What to Know About PTSD, Sleep Disturbances and Nightmares

Most people sleep at the end of their day. Some people nap during their day. Regardless of when, where or how they sleep, people do it daily. We have apps that track it, companies that claim to improve it, medicines to promote it. Ask any tired parent or exhausted overtime worker, and they will tell you how much they crave it, need it. Ask scientists and doctors and they will tell you all about sleep’s benefits, from weight loss to stress management to creativity and better moods.

• What is PTSD?

Ask anyone with post-traumatic stress disorder (PTSD) about sleep, and they just may reply with “what sleep?”

One of the diagnostic criteria of PTSD is sleep disruptions, which can come in the form of night terrors, persistent waking, inconsistent sleep patterns, hyperarousal that makes it impossible to fall asleep, or for some, even fear of lying down or closing one’s eyes. For people with PTSD, talking about sleep means talking about not sleeping. Granted, some have found ways to manage their sleep disruptions using medications, meditation or even naturalistic approaches such as essential oils or teas. But for many, and I daresay the vast majority, sleep is a constant battle.

My husband and I have banned the phrase “I’m tired” from our general vocabularies because of how silly it sounds to us after using it so many times. It just doesn’t convey what needs to be conveyed. I can commiserate with my friends who say “I’m exhausted” after a bad night’s sleep or an extra long day of work. I get it. I do. I have “normal” tired days too — the ones where there is more to do than normal or the ones with a sickness that makes sleep difficult, or when a little one pops up ready to go at 5:00 a.m. But when I talk about sleep and being tired, I mean something different. It is a kind of exhaustion that lives in your bones, settles in there and starts messing around.

Like many with PTSD, I struggle with night terrors. I consider myself a well-managed survivor; I am highly functional, out and about every day and dedicated to my path of healing and thriving. Yet no matter how well I am doing with managing daily symptoms, it sometimes catches up to me at night. There is simply no controlling your subconscious mind. Things I refuse to think about when I am awake, things I have entirely blocked out or things I only think about in controlled settings come crashing in. I may fall asleep quickly, beat after a busy day that followed a sleepless night, only to wake up, wide awake, startled back into my past with a shove, like falling off a cliff I knew was there and was purposefully avoiding. And there I will stay, incapable of sleeping again, doing everything I can to at least rest. Other nights I can’t fall asleep at all, an indefinable panic inching under my skin, making me too nervous to close my eyes or even shut off the light. And there I’ll stay, the hours marching past me, the quiet of our sleeping home surrounding me, reminding me that no matter how well I am doing, no matter how productive, enjoyable and beautiful my life is, my memories are seared into my brain, stuck on repeat. Other nights, the ones that sustain me, I doze in chunks, sleeping for an hour or two at a time, waking up, realizing I am OK and dozing off again in a short while. In the morning, I add it all up to a sleep win.

If you do a simple Google search with the terms “sleep PTSD,” you will quickly realize how widespread and problematic this is for survivors. Veterans report hearing bombs going off while sleeping, leaping out of bed into an otherwise silent room, only to lie wide awake afterward. Survivors of rape or sexual abuse may lie awake, eyes wide open, terrified to shut them, afraid to not see everything in the room. The quiet hours of night are often horrifying for those with PTSD. 

For anyone sharing a room, your sleeplessness can become a challenge for the other person, too. If you cry out in your sleep, you wake up the other person. If you startle awake, jerking out of bed, you wake the other person. If you need to keep the light on, it affects the other person. Enter the guilt of insomnia.

One research study by the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center in New York City found that between 70 and 91 percent of those with PTSD experience sleep disturbance. The study reiterates a truth the study’s subjects already knew all too well: a lack of sleep leads to an increase in the severity of symptoms during daytime hours. In my experience, I know I feel better and more prepared to manage symptoms, flashbacks or memories when I have had the most sleep. I can predict bad days before they come, based on how I have been sleeping.

I do sleep. There are some weeks I cannot believe how much I have been sleeping. There are sometimes chunks of time when I sleep so deeply and so soundly my husband jokes that nothing could wake me up. My body seems to suddenly realize how behind it is on rest and soaks up every last possible moment of sleep it can muster. I hope for those nights, those weeks, those month-long stretches, where I have no nightmares, no sudden wakings, no night sweats or sudden panic at the thought of lying down. I have my tricks too, that often help me sleep or at least rest — the scents that calm me, sleeping with one of our dogs every night, having a great TBR pile next to my bed for quick access if I need to distract myself. As with everything else that comes with PTSD, I manage it. I make it work.

Sleeping is less normal for me than having trouble with it, and it is a part of my life that although longed for, I cannot reliably expect. I have seen many dawns in my life. My favorite part of the day is when the sun first starts to color the sky, brighter in the winter if there is snow on the ground to enhance its rays, or accompanied by the sweet sounds of birds in the warmer months. I used to think it was because I knew it was done, the end of pathetic attempts at sleep for the night. But now I see it differently. I don’t think in endings anymore. That moment when night turns from darkness to light, and I am reminded to the depths of my soul that even the longest periods of darkness in my life have ended in the mercies of a new day.

Never take sleep for granted. There are so many of us who can’t, lying awake in the quiet hours of night.