Better sleep can help Veterans with PTSD

A symptom that accompanies many mental illnesses, including PTSD, is insomnia. This could include insomnia, nightmares, obstructive sleep apnea (OSA), difficulty sleeping, or anything else that prevents you from getting proper rest.

Sleep problems are especially common among veterans diagnosed with PTSD. In fact, PTSD and sleep are so closely related that treating sleep problems can make PTSD treatment more effective.

Sleep and mental health

According to researchers, sleep and mental health go hand in hand. If left untreated, sleep disorders can interfere with recovery or potentially trigger other mental illnesses, and untreated psychological problems can interfere with sleep. Similarly, treating sleep problems and other disorders separately does not solve any of them, as well as treating them together.

Sleep-specific treatment can easily be overlooked, but is an important element in improving the overall mental health of veterans.

insomnia

Characterized by difficulty falling or staying asleep, insomnia is the most common sleep disorder veterans report. While there are many treatment options, research has shown that cognitive behavioral therapy (CBT-I) is most effective for insomnia and does not require medication. PTSD treatment alone does not seem to resolve insomnia.

The provider’s recommendations for insomnia include the following:

  • Relax 30 minutes before bed
  • Wake up at the same time each day
  • Limit caffeine consumption after noon
  • Avoid alcohol and drugs before bed
  • Avoid regular use of hypnotic-type drugs – for example, Ambien (zolpidem) – and discuss the use of these drugs with a psychiatrist

nightmares

By some estimates, up to 90% of veterans with PTSD experience nightmares, which are bad dreams that repeat an unpleasant memory and can cause the dreamer to panic and find it difficult to get back to sleep. Nightmares can cause veterans to repeat traumatic experiences, sometimes for years.

Treating sleep problems can make PTSD treatment more effective.

Nightmares tend to go away with evidence-based treatment for insomnia (like CBT-I), OSA, or PTSD (prolonged exposure therapy, cognitive processing therapy).

Providers recommend using breathing techniques to calm yourself down after waking up from a nightmare. Additionally, you can talk to your doctor about insomnia, OSA and PTSD treatments, and medications (like prazosin) to reduce the frequency of nightmares.

Obstructive sleep apnea

OSA refers to pauses in breathing (called apnea) and shallow breathing (hypopnea), which disrupt a person’s sleep cycle. OSA can look like heavy snoring and intermittent waking up. It can be underdiagnosed as the sleeper will be half awake when their sleep is interrupted. Because signs and symptoms of OSA can be difficult to localize in veterans with PTSD, researchers recommend that every veteran with PTSD take a sleep test at home.

Using a positive airway pressure (PAP) device is the most effective treatment for OSA. It is normal for PAP users to take a while to familiarize themselves with the device. Additionally, losing weight and sleeping on your side can reduce the severity of OSA.

Take the next step

By treating sleep disorders alongside PTSD treatment, veterans with PTSD are likely to achieve better results and a better quality of life. Talk to your VA care team if you have PTSD to develop an effective treatment plan that addresses both sleep and PTSD issues.

More information and help

Visit the Healthy Sleep section of My HealtheVet to learn the importance of a good night’s sleep and to find tools and information for veterans and caregivers.

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