Common Treatments For PTSD Nightmares

Medically reviewed by Julie Dodson
Updated February 20, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

Post-traumatic stress disorder (PTSD) is a mental illness that develops due to a traumatic event or a series of traumatic occurrences. The individual may have been directly impacted or witnessed the event occurring. 

For some people with PTSD, persistent nightmares can be a distressing symptom. These nightmares may surface directly after the traumatic event has occurred or years later. Regardless of when they appear, the symptoms are often similar, though the severity may vary from individual to individual. 

If you’re experiencing symptoms of PTSD, including nightmares, you aren’t alone. It’s estimated that approximately 50% to 70% of those diagnosed with this condition experience nightmares and other sleep disturbances that impact daily functioning. Many treatments can help those affected by PTSD nightmares navigate their symptoms and move forward.

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What is the connection between nightmares and PTSD? 

Nightmares are a symptom of PTSD and often include imagery or distressing ideas related to a traumatic event someone experienced. For some experiencing PTSD nightmares, the event is relived in the dream exactly as it occurred. For others, it might involve images or symbolism or the fear they might have felt during the trauma. PTSD nightmares can result in sleep challenges, including insomnia and sleep deprivation. 

Some PTSD nightmares may occur nightly, whereas others might occur occasionally. Therapists consider the number and frequency of the nightmares when developing a treatment plan. Those with a high frequency of nightmares or nightmares every night may be recommended for medications for PTSD. However, consult a doctor before starting, changing, or stopping a medication.

What is the impact of PTSD nightmares? 

Nightmares are a symptom of PTSD and often include imagery or distressing ideas related to a traumatic event someone experienced. For some experiencing PTSD nightmares, the event is relived in the dream exactly as it occurred. For others, it might involve images or symbolism or the fear they might have felt during the trauma. PTSD nightmares can result in sleep challenges, including insomnia and sleep deprivation. 

PTSD nightmares differ from frequent nightmares. They often occur earlier in the sleep cycle, making it difficult to fall back to sleep and enter deep sleep. This impact can be harmful, as deep sleep is essential to the immune system. In addition, PTSD nightmares may cause movement during sleep, which might involve kicking, punching the air, or thrashing. Some people talk in their sleep or wake up in sweat from these nightmares. 

PTSD nightmares that cause movement during sleep are also potentially dangerous to the individual. During healthy sleep, the body is paralyzed while dreaming to reduce the chance of moving, sleepwalking, or acting out dreams. As PTSD nightmares occur during light sleep, the movement might be involved due to the fight or flight response. This movement may increase the risk of sleepwalking. When this occurs, the sleeping person can swing their arms, kick, or get up and walk, increasing the potential for physical injury to themselves or others. 

When do PTSD nightmares occur? 

PTSD nightmares can occur in all sleep stages, although they are most prevalent during the first few stages of sleep. The disturbance to the different sleep stages may cause symptoms similar to the impact of sleep deprivation. In addition, frequent waking in the night can cause individuals to not fall into a deep sleep, which may limit the time their body has during the night to adjust. 

Some evidence suggests that breathing disorders may initiate PTSD nightmares during sleep. Individuals with PTSD who receive apnea treatment may experience fewer nightmares. However, sleep apnea can produce nightmares even when PTSD is not present. If you’re experiencing nightmares, snoring, and a feeling of exhaustion during the day, consider reaching out to your doctor about a sleep study.

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Causes of PTSD nightmares

PTSD is linked to biological changes inside the brain resulting from difficulty with the cognitive processing of traumatic events. Not all trauma survivors develop this disorder, and no single type of event ensures the development of PTSD. As PTSD impacts many areas of the brain, the areas responsible for dreaming can also be impacted. When people with PTSD feel hypervigilant of their surroundings, they might struggle to fall asleep. When they do sleep, their mind may replay images that distress them, waking up to fear or difficulty falling back asleep. 

Common treatments for PTSD nightmares

Not everyone with PTSD develops nightmares, but those with this symptom may see a decline in these dreams by attending therapy or seeking medical or mental health intervention. Below are a few of the most common treatments for these nightmares. 

Sleep testing 

Although treating PTSD can reduce the occurrence of PTSD nightmares, nightmares may sometimes have another cause. If you suspect you may be experiencing a sleep disorder like sleep apnea, consider asking your doctor for a referral to a sleep center to rule out breathing difficulties. 

Lack of oxygen while sleeping can incite disturbing nightmares for those who do not have PTSD, and for those who do, the nightmares may be worsened. If a sleep study shows that sleep apnea or other breathing difficulty exists, treatment for that problem could lessen the impact of your nightmares. 

Medication 

A psychiatrist or medical doctor may be able to provide medicine to reduce the occurrence of PTSD nightmares. New research has found that several medications may reduce symptoms. However, consult your doctor before considering medication, as each person is different, and not all medications may offer the same benefits. 

Therapy 

Cognitive-behavioral therapy (CBT) is a standard method therapists use to treat individuals experiencing PTSD nightmares. In CBT, clients are taught to revisit the event or events associated with the nightmare to explore their thought patterns. This exploration includes identifying maladaptive or unhelpful thought patterns that create barriers to healing. 

When these patterns are uncovered, the therapist can work with the client to overcome these barriers by reframing their understanding of the traumatic event to understand themselves better and develop successful coping mechanisms. Once a client achieves a cognitive shift, PTSD nightmares may subside. 

However, note that CBT is not the only treatment effective for PTSD. A few treatments have been developed explicitly for PTSD and have high rates of effectiveness as well, including EMDR and internal family systems (IFS) therapy.

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Alternative counseling options 

PTSD may be difficult to resolve without professional support. In addition, research indicates that approximately 80% of clients with PTSD present at least one comorbid disorder, including anxiety disorders, depression, and substance use disorders. Therefore, people experiencing PTSD symptoms, including nightmares, may benefit from speaking to a therapist for symptom relief.   

Despite its prevalence, some people experiencing PTSD don’t receive quality mental health assistance due to barriers to attending in-person care. These barriers might be related to a lack of flexibility, time constraints, reluctance to travel, or a lack of availability of providers. The rise in online therapy through platforms like BetterHelp has removed many of these obstacles, providing therapy for people who may not be able to get it. 

Online therapy allows clients to speak with their mental health professional via messaging, phone, or video calling anywhere with an internet connection. In addition, studies back up the effectiveness of this format, showcasing how treatment methods like EMDR and CBT can be practiced online to reduce PTSD symptoms. 

Below are some reviews from clients on how BetterHelp therapists helped them cope with PTSD

“Carmen is really insightful listens to me, and acknowledges my experience and challenges with PTSD. I feel heard and supported. It’s been only a short amount of time but I am confident in her ability to help me.” 

“Laurie is helping me to take control of structures and routines in my life to help me overcome anxiety, ptsd, and manage my major depression. I have never been so pleased with a counselor as I am with her. Her first step with me was to ask about my sleep- which I have been waiting for a doctor to ask me about for years (instead of a here try this pill- her strategy is let’s begin at square 1)... Laurie is logical, rational, smart, warm and understanding. I love working with her and feel her support in my corner because she always chats me back in a timely manner. I am truly so grateful for her guidance and care.” 

Takeaway

If you’re living with PTSD nightmares and looking for relief, reaching out to a professional may be beneficial. PTSD can come with severe symptoms that can be difficult with which to cope alone. However, knowing you’re not alone can be helpful, and many of these symptoms can be manageable or treatable with time and support. Consider reaching out to a therapist to get started.

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