Why Do PTSD Nightmares Occur?

posted in Mental Health, Recovery

When someone experiences nightmares from PTSD, they can seem very real to them. They might feel like they are back in a situation that is not safe, the traumatic experience that caused the disruption in the first place.

Symptoms can keep them awake or unable to fall asleep for long periods of time. Sleep is essential to healing the body, keeping it healthy, and feeling secure. Find out why nightmares occur with PTSD and how to offer support for someone who is struggling. 

Challenges with Sleep

The brain and body are wired for sleep at certain hours of the day. When it is dark, people feel tired and ready for rest.

When it is light, people typically feel ready to do things like work, go out with friends, socialize, and take part in activities. Shift workers often struggle with staying up during the nighttime hours and sleeping when it is light outside.

A full night of sleep with PTSD can be challenging and taxing on the body. Nightmares are part of the symptoms of PTSD, which impact overall sleep quality.

With a night’s rest, sleep includes REM and non-REM sleep, alternating cycles throughout the night. Disruptions due to PTSD can cause feelings of hopelessness and despair as a person desperately wants to sleep but cannot.

When they do sleep, they are disturbed by dreams that put them back in a situation where they feel in harm’s way. 

Impact on PTSD

Nightmares are a feature of PTSD. Even general nightmares can feel life-threatening, but with PTSD, they are actually tied to an existing trauma that happened in the near or far past.

Replaying traumatic events over and over can cause a struggle for someone to cope. A nightmare usually involves replaying the traumatic event, feeling like they are right back there again.

For veterans, this might mean re-witnessing horrific events or even deaths of people they witnessed while on combat missions. Physical abuse, violence, and other things can be triggering the nightmares and inability to sleep.

When someone fears going to sleep and is not wanting to go to bed, that can be traumatic. Sleep avoidance in combination with affected sleep cycles causes people to feel less connected to family, their work, and social life. They risk suicidal thoughts and are three times more likely to suffer PTSD-related risk factors such as addiction.

Treatment Options

Dual diagnosis, or experiencing PTSD symptoms with substance use, are not uncommon. It is one way people use to numb the feelings of pain and stress, including flashbacks and nightmares.

Appropriate treatment varies but every person should be evaluated thoroughly to see how they are coping with the nightmares and subsequent issues related to PTSD. This might include looking at relationships, work, and family life to see where they suffer the impact. 

Cognitive Behavioral Therapy (CBT)

CBT is used to identify and adjust thoughts, emotions, and behaviors they struggle with. These can include sleep therapies, self-exposure therapy, desensitization, and lucid dreaming therapy.

CBT is a time to sit down with a therapist and work out what has gone on to see if there are identified triggers that may be helpful to work on. The techniques can be used in combination or alone, though future research is needed to determine the best practices related to trauma. 


Medication for PTSD nightmares has had controlled trials and limited studies. One of the drugs looks to reduce the central nervous system’s sympathetic output.

This can help with people who have PTSD because their CNS output is relatively high. With controlled studies and the effects on sleep, this helps them to reduce nightmares.

Other proposed nightmare medications can be prescribed but must be closely monitored, especially with people who experience substance abuse or misuse of opioid and painkiller medications. They may be more sensitive to addictive medication and need to be mindful of what they use. 

Creating Safe Spaces

People who struggle with symptoms of PTSD often feel they are not safe or have moments of uncertainty over safety. Practicing good sleep hygiene involves adequate time for sleep.

Keeping electronic devices use to a minimum and away from the bedroom an hour before bed is most ideal. Sleeping when the body is tired is essential.

Whenever that is, let the body rest. Drop other activities for the time being that are non-essential and get rest.

Get help for substance use disorders and seek support for stress that may kick up negative feelings. Try some exercise to release stress and don’t worry about getting up and going to do things that don’t feel comfortable right now.

Helping a Loved One Through PTSD

Loved ones who struggle with symptoms of PTSD can have trouble letting go. Research done on nightmares directly related to PTSD show that support is critical for them but it can be difficult to know how to help.

Seeking individual therapy for them is crucial. Veterans and first responders can use therapies to help align their thoughts and feelings in a different way so they view the world more openly rather than closing off and isolating themselves when they are struggling.

Alcohol and substance use disorders require dual diagnosis treatment when occurring with symptoms of PTSD. It helps to have someone come alongside and help deal with the symptoms.

Recovery groups and community support systems are also important so people know they are not alone in dealing with the reality of addiction and mental health issues. 


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