Post-traumatic stress disorder (PTSD) can develop after a person experiences a traumatic event or perceived threat, such as an accident, war, or crime. PTSD nightmares often incorporate similar feelings and sensations to the experience during the trauma.

Post-traumatic stress disorder (PTSD) is a mental health condition that arises after experiencing or witnessing a traumatic event.

One of the hallmark symptoms of PTSD is recurrent, distressing nightmares. These nightmares may vary depending on the type of trauma and can severely impact a person’s quality of life, making it crucial to understand their nature, causes, and potential treatments.

In this article, we look at the links between sleep and PTSD, the signs and causes of PTSD nightmares, when to contact a doctor, treatment, and support options, with a personal story from Andy Ellis.

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Nightmares are a common but challenging symptom of PTSD. They often occur as intense, distressing, or vivid dreams that replay the traumatic event or aspects of it, causing significant anxiety and fear.

People with PTSD may experience these intense nightmares regularly, and they often go beyond typical bad dreams. A study of 32 veterans with PTSD found that 88% of participants had at least 1 nightmare per week.

PTSD nightmares sometimes result in severe sleep disturbances such as insomnia, which may exacerbate the symptoms of PTSD. Sleep disorders can make PTSD nightmares worse, but improving sleep can help reduce these nightmares and enhance the effectiveness of other PTSD treatments.

Understanding the nature of these nightmares is crucial for effective management and treatment.

What is PTSD?

PTSD is a mental health condition that can develop after an individual witnesses or experiences a traumatic event such as:

  • serious accidents
  • loss of a loved one, whether or not this involved violence
  • sexual assault
  • harassment and bullying, including racism, sexism, homophobia, biphobia or transphobia, and other types of abuse
  • experiencing crime
  • regularly seeing or hearing distressing things, such as working in the emergency services or armed forces

Affecting approximately 6% to 9% of people, PTSD can cause intense, disturbing thoughts and flashbacks that relate to the traumatic experience. Symptoms usually occur within 3 months of experiencing a traumatic event and may last from 4 weeks to long after it ends.

The effects of PTSD can impact a person’s mental health and ability to function properly. It may also cause chronic impairments, lead to other psychiatric illnesses, and can increase the risk of suicide.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Learn more about PTSD.

PTSD nightmares are typically more severe and distressing than regular nightmares as they relate to the actual event. They can lead to negative effects on both mental and physical health.

Signs of PTSD nightmares often include:

  • recurrent, involuntary, and intrusive memories of the traumatic event
  • dreams that cause significant distress or social impairment
  • physical reactions such as sweating, trembling, or an increase in heart rate
  • avoiding sleep due to fear of having another nightmare
  • difficulty falling or staying asleep

PTSD nightmares also increase the risk of suicidal ideation. An older 2012 study found that individuals experiencing PTSD nightmares were five times more likely to have suicidal tendencies than those who do not have nightmares.

These symptoms can create a vicious cycle where fear of nightmares leads to sleep avoidance, which in turn exacerbates PTSD symptoms.

Andy’s story: PTSD nightmares

“I live with CPTSD (complex PTSD), and I experience nightmares regularly.

They are suffocating. That’s the first word that comes to mind when I think of them. I vividly remember every nightmare I have, and I often write them down when I wake up. I wake up bruised most mornings, and sometimes I wake up with cuts.

When people talk about PTSD, they usually focus on the flashbacks and the mood swings. They forget about the nightmares and the issues with sleep and how it leads to you feeling drained of all your energy, constantly fatigued, and borderline terrified of falling back to sleep.

Emotionally, it’s even harder because you’re forced to relive twisted variations of your fears and trauma every night, and you wake up feeling more terrified than you were when you were falling asleep. It’s taxing and debilitating, and it feels like things will never get better.

I use therapy and mindfulness, and it helps a little. Some nights, I dream normally, and it’s peaceful, but I also know the nightmares may take a while to go away forever. It’s all about learning to live and cope with it.”

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It is crucial to seek medical advice if PTSD nightmares:

  • persist for more than a few weeks
  • cause severe distress or interfere with daily functioning
  • lead to avoidance of sleep due to fear of nightmares
  • occur alongside other symptoms of PTSD, such as flashbacks, severe anxiety, or depression
  • cause suicidal thoughts

A healthcare professional can provide a comprehensive evaluation and recommend appropriate treatment options to manage the condition effectively.

Sleep disturbances are common in individuals with PTSD.

Besides nightmares, people may experience difficulty falling asleep, frequent awakenings, or issues with sleep quality. PTSD may also cause worries to worsen at night, disrupting sleep. Here are some examples:

  • Avoidance: People with PTSD may avoid going to sleep due to fear or feeling as if going to bed is unsafe.
  • Loss of sleep time: Problems falling asleep, being restless during the night, and waking up earlier than wanted can affect sleep time.
  • Feeling on edge: People with PTSD may feel the need to be on guard to protect themselves from danger, impacting the ability to have a restful sleep.
  • Not liking silence: Some individuals may dislike silence after a traumatic event and keep a television on all night. These changes in light and sound can disrupt sleep.
  • Increase in arm and leg movement: After a trauma, people may experience more arm and leg movements during sleep, which can cause feelings of restlessness.

Sleep disturbances can further exacerbate PTSD symptoms, leading to a decline in overall health and well-being. Ensuring adequate and restorative sleep is crucial for the management of PTSD.

PTSD nightmares are thought to result from the brain’s attempt to process and make sense of the traumatic event. Factors that may contribute to the development of PTSD nightmares include:

  • Hyperarousal: PTSD often occurs due to a heightened state of arousal, which can interfere with sleep and contribute to the development of nightmares.
  • Conditioning: The brain may become conditioned to associate sleep with the distress of the traumatic event, leading to recurring nightmares.
  • Memory processing: Nightmares may be the brain’s way of processing and integrating traumatic memories.

Nightmares may vary depending on the type of trauma, but they often stem from imbalances in brain chemicals and dysfunction in certain areas of the brain, including:

When treating PTSD nightmares, a doctor will take the individual’s experience into account to find the most appropriate treatment strategies. Treatment options may involve a combination of therapies and, in some cases, medication.

Behavioral therapy

  • Imagery rehearsal therapy (IRT): A technique specifically for nightmares, IRT involves modifying the content of the nightmare into a new, less distressing scenario and rehearsing it during the day.
  • Exposure, relaxation, and rescripting therapy (ERRT): This therapy combines exposure to the nightmare, relaxation techniques, and rescripting of the dream.
  • Systematic desensitization: Uses relaxation techniques in combination with exposure to anxiety-provoking stimuli in a controlled manner.
  • Eye movement desensitization and reprocessing (EMDR): This therapy uses guided eye movements to help process and integrate traumatic memories.
  • Lucid dreaming therapy (LDT): Helps patients gain awareness within their dreams to alter the dream content and reduce fear.
  • Cognitive behavioral therapy for insomnia (CBT-I): CBT-I focuses on improving sleep hygiene and treating insomnia symptoms associated with PTSD.


Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can help manage symptoms of PTSD.

A doctor may also prescribe prazosin, a medication that usually treats high blood pressure, however it is effective in reducing the frequency and intensity of PTSD nightmares.

Combination therapies

Combining therapies like CBT-I with IRT to address both sleep quality and nightmare content can enhance overall treatment effectiveness.

With appropriate treatment, individuals with PTSD can see a significant reduction in the frequency and severity of nightmares and other symptoms.

Early intervention is crucial, as long-term sleep disturbances can lead to more severe complications such as chronic sleep disorders, depression, and substance use disorders.

Support for post-traumatic stress disorder (PTSD) can help with the emotional, mental, and financial effects of the condition. Options include support groups, financial aid, and therapy.

The following organizations may offer in-person or online support groups:

Support groups can be beneficial for people experiencing PTSD nightmares by giving them a space to talk and connect with others who share similar experiences.

PTSD nightmares are a debilitating symptom of PTSD that can severely impact an individual’s sleep and overall well-being. Understanding the signs, causes, and treatments of these nightmares is essential for managing this condition.

With a combination of therapeutic approaches, medication, and support, individuals with PTSD can achieve significant improvements in their symptoms and lead fulfilling lives. Early intervention and comprehensive care are key to overcoming the challenges posed by PTSD nightmares.