Post-Traumatic Stress Disorder (PTSD) is a well-known cause of insomnia. While not as common as anxiety, it can trigger an especially challenging type of insomnia in which the sufferer has an unconscious aversion to sleeping because of the fear of being vulnerable or the fear of nightmares.
Since PTSD is often triggered by experiences of violence either first-hand or as witnesses, the fight-or-flight response is very active. This state of severe hyperarousal will not allow the body to sleep soundly for any length of time.
PTSD-related insomnia may include these common symptoms:
- Flashbacks of the event running through your mind in endless cycles before you go to sleep or when you wake up in the middle of the night.
- Dreams of the event, which usually end by waking up with a start.
- Waking up with symptoms of fright, such as pounding heartbeat, sweating and breathlessness, even if you feel you haven’t been dreaming.
- Ultra-sensitivity to noises and disturbances in your environment.
- Sleep that is more restless and less peaceful than normal.
Of course there are vastly more symptoms of PTSD than what I’ve mentioned here that are not sleep related. The complete symptom picture and treatment methodology is beyond the scope of this site. Mainly, I just want to point out that if you feel you have some of these signs, or if you have recently gone through a very difficult and disturbing experience, you should feel encouraged to seek out appropriate treatment rather than suffer alone night after night.
Who Has PTSD
Post Traumatic Stress Disorder is a condition we expect mainly in war veterans, crime victims, accident victims, and those on the front lines of natural or manmade disasters such as tornados and terrorism. While the trigger may be one isolated event, it can also involve a series of events over a longer period of time, such as in combat, domestic violence, or childhood sexual abuse.
The clinical diagnosis of PTSD requires an intensely threatening event or series of events as part of the pre-assessment for treatment.
Milder cases may arise from less-threatening experiences. Sometimes an episode in your personal life, such as a family dispute, job layoff, divorce, lawsuit, etc., can trigger emotional aftereffects that feel very similar to post-traumatic stress, even if they can’t be technically classified as PTSD.
As I’ve mentioned in many previous posts, finding out what is causing your insomnia is the first step to treating it effectively. If trauma-induced flashbacks and hyperarousal are the cause, there is no sense in beating yourself up about it—just find help and get yourself on the road to recovery and better sleep sooner rather than later.
Treatments Available
If you suffer from PTSD caused by events or series of events such as war, crime, accidents, disasters, domestic violence, childhood sexual abuse and so on, the best thing you can do is get professional help and treatment.
Many sufferers find that as their symptoms begin to ease, their sleep improves, although in some cases, sleep is the last area of life to improve, which can be very frustrating. In these cases, sleep anxiety might be a secondary factor, which you can treat on your own once your PTSD symptoms have eased.
If you have insomnia due to milder post-traumatic stress from events that were not life-threatening but still disturbing to you, you should consider professional counseling and treatment, especially if your anxiety is high during the night, your flashbacks or dreams are troublesome, and you fear sleep despite your exhaustion.
Where to Get Treatment
I highly recommend that everyone with PTSD do some further research on sites that are much more knowledgeable than mine.
If you are a United States Veteran with PTSD symptoms, the best thing you can do is go to the Veterans Administration website and see what resources are available closest to where you live.
If you are not a veteran and have PTSD, you might want to visit the Sidran site for more information about post-trauma and healing.
You can also do local research to find therapists in your area who state they treat PTSD. You should ask them what type of treatment they use, as well as how much training and experience they have in the field.
Recommended methods of treatment
The three main treatment methodologies are: 1) Cognitive Behavioral Therapy (CBT), 2) Exposure therapy and 3) Eye Movement Desensitization and Reprocessing (EMDR). A multiple approach may be needed. Those who have other concurrent problems like depression or substance abuse may need additional forms of therapy. Medication may be prescribed.
Fear of Remembering
Most sufferers of PTSD are afraid of the memories and want to shut them out. This is an impossible task that can lead to unhealthy behaviors, such as substance addiction, or to emotional numbing — the brain’s unconscious, involuntary attempt at self-protection that unfortunately makes recovery more difficult.
The intense fear of and desire to avoid remembering may cause a constant internal struggle that gets in the way of the healing process. Whatever therapy is chosen is meant to allow you to confront the memories but in a safe and supportive environment, where you can learn a calmer and more objective way to view the past trauma so you don’t have to fear your memories and thoughts so much.
All of the therapies above – CBT, Exposure and EMDR – are designed to do this and have been proven effective when practiced by skilled therapists. Because traumatic stress requires specific treatment that is outside the typical skillset of many counselors and therapists, make certain the person you choose can describe their own training, experience, success rates and types of problems they treat with specificity and clarity. Anyone who bristles at your questions, gives you vague answers or tries to avoid the questions in some way is probably not the right therapist for you.
Once you have reached a state of mind more conducive to long-term healing of PTSD, you can focus more clearly on improving any residual sleep problems. Then you may gain benefits from the Insomnia Tutorial, making sure to give yourself the support and encouragement you need for more restful, peaceful slumber.