Sleep disturbances, such difficulty falling asleep, nightmares, or waking up throughout the night are some of the most common, persistent, and disturbing symptoms of posttraumatic stress disorder (PTSD). Modern research (Philbert, Pichat, Beeské, Decobert, Belzung, Griebel (2011), clearly shows that an acute inescapable stress exposure may cause long-lasting alterations in sleep patterns and behavior. (1) In addition, posttraumatic nightmares are reported by up to 70% of individuals suffering from PTSD. (2)
An occurrence of a traumatic event leads to increased stimulation of your autonomic nervous system which causes you to be in a chronically high levels of arousal, thus having a serious negative impact on your sleep and health in general. On top of this physiological condition, your sleep may be affected further by negative thinking patterns, including thoughts about being unable to sleep or fears of having nightmares. Having a glass of wine before bedtime may relax you but overall, drinking alcohol often disrupts your sleep further.
According to research (Lamarche, Koninck, 2007), cognitive-behavioral therapy including a component for nightmares (imagery rehearsal therapy) and insomnia has been found to significantly improve sleep disturbance among trauma survivors. In addition, the research suggests that other techniques, such as relaxation exercises, positive self-talk, imagery rehearsal related to recurring images before bed, and a daytime nap, may improve sleep disturbances to a greater degree, which may then lead to a significant decrease in other PTSD symptoms and overall PTSD severity. (3)
Let’s look at some simple strategies you can implement at home right now to improve your sleep.
Throughout your day:
- Engage in any form of exercise that you enjoy, but not too close to your bedtime. The only exception is bedtime yoga or light stretching.
- Read or listen to something that makes you laugh, even for just a few moments.
- Pick a memory that bring smile to your face and dwell on it for a little while.
- Try to avoid conflict in the late afternoon/evening and before bedtime. Only talk to those people that calm you.
- Get some fresh air and especially some sunlight, which increases natural production of melatonin in your brain.
- Avoid caffeine before bedtime (even in tea and soft drinks)
- Don’t nap during the day. If you must, only take a super short nap no longer than 15 minutes.
2. Prepare your bedroom.
- Invest into a diffuser and use essential oils to help you relax and sleep.
- Set you thermostat at a cooler temperature.
- Ideally, you should make your room nice and dark and block all the sunlight; however, if that gives you anxiety, using a small night-light may be very helpful.
- Make sure that you remove all triggers that could remind you of your traumatic experience from you bedroom.
- In general, your bedroom should be painted and arranged in a way that is soothing to you. It is your shelter and center of comfort after dealing with daily issues, it should feel that way.
3. Have a set bedtime routine.
- Choose a reasonable bedtime and go to bed at the same time as many nights a week as possible.
- Start getting ready for bed about an hour before your bedtime. Plan your day, prepare your clothes and other needed items for the next day, take a nice hot shower or a bath, put on cozy clothes, brush your teeth, etc…
- Do something relaxing – engage in a meditation routine or listen to nice and relaxing music.
- Avoid seeing, hearing, or thinking about anything that reminds you of the traumatic event.
- Have a night cup of a soothing herbal tea (such as, Yogi bedtime tea; again, no caffeine).
- Turn off all electronics, preferably at least an hour before bedtime.
- Use your bed for sleeping, not to watch TV or use electronics. Train your brain into thinking that once you head hits the pillow, it is time to sleep.
- Engage in deep breathing – at least 5 sets of deep breathing in and out is very relaxing.
- Once in bed, close your eyes and focus on positive dreams, hopes , and visions.
If you are struggling with nightmares, especially repetitive ones, there is an exercise that may be very helpful to you. This technique is adapted from Williams and Poijula (2016). (4)
Rewriting Nightmares:
- In your journal, describe your nightmare in as much details as possible, including your feelings, thoughts, and bodily sensations you experienced during the nightmare. You can describe as many nightmares as you can remember.
- Now, think of ways to change the ending of your nightmare. Rewrite the ending of your nightmare in a very positive way to regain control over your dream. Often it is the best to do this exercise right after the nightmare.
- Do a simple relaxation exercise and go back to sleep.
Resources for this article:
1. Philbert J, Pichat P, Beeské S, Decobert M, Belzung C, Griebel G. Acute inescapable stress exposure induces long-term sleep disturbances and avoidance behavior: a mouse model of post-traumatic stress disorder (PTSD).Behav Brain Res. 2011 Aug 1;221(1):149-54. PubMed: 21377492
2. Wittmann L, Schredl M, Kramer M. Dreaming in posttraumatic stress disorder: A critical review of phenomenology, psychophysiology and treatment. Psychother Psychosom. 2007;76(1):25-39. PubMed: 17170561
3. Lamarche LJ, De Koninck J. Sleep disturbance in adults with posttraumatic stress disorder: a review. J Clin Psychiatry. 2007 Aug;68(8):1257-70. PubMed: 17854251
4. Williams MB, PhD, LCSW, CTS; Poijula S., PhD. The PTSD Workbook, 3rd Edition, 2016
