Post-traumatic stress disorder (PTSD) is a health condition that can develop after someone experiences a traumatic event. PTSD has both mental and physical symptoms. The side effects of PTSD can impact sleep in several ways, including:1-3
- Nightmares
- Insomnia (trouble falling asleep or staying asleep)
- Sleep apnea
- Daytime sleepiness (hypersomnia)
- Sleepwalking
- Teeth grinding (bruxism)
- Periodic limb movements
- Restless legs syndrome
People with PTSD are also at higher risk of depression and substance abuse. In turn, PTSD, depression, and substance abuse all can cause sleep problems. Studies have found that lack of sleep before deployment leaves soldiers more susceptible to PTSD.4
Who gets PTSD?
People understand that post-traumatic stress disorder (PTSD) occurs in military veterans. But many do not know that there are many types of PTSD and that it impacts the whole body, not just the mind. PTSD can occur in people who have seen or experienced a wide range of traumatic experiences, including:1
- Sexual violence, physical assault
- Unexpected death of a loved one
- Life-threatening illness of a child
- Childhood abuse
- Combat, especially if injured
- Living in a war zone or violent neighborhood
- Witnessing death or serious injury
- Car accidents
- Natural disaster
- Heart attack and stroke
- A stay in intensive care (ICU)
The more often the traumatic event happens, or the more overlapping bad experiences someone has, the more likely they are to develop PTSD.
PTSD and insomnia
Nearly everyone with post-traumatic stress disorder (PTSD) experiences insomnia and nightmares. Insomnia in people with PTSD may be made worse if they also have sleep apnea, restless legs syndrome, or periodic leg movement disorder. Doctors believe that the stress and nightmares of PTSD lead to insomnia. Avoiding sleep to avoid the nightmares makes it worse.3
PTSD and sleep apnea
Though doctors do not understand why, there seems to be a connection between sleep apnea and PTSD. One study of Iraq and Afghanistan veterans being screened for PTSD found nearly 7 out of 10 were at high risk for sleep apnea. Other studies show that people with PTSD have an even greater risk of developing sleep apnea.3,5
Treating sleep apnea is an important part of treating PTSD.
PTSD, narcolepsy, and hypersomnia
PTSD often causes daytime sleepiness, sleeping too much, vivid, distressing dreams, or hallucinations just before falling asleep. All of these are symptoms of narcolepsy or hypersomnia (daytime sleepiness or sleeping too much). Doctors believe that some people with PTSD may develop narcolepsy as their body’s way of dealing with the strong emotions of PTSD.6
PTSD and restless legs syndrome
Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are more common in people with PTSD than the general population. These conditions are not the same thing but there is a significant overlap. RLS is a creepy-crawly sensation in the limbs that gets worse in the evening while the person is at rest. PLMD results in limb movements that can be seen during a sleep study or reported by a bed partner.3,7-10
One study of Vietnam veterans with severe PTSD found that 3 out of 4 had periodic leg movement disorder, more than twice other groups. Another study found one-third of veterans had PLMD. Doctors do not understand how PTSD, RLS, and PLMD are connected.3
Treating the sleep problems of PTSD
It is important to be treated for both PTSD and the sleep problems it causes. That is because a lack of sleep can make PTSD symptoms worse in the daytime. The sleep problems of PTSD can also make physical pain worse, increase blood pressure, and lead to obesity.1-4
Cognitive behavioral therapy for insomnia (CBT-I) is one of the key non-drug ways to treat the sleep problems of PTSD, especially insomnia. CBT-I basically teaches someone about healthy sleep habits and coaches them on ways to deal with nightmares. It also includes relaxation exercises and positive self-talk. People with PTSD and sleep apnea are treated with a CPAP machine.1-4,11