Causes and Treatment of PTSD Nightmares

People with post-traumatic stress disorder (PTSD) often experience nightmares in which they re-experience the trauma they went through. The prevalence of PTSD nightmares seems to be higher among people with a coexisting anxiety or panic disorder. The nightmares may occur multiple times per week and can be very distressing and disruptive to the sleep of the affected person and others in the household.

This article will go over how PTSD can cause sleep disturbances such as nightmares, and what treatment options are available.

A stressed woman with her head in her hands
 Peter Dazeley / Getty Images 

How PTSD Affects Sleep

PTSD is a combination of symptoms that occur as a result of trauma. It is characterized by intrusive thoughts, nightmares, and flashbacks of past traumatic events.

If you suffer from PTSD, you may often re-experience the trauma that you endured. This may occur during the day or at night. Nighttime memories often manifest as distressing dreams or nightmares in which the event is relived. Additionally, intrusive daytime memories, called flashbacks, may occur.

You will likely notice that you also have increased arousal, meaning that you are more reactive to your environment. This may be associated with significant anxiety. These symptoms may lead to difficulties falling or staying asleep, which is characteristic of insomnia.

It is estimated that nightmares occur in 5% of all people. In a study of combat veterans, 88% reported nightmares that occurred at least once per week. Researchers have also found that PTSD, nightmares and suicidal thoughts are closely linked.

Why PTSD Affects Sleep

The disorder itself seems to result from gene-environment interaction. Some research suggests that genetic factors affecting the transport of serotonin, a chemical in the brain that transmits signals, may play a role. Serotonin, in addition, has important effects on modulating emotions and sleep.


The nightmares and flashbacks associated with PTSD are often accompanied by increased anxiety and often panic attacks. A type of counseling called cognitive-behavioral therapy (CBT) has been shown to be most effective for treating nightmares associated with PTSD. This treatment can help you to understand and change your thoughts about the trauma and your programmed response to them.

There are multiple sub-types of CBT available, including Cognitive Processing Therapy (CPT).

Cognitive Processing Therapy helps to train you to replace these negative thoughts with more accurate and less distressing thoughts.

CPT may aid you in coping with feelings of anger, guilt, and fear associated with the prior trauma. A therapist can help you to process the event, learn not to blame yourself, and discover that the incident was not your fault.

With exposure therapy, you will learn to have less fear about your memories. Any associated thoughts, feelings, or situations that remind you of the trauma will become less distressing.

By thinking about the trauma in a controlled, safe environment, you will gradually be less stressed or anxious about the event.

This is accomplished in part through desensitization. This helps you to address upsetting thoughts and defuse bad memories by dealing with them incrementally. In some cases, an intervention called "flooding" is used to deal with a lot of bad memories at once.

In addition, relaxation techniques such as breathing or progressive muscle relaxation can be integrated to help relieve anxiety when reviewing a stressful memory.

Eye Movement Desensitization and Reprocessing

This therapy helps you to change how you react to traumatic memories. While thinking or talking about these recollections, you focus your mind on other stimuli. These may include eye movements, hand taps, or even repetitive sounds.

The therapist may wave a hand in front of you and you simply follow the movements with your eyes. This seems to be helpful, but it is unclear if discussing the trauma is by itself enough or if the movements are an integral part of the treatment.


Beyond these therapies, medications also may have a role in treating PTSD symptoms. There are some that are directed toward the specific symptoms. In the case of nightmares, a medication called prazosin has been found to be effective. Its side effects include drops in blood pressure, headache, and lethargy.

There are many other psychiatric medications that can be effective in treating the symptoms associated with PTSD. These include the selective serotonin reuptake inhibitors (SSRIs) used to treat anxiety and depression, such as:

  • Citalopram (Celexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

In many cases, a combination of appropriate medication and therapy can be highly effective to improve or resolve the condition.

A Word From Verywell

Being open about your nightmares or other sleep concerns with your healthcare provider is the first step in getting the sound rest you need. Start by having a candid conversation about your concerns and start to get the help that will leave you sleeping better.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Post-Traumatic Stress Disorder. National Institute of Mental Health.

  2. El-Solh AA. Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nat Sci Sleep. 2018;10:409–420. doi:10.2147/NSS.S166089

  3. Norrholm SD, Ressler KJ. Genetics of anxiety and trauma-related disorders. Neuroscience. 2009;164(1):272–287. doi:10.1016/j.neuroscience.2009.06.036

  4. Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatr Dis Treat. 2011;7:167–181. doi:10.2147/NDT.S10389

  5. Kung S, Espinel Z, Lapid MI. Treatment of nightmares with prazosin: a systematic review. Mayo Clin Proc. 2012;87(9):890–900. doi:10.1016/j.mayocp.2012.05.015

Additional Reading
  • National Center for PTSD. U.S. Department of Veterans Affairs.

  • Bisson, J. Post-traumatic stress disorder. BMJ. 2007;334:789.

  • Miller, LJ. Prazosin for the treatment of posttraumatic stress disorder sleep disturbances. Pharmacotherapy 2008;28:656.

  • Raskind, MA et al. Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study. Am J Psychiatry. 2003;160:371.

  • Stein, DJ et al. Post-traumatic stress disorder: medicine and politics. Lancet. 2007;369:139.

  • Taylor, FB et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry. 2008;63:629.

  • Vieweg, WV et al. Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. Am J Med. 2006;119:383.

  • Yehuda, R. Post-traumatic stress disorder. N Engl J Med. 2002;346:108.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.