Can PTSD Cause Insomnia? (And How is It Treated)

Insomnia is incredibly common in those with PTSD.

It has been studied heavily in combat veterans, but insomnia is a risk for PTSD sufferers from any cause.

Interestingly enough, insomnia can also put you at a higher risk of developing PTSD in high stress situations. Studies have found that soldiers with insomnia are more likely to have PTSD months down the line at a follow-up assessment (1).

This is a short summary of research on why PTSD affects sleep so much, and how it’s typically treated.

How Does PTSD Cause Insomnia?

It’s not too surprising that PTSD causes a lot of stress and anxiety, which are 2 of the main causes of insomnia.

One study compared patients with insomnia and PTSD to just “normal” insomnia patients to find the biggest differences (2).

The PTSD group reported symptoms of anxiety, agitation and concurrent body movement which were associated with insomnia. Nightmares of this group were more repetitive and more disruptive of a return to sleep than the non-PTSD insomnia group.

They went into a bit more detail on what the anxiety and nightmares were comprised of and found that they originated from a variety of sources including:

• Intrusive recollections (bad memories)
• Flashbacks
• Alienation from others
• Hyperalertness
• Survivor guilt
• Social and emotional problems

Even if a PTSD patient wasn’t in combat, they likely share some of these symptoms that can lead to insomnia.

Finally, the questionnaires in the study revealed that people with PTSD are much more likely to have stress from other areas of their lives (e.g. relationships, legal problems, employment, financial, physical health).

Note that this increase in stress is compared to the “normal” insomnia patients, who also have levels of stress than the general population.

SummaryWhile normal causes of insomnia can still apply, most cases of insomnia in PTSD patients are caused by anxiety, stress, and nightmares that interrupt sleep.

How is Insomnia in Patients With PTSD Treated?

With this sort of insomnia, the standard sleep hygiene education might help a bit, but won’t address the root cause.

Similarly, sleep medication can help in certain situations, but comes with a long list of potential side effects that can be even worse than the sleep problems.

Modern treatment plans for patients with PTSD and insomnia are typically based around cognitive behavioral therapy for PTSD (3).

CBT is a flexible therapy that involves restructuring thoughts and mistaken beliefs in order to develop a “healthier” mindset. The idea here is that you need to deal with the underlying PTSD symptoms before anything else, treating insomnia symptoms alone won’t fix anything.

How CBT for PTSD Works for Patients With Insomnia

The study referenced just above had subjects with an average of 16.3 individual CBT sessions. The plan was specifically tailored towards PTSD (note that CBT can be tailored around other conditions like insomnia as well).

The graph below shows that many PTSD symptoms were nearly eliminated for most patients, including nightmares, flashbacks, and hypervigilance.

With that being said, notice that difficulty sleeping and irritability/anger were still common problems even after treatment.

SummaryCBT for PTSD is a good start, but often requires further treatment. Even if anxiety and stress is fixed, insomnia often persists in about half of cases.

Further Treatment Options for PTSD and Insomnia

There’s not a ton of research on what to do after that initial treatment if it doesn’t fix sleep issues sufficiently.

One research team found 5 subjects who had done CBT for PTSD, but still had issues with sleep (4).

They tested the effectiveness of 5 sessions of PTSD Insomnia Treatment (PIT), which is based on Morin’s protocol for insomnia (established in 1993).

PIT involves

• Stimulus control
• Sleep restriction
• Focusing on strengthening connections between sleep-related cues

There were also standard sleep hygiene guidelines (e.g. limiting caffeine, doing exercise).

While it’s a small sample, insomnia scores improved significantly for most subjects.

SummaryA lot more research needs to be done on insomnia that persists after underlying PTSD symptoms have been improved, but treatments like PIT do show promise.

References

1. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans
2. Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia
3. Residual insomnia following cognitive behavioral therapy for PTSD
4. Treatment of residual insomnia after CBT for PTSD: Case studies