Insomnia and PTSD

Ashleigh Fellows

Aug 7, 2019

Most people suffering from post-traumatic stress disorder (PTSD) also experience sleep problems, including insomnia. PTSD can lead to insomnia for a variety of reasons, including nightmares, an over-active “fight or flight” response that leads to hyper-vigilance, increased worrying, and distressing thoughts. In addition, although sleep problems are typically considered a symptom of PTSD, over time they can develop into independent disorders that sometimes persist even after successful treatment of the PTSD itself.  Thus, it can be helpful for some patients living with PTSD to also seek treatment for their sleep concerns.


The preferred treatment for insomnia, whether accompanied by PTSD or not, is cognitive behavioral therapy for insomnia (CBT-I), which uses a variety of techniques that address the many different factors that can promote insomnia, including psychological distress, the sleep environment, hyper-arousal, and inadequate sleep hygiene. For individuals experiencing PTSD-related nightmares, a type of therapy called imagery rehearsal therapy (IRT) can be also be beneficial, as it has been shown to reduce nightmares in individuals with PTSD. The benefits of both CBT-I and IRT continue for years after treatment. This is because these therapies provide individuals with techniques they can use for the rest of their lives.

Below you will find several things you can do today to help improve your sleep. However, if your sleep problems continue, consider seeking comprehensive treatment with a trained professional.


  • Go bed when you’re sleepy. Don’t try to “force” sleep by going to bed when you think you should, as this rarely works.
  • Avoid caffeine and alcohol. Stop consuming all these substances at least 4-6 hours before bed. Caffeine is a stimulant that can remain in your body for many hours. Alcohol, though a sedative, actually decreases the quality of your sleep and causes you to wake up more often.
  • Keep your bedroom dark and cool. Cooler temperatures and darkness cue our minds that it’s time to sleep by adjusting our internal state (e.g., increasing the body’s melatonin production).
  • Avoid screens. Artificial light, especially the type of light emitted by televisions, computers, and phones, can inhibit sleep in some people. Experiment with avoiding all screens 1-2 hours before bedtime.
  • Don’t worry or plan. Try not to worry or make plans while in bed. If you can’t stop the thoughts, get out of bed and engage in a quiet activity (e.g., reading, drawing, or playing cards). This will help prevent your bed from becoming a cue to worry and will also give you mind time to relax and prepare for sleep.
  • Avoid clock-checking. Though it’s a natural impulse, frequently checking the clock can make it hard to fall asleep, especially if you turn on the light to see it or check the time on your phone. In addition, watching the hours tick by can increase anxiety and negative thinking, both of which make falling asleep much more difficult.

Dr. Fellow’s provides diagnostic testing for individuals ages 6 years through adulthood. Her areas of training include diagnostic evaluations, pre-surgical evaluations, insomnia, anxiety, weight management, depression, autism, and chronic pain management.


Written by:

Ashleigh Fellows

Psy.D., Post Doctoral Fellow

Aug 7, 2019


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