I’m so grateful for our service members and veterans, the men and women who risk their lives to defend our country and keep us safe. As a physician specializing in sleep disorders, I treat many veterans in my Arizona clinic—a large percentage with symptoms of post-traumatic stress disorder—and it’s a great honor to use my knowledge and medical specialty to serve those who serve us all.
As Veterans Day approaches, I’ve been thinking about what more I can do to give back to those who suffer from PTSD. And what I have to offer is some heartfelt advice about a topic that doesn’t get enough attention: the relationship between PTSD and difficulty sleeping. The two are linked in complex ways, and for PTSD symptoms to improve, it’s vitally important to look at the component of healthy sleep, and to get specialized treatment if you need it.
There are three main symptoms involved with a diagnosis of PTSD—re-experiencing the trauma, increased arousal, and emotional numbness and avoidance—and believe it or not, all three are linked to sleep. Let’s look at them one at a time:
· Re-experiencing the trauma. One of the classic, and most disruptive, symptoms of PTSD is experiencing the event that caused the trauma over and over in the mind. This manifests as flashbacks during the day. At night, it becomes nightmares, night terrors and frequent awakening.
· Increased arousal. This is another cornerstone symptom of PTSD, and of course it makes it very difficult to fall asleep and stay asleep (sometimes called onset insomnia and maintenance insomnia). The stress caused by insomnia can increase arousal further, turning this into a vicious cycle.
· Emotional numbness and avoidance. PTSD therapy often tries to address avoidance—the sufferer’s unwillingness to do anything that might remind them of their trauma. Studies show that this cognitive behavioral therapy is much more effective when accompanied by healthy sleep patterns, including uninterrupted REM sleep, which is the stage when emotional processing occurs. If frequent sleep interruptions reduce the effectiveness of therapy, then the original trauma just continues to manifest as nightmares.
You can see how interlinked PTSD is with difficulty sleeping, and sadly many veterans do not make the connection unless they have a savvy primary care physician who is knowledgeable enough to refer them to a sleep specialist. At my clinic, we find that treating the sleep disorders that so often accompany PTSD helps sufferers better manage every part of the disorder: They fall asleep more easily, they get more continuous REM sleep, they wake up less frequently, and their nightmares and night terrors begin to subside.
Also, getting good-quality sleep is vital to helping people process their emotions. So once a veteran who suffers from PTSD begins to experience better sleep, they start to function better in their daily lives, which can lead to more engagement in therapy and increased self-confidence. It becomes a virtuous circle where better sleep leads to better functioning, which leads to even better sleep!
It breaks my heart to see young men and women—many of them only in their 20s and 30s, with young families—come back from the field and have to go on psychiatric disability because their PTSD leaves them unable to function in their daily lives. I’ve seen it over and over: When we can stop the downward spiral and help them begin to address the underlying issues, they feel great about themselves, and the whole family benefits.
If you’re suffering from PTSD and have never been told about the treatable sleep disorders that so often accompany it, it’s time to have that conversation with your doctor. You deserve to experience hope and healing, and I assure you that it is possible.