One symptom that accompanies many mental health conditions, including PTSD, is trouble sleeping. This can involve insomnia, nightmares, obstructive sleep apnea (OSA), being unable to stay asleep or anything else that keeps you from getting proper rest.
Sleep issues are especially common among Veterans who have been diagnosed with PTSD. In fact, PTSD and sleep are so closely linked that treating sleep issues can make PTSD treatment more effective.
Sleep and mental health
According to researchers, sleep and mental health go hand in hand. If sleep disorders go untreated, they can interfere with recovery or possibly trigger other mental health conditions, and untreated mental health issues may interfere with sleep. Similarly, treating sleep issues and other conditions separately does not resolve either of them as well as treating them together.
Sleep-specific treatment can be easy to overlook, but it is an important element in improving Veterans’ overall mental health.
Characterized by difficulty falling asleep or staying asleep, insomnia is the most common sleep disturbance that Veterans report. While there are many treatments available, research has shown that Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective and it does not require medications. PTSD treatment on its own does not seem to resolve insomnia.
Provider recommendations for insomnia include the following:
- Wind down for 30 minutes before bed
- Wake up at the same time every day
- Limit caffeine use after noon
- Avoid alcohol and drugs before bed
- Avoid the regular use of hypnotic-type medications — for example, Ambien (zolpidem) — and discuss any use of these medications with a psychiatrist
By some estimates, up to 90% of Veterans with PTSD experience nightmares, which are bad dreams that may replay an unpleasant memory and cause the dreamer to wake up in a panic and have difficulty falling back asleep. Nightmares can cause Veterans to relive traumatic experiences, sometimes for years.
Treating sleep issues can make PTSD treatment more effective.
Nightmares tend to go away with evidence-based treatment for insomnia (like CBT-I), for OSA or for PTSD (prolonged exposure therapy, cognitive processing therapy).
Providers recommend using breathing techniques to calm down after waking from a nightmare. In addition, you can talk with your provider about insomnia, OSA and PTSD treatments and medications (like prazosin) to decrease the frequency of nightmares.
Obstructive sleep apnea
OSA refers to pauses in breathing (called apnea) and shallow breathing (hypopnea) that disturb a person’s sleep cycle. OSA can look like heavy snoring and intermittently waking up. It may be underdiagnosed since the sleeper is half-awake when their sleep is interrupted. Because signs and symptoms of OSA can be hard to pinpoint among Veterans with PTSD, researchers advise that any Veteran with PTSD take a home sleep test.
Using a positive airway pressure (PAP) device is the most effective treatment for OSA. It is normal for it to take a little while for PAP users to become comfortable with the device. In addition, losing weight and sleeping on your side can decrease the severity of OSA.
Taking the next step
By addressing sleep disturbances alongside PTSD treatment, Veterans with PTSD are likely to see better results and have a better quality of life. Speak with your VA care team if you have PTSD to develop an effective treatment plan that addresses both sleep and PTSD issues.
More information and help
Visit the Healthy Sleep section of My HealtheVet to learn the importance of good sleep and to find tools and information for Veterans and caregivers.