Sleep Problems And PTSD: How To Deal With Trauma-Related Sleep Dysfunction?

When you have post-traumatic stress disorder, all aspects of your life are, in a very real sense, pulled into orbit around the black hole of the trauma you lived through. Nothing remains untouched. Your memory? Your sense of identity? Your mood and ability to process emotions? Your relationships with other people? Your ability to function in daily tasks ranging from shopping to work, and from going to the doctor to answering the door? You bet that all these aspects of your life are, in one way or another, going to be impacted by PTSD — even if you don't realize just how much while you're in the thick of it. 

How might PTSD impact your sleep quality?

Nightmares and a vague "sleep disturbance" such as "difficulty falling or staying asleep or restless sleep" are both recognized as possible PTSD symptoms in the diagnostic and statistical manual of mental disorders (DSM-5). They don't even come close to covering the full spectrum of sleep disturbances that people with post-traumatic stress disorder may experience, however.

Research has shown that it's not uncommon for PTSD sufferers to be plagued by any of these sleep difficulties:

• Insomnia — the inability to get to sleep or stay asleep, as well as a pattern of consistently waking up much earlier than you planned to — may affect up to 92 percent of people with PTSD. You may find it hard to get to sleep because of your hypervigilance, because intrusive memories have a way of showing up as you try to drift off, or because you spend time ruminating about your worries. You may be awoken by nightmares or small sounds and subsequently find it nearly impossible to go to sleep again. 
• Substance abuse, which many people with PTSD turn to to cope with debilitating symptoms, can induce sleep difficulties. 
• Nightmares may wake you up. Even if they don't, they can cause you to have a night of non-refreshing sleep. Some people with PTSD will physically act their nightmares out, believing, for instance, that they're back on the battlefield. Kicking, punching, screaming, and running are all possible. This can look quite similar to night terrors in children.
• Physical pain, which will affect a significant portion of people with PTSD and may be caused by injuries or tension, can likewise make it hard to go to sleep and stay asleep. Some people will have physical symptoms like hot flashes and sweating as a result of their distressing sleep as well. 

How can you cope with disturbed sleep as a result of PTSD?

You can try to cope with PTSD-related sleep dysfunction in numerous different ways, and some of these strategies can be employed simultaneously. While we're not going to say anything ground-breaking and I know from experience that you'll probably be unhappy to learn that there isn't an easy path to better sleep, some of these things really will help — not just others, but you personally. 

I don't want to waste your time, so I'll start with the scientifically-proven tips I find most helpful myself and then share some less science-based things that worked for me. 

• Seek treatment for PTSD. This may not be what you want to hear if you're not in treatment already, nor if you are and your sleep quality is still poor, but in the long run, it can help. If your dysfunctional sleep is caused by PTSD, reducing your symptoms across the board is also extremely likely to improve your sleep. 
• Ask your doctor about sleeping pills and talk about other medications. Medications to help you sleep better are around, and they can work very well. They can also have side effects, so should be considered carefully. If you're already taking medications, for instance antidepressants, these may be interfering with your sleep. Examining whether that is true for you is worthwhile. 
• Take another look at your sleep hygiene. That's basic stuff like going screen-free before bed, not caffeinating or boozing it up in the hours before you go to bed, and having a set routine in place. (I didn't think doing any of these things helped me, to be fair, but science suggests otherwise.)
• Engage in regular physical activity, especially outside, and see if it makes a difference. 
• Meditate before bed or while in bed. 
• If you really can't sleep, get up and do something quiet, comforting, and boring. Like a shower, reading for a bit, or playing solitaire with actual cards. 

Hours of worrying, mostly about impending doom, stopped me from going to sleep at the height of my PTSD symptoms. When I got there, dreams would soon interrupt me. I tried everything from too much alcohol (don't do it — it only makes things worse) to trying to force myself to think about nice things. Nothing worked very much until I progressed in talk therapy, but playing verbal games with myself was slightly comforting. Specifically, one in which you come up with a word, and then another word that starts with the last letter of that word, and so on. I know it counters the sleep hygiene recommendation above, but watching mindless and non-triggering TV shows helped some, as they kept the rumination at bay at least. In-browser games for which you don't need much in the way of cognitive power were another helpful out. If you're religious, praying can help — and if you aren't, reciting a mantra or even song lyrics may. 

These are all strategies to get you so tired you may be able to go to sleep without letting your mind wonder places that will keep you from drifting off, and not ones for staying asleep, but they helped me some. Ultimately, however, time and therapy did the trick for me, mostly. I wouldn't be surprised if the same turned out to be true for you.