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PTSD Nightmares: Causes, Effects, Treatment & Prevention

Last Updated: November 27, 2023

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Nightmares are considered to be one of the hallmark symptoms of PTSD. PTSD nightmares significantly affect sleep quality and, therefore, the overall physical and mental health of someone who experiences them. PTSD nightmares are thought to occur in the same way that PTSD flashbacks do, but during sleep instead of during the daytime. Nightmares that prevent quality sleep can negatively impact someone's life if not dealt with. 

How PTSD Affects Sleep

Trouble sleeping is a common symptom of PTSD. Those with PTSD regularly report poor sleep quality, which can include frequent wakings, jerky leg movements, difficulty falling asleep and nightmares. Studies have found that people with PTSD experience less deep sleep and have long periods of rapid eye movement or REM sleep. REM sleep is also where there are more frequent dreams, which can also mean more nightmares. 

Several health concerns are associated with sleep deprivation. Lack of sleep can increase anxiety or depression, cause issues with concentration and even affect someone's physical health over time. 

How PTSD Nightmares Affect Mental Health

PTSD nightmares are thought to be the reliving of the traumatic experience but during sleep. This can be thought of as PTSD flashbacks, but they occur when someone is asleep rather than during awake times. Studies have found that up to 72% of people with PTSD experience nightmares. 

These nightmares are often of the trauma the individual experiences, which will then jolt them awake. When someone wakes from a PTSD nightmare, they are often flooded with feelings of anxiety and fear, which can linger and affect their day-to-day functioning. Continued sleep disruption can lead to fatigue, trouble concentrating, irritability, feelings of hopelessness, anxiety, depression and increased risk of suicidal ideation. 

Sleep Disorder Treatment in People with PTSD

Thankfully, there is treatment for managing PTSD nightmare symptoms. The recommended way to begin treatment of PTSD nightmares is for the person experiencing the nightmares to document the content and frequency of the nightmares. No other tool is available yet to help measure nightmares, so self-reporting is the best way to gather information. Once a baseline is understood, a therapist can work with someone who is having PTSD nightmares to determine what treatment plan is best. 

Image Rehearsal Therapy

Imagine rehearsal therapy (IRT)  is a form of therapy that takes the scenario in a nightmare and reframes it during waking time. A therapist and client will go over what happens in the nightmare, but change the story of the nightmare or the ending so that it no longer mimics the traumatic event. It changes the nightmare dream script to something non-threatening. 

IRT usually occurs within twelve weeks, with sessions lasting approximately sixty to ninety minutes. A study using IRT found that after treatment, there was a 60% reduction in sleep disturbance and PTSD symptoms.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can be used to help treat PTSD nightmares and also the insomnia that typically accompanies PTSD nightmares. Behavioral therapy for PTSD nightmares works off of the idea that nightmares are a learned behavior that is based on an experience, and therefore the behavioral reaction to the trauma can be unlearned as well. There have been discussions in the medical community that a combination of different treatment modalities might be the best approach to treating PTSD nightmares due to the complexity of the condition and symptoms.

EMDR Therapy

Eye movement desensitization and reprocessing (EMDR) is based on the theory that PTSD nightmares or responses to trauma have not been properly processed by the brain and therefore, ingrained in the brain as something that is continuously dangerous or scary. 

EMDR therapy has a client recall the traumatic event while engaging both sides of their brain, such as tapping left and right or holding sensors that vibrate in alternating hands. This helps lessen the fear response to the traumatic memory so that it does not affect the person so intensely over time. Those who have completed EMDR therapy have reported less nightmares after sixty to ninety days, versus the success of CBT and other therapies for nightmares. 

Medication

The success of using medication to treat PTSD nightmares is not well documented and a lot of research is still left to be done on the efficacy of medication management for PTSD nightmares. There has been one medication, Prazosin, that has been found to have positive outcomes so far for the treatment of PTSD nightmares. Prazosin helps to reduce the levels of norepinephrine in the brain, which is what helps to regulate nightmares in the brain. 

Preventing PTSD Nightmares

Nightmares are a complicated side effect of PTSD, but there are steps that can be taken to help prevent or reduce the occurrence of them. Having insomnia from PTSD nightmares can lead to poor sleep habits that affect someone's mental and physical health. Tips to help ease the effects of PTSD nightmares include:

  • Avoiding drugs and alcohol
  • Avoid eating late at night
  • Only using the bed for sleep
  • Practice relaxation techniques
  • Create a calming sleep environment 
  • Avoid intense shows or movies before bedtime
  • Create a regular bedtime routine 

PTSD Treatment in Kansas City, MO

If you or someone you know is suffering from PTSD nightmares, seeking treatment may be necessary. The Recovery Village Kansas City is a treatment facility that offers primary mental health services for people with or without co-occurring substance use disorders. They also accept several insurance providers for services. Reach out to the admissions team at The Recovery Village Kansas City today for treatment for PTSD nightmares.

Sources

Koffel E, Khawaja IS, Germain A. “Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment.” Psychiatr Ann, March 2016. Accessed November 16, 2023. 

El-Solh AA. “Management of nightmares in patients with posttraumatic stress disorder: current perspectives.” Nat Sci Sleep, November 26, 2018.

Hudson SM, Whiteside TE, Lorenz RA, Wargo KA. “Prazosin for the treatment of nightmares related to posttraumatic stress disorder: a review of the literature.” Prim Care Companion CNS Disord. March 22, 2012.