no-brainer. Many days I am fine, but then the incredible pain of betrayal rises to the surface, and I am stunned, reeling, and almost unable to function. Is there a therapist who specializes in this arena?

  • Peter

    October 23rd, 2020 at 7:38 PM

    I’m sorry to hear about what you are going through but you are not alone. If you have insurance you could find a psychotherapist who is in your network. To heal, I recommend you look up youtube videos having to do with EFT. Emotional Freedom technique. It is really powerful.

  • Alicia

    February 9th, 2021 at 4:27 AM


    It seems that you have studied what a narcissist is and understand how they function. It doesn’t mean just because you understand that you shouldn’t be affected. They often leave severe PTSD behind however you did stick up for yourself during a painful divorce and I hope got what’s right in the end. Despite all the trauma this person has left you they didn’t take everything from you. They’ll always go on being a narcissist and you’ll despite how you feel be the stronger one. Narcissists thrive off the strong not even realizing it because they’re that insecure despite how they try to project. If you find yourself missing this person don’t judge yourself. They created a huge cycle that’s mentally addicting and hard to break. One step at a time one foot in front of the other. Despite how you feel you are in control.

  • Lars

    December 25th, 2022 at 1:45 AM

    This was hard to write but i have been diagnosed with complex ptsd and i didnt and dont want to write everything down that i experienced cause there are soo many episodes in my life that arent good to anyone at all,, i do get help but my sleeping cycle is broken, i sleep 3 to 5 hours everyday and once in a while after a month or even more months i get to sleep 8 to 14 hours for a single day! and then it starts all over again with 3 to 5 hours sleep and most of my concern is that i dont and i repeat I DONT feel tired at all during waking up or on my way to bed even the single day i sleep 8 to 14 hours and i just fall asleep at some point, mostly cause im on alert all the time wich can confuse my thought some times or even make me complete numb or make it worse and i used to have prescription drugs that was working in the few first weeks and then stop working or i dont feel the effect any longer and stopped with the old pills and started new so i use now rivotril at 2mg and phenergan to get some sleep and if i dont take them i cant sleep more than and hour or 2 and cant fall asleep again and something else builds up that mostly ends bad for me but when im in psykiatrik/Hospitalized i get a normal sleeping cycle cause i used to feel safe and knowing i can talk to a doctor or psychologist but i have experienced some few psychologist that only cared about getting me out from there cause need of space for other people or i seem to been getting better even if i am not okay, i am also good at hiding how i feel by smiling and being nice when i have the chance to do it altho i am not in control on my thoughts mostly, how it became that way and hard to change cause of trauma growing up and my dad used to tell me not to tell anyone that he beat me up and my mom but he didnt beat my other siblings and i got bullied alot in school and gotten beat up by the bullies on my way home for some long time,.There where also that my words means nothing by either the teachers ignore i am getting bullied and almost all the teachers usually ignores me when i needed help for a task, they usually say you figure it on your own while they help other kids with quite happiness and one teacher used to crap my arm hard so hard that it hurts so i have trouble trusting people that shows a bit of neglet towaards me or if they act the same way, i am also starting soon on amitriptylin next year and i hopefully hope that it will work, i have to go bed at 19:00 just trying to relax cause i cant control my thoughts from the past and fall asleep at a around 23:00 to 01:00, im just sharing what i can tell from my own experience since it was not written in the article. i am ok moslty so no worries

  • Jack

    September 30th, 2023 at 3:49 AM

    Pfff… if I could keep my bedroom quiet, I wouldn’t be dealing with this crap. When you constantly hear your neighbors, and effectively have no separation from others in your own home, try living with it after surviving a home invasion. I don’t even remember the last time I slept well…. I think it was maybe a year ago, one night. Before that… probably some more years

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