When you routinely can’t sleep, it’s hard to function or feel good about life. Unfortunately, insomnia and sleep problems are a frequent symptom of post-traumatic stress disorder (PTSD), which about 6% of people in the U.S. will experience at some point in their lives. They’re also one of the more common reasons people with PTSD turn to drugs and alcohol for relief.
At FHE Health, insomnia treatment is a first step in our therapeutic approach to PTSD, which works on the problem at its root rather than only on the symptoms. We’ve found that when patients sleep better, they can focus and engage well in their plan of treatment. Sleep is also a critical component of healing for both the brain and the body.
To treat insomnia and help restore sleep faster, we use brain-based technologies that train the brain toward healthier function and self-regulation. A healthy, self-regulating brain knows how to sleep. It just needs some help getting there after trauma and PTSD.
In the sections below, you can learn more about the link between PTSD and insomnia, the treatment options available and how insomnia treatment works at FHE Health.
PTSD Sleep Problems and the Link Between PTSD and Insomnia
PTSD sleep problems can include various disturbances, ranging from trouble falling asleep or staying asleep to poor, restless sleep. These disturbances are a symptom of the arousal and reactivity that are core features of PTSD. A diagnosis of PTSD (according to the DSM-5, the official diagnostic manual for mental health professionals) requires two or more symptoms of arousal, one of these being sleep disturbance.
Can PTSD Cause Insomnia?
Insomnia and sleep problems are common in PTSD and may be associated with nightmares and safety concerns, or with generalized arousal levels that interfere with the ability to get quality sleep. One of the earliest indicators of PTSD can be sleep disturbance in the form of nightmares, insomnia and interrupted sleep quality.
How Common Is Insomnia in People With PTSD?
A meta-analysis of 75 studies covering more than 570,000 people found that 63% of people with PTSD experience insomnia. Among veterans specifically, more than half of those with PTSD have clinically significant insomnia.
When a person is unable to relax, it’s harder for them to fall asleep. Over time, the stress of not being able to fall asleep may lead to further problems, as the person attempts to manage those problems with unhealthy coping strategies such as napping during the day or using alcohol and other substances.
Why Resolving Insomnia Is So Important
Resolving insomnia matters for several reasons. First, the presence of sleep problems can worsen PTSD symptoms, and improving sleep often improves PTSD symptoms in turn.
Sleep is critical to mental health. Without enough sleep, the brain cannot function properly, and prolonged sleep problems are associated with depression and with increased suicide risk. Research summarized by the VA’s National Center for PTSD found that veterans with both PTSD and insomnia had higher odds of suicidal ideation and suicide attempts than veterans with PTSD alone. If you or someone you love is having thoughts of suicide, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day.
Sleep is also tied to memory and the processing of emotional memories. A person needs sleep for the brain to sort out and process a traumatic event. Without it, the brain may keep cycling through the trauma during the day, making it harder to function.
Treatment Options for PTSD-Related Insomnia
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy for insomnia, usually shortened to CBT-I, is the treatment the VA and Department of Defense clinical practice guidelines recommend first for chronic insomnia. It’s a structured protocol rather than general advice, and it typically combines stimulus control, which strengthens the link between your bed and sleep, sleep restriction, which limits time in bed to time actually asleep, work on the anxious thinking that builds up around sleep, and sleep hygiene habits.
Studies of CBT-I in people with PTSD have generally found improvement in both sleep and PTSD symptoms. How it fits alongside trauma-focused therapy depends on the person, which is something your care team works out with you rather than applying a fixed sequence.
The Limitations of PTSD Sleep Medication
Sleep medications can provide some relief, but they have limitations. Most are intended for short-term use. Many carry side effects, and some are habit-forming or addictive. Without supervision, what begins as a temporary prescription for an anti-anxiety medication like Xanax can develop into a substance use problem.
How Neurotherapy Can Provide Relief From PTSD and Insomnia
Sleep quality is an indication of underlying brain function. Neurotherapy is the process by which we guide or train the brain toward better functioning. Better sleep is a byproduct of this neurorehabilitative process.
Many regions of the brain play a role in sleep regulation. Neurotherapy is training in neurological self-regulation, or training the brain how to regulate itself, bringing it into a less aroused, more relaxed state. When the nervous system is in a calmer state, sleep tends to improve.
Our Insomnia Treatment Protocol
“Neurostimulation” is a key part of our insomnia treatment protocol in Deerfield Beach, Florida. Here’s how it works.
How It Works
First, we meet with you to get a brief history and discuss the symptoms currently causing problems. We gather pre-treatment ratings on the most bothersome symptoms, including PTSD and sleep.
Next, we do an individualized assessment, which may include a QEEG (brain map) and additional neuropsychological testing (ERP testing). This assessment process allows us to pinpoint problems in the brain that may contribute to PTSD symptoms or sleep disturbance.
Afterward, we create an individualized neurostimulation treatment protocol. We gather symptom ratings for each symptom to track progress. After 15 treatment sessions, we repeat the QEEG and ERP testing to examine the brain changes that have resulted from the treatment. From there, we decide in consultation with you whether to continue neurostimulation treatments.
Because we collect symptom ratings at every stage, you and your care team can see how your sleep is tracking over the course of treatment rather than relying on recall alone. Patients in our program, including first responders with PTSD and sleep disturbance, have reported improvement in their sleep ratings over the course of neurostimulation treatment.
