Up to 90% of those suffering from Complex PTSD (C-PTSD) have trouble sleeping. This is due to the impact of trauma on the nervous system and on mental wellness. Sleep disturbances such as insomnia, nighttime anxiety, nightmares and stressful dreams are common. This has a major impact on the healing process as improved sleep is a key element to overcoming C-PTSD. Read on to learn more.

Sleep Disturbances and Complex PTSD

One of the most challenging aspects of C-PTSD are sleep disturbances. Sleep and C-PTSD are interrelated in a bidirectional manner. Sleep disturbances can worsen C-PTSD and C-PTSD can worsen sleep issues.

But what is C-PTSD? It’s a type of trauma that is caused by long or repeated exposure to traumatic events, particularly during childhood or early adulthood. These events often involve:

• Interpersonal violence, such as physical or sexual abuse
• Neglect
• Abandonment
• Incarceration 

The effects of complex trauma can be severe and long-lasting. Research has shown that complex trauma impacts the brain and body in several ways. It is a chronically heightened state of arousal after a traumatic event. The impact of complex trauma is far-reaching and multidimensional, affecting:

• Emotional regulation
• Consciousness
• Self-perception
• Perceptions of perpetrators
• Relations with others
• One’s system of meaning 

Individuals with complex trauma may experience severe psychological challenges including 

• Difficulties in controlling emotions
• Profound feelings of shame or guilt
• Challenges with forming healthy relationships. 

They are also at a higher risk of developing mental health disorders such as C-PTSD, depression, and anxiety disorders.

Sleep disorders are a central part of the symptoms for people with C-PTSD. They usually show within several weeks to months after the trauma. Poor sleep may lead to [1]:

• Slow reaction time
• Trouble with learning and memory
• Feeling irritable and mood problems
• Trouble with thinking and concentration
• Thinking about suicide or acting in ways that self-harm

Sleep problems that persist are also related to medical problems such as heart disease, depression, high blood pressure, obesity and stroke.

Hypervigilance is a core characteristic of C-PTSD, with continual attention and monitoring for prospective dangers. This makes it difficult for people with C-PTSD to relax and feel comfortable enough to sleep. As a result they suffer sleep problems and fragmented sleep patterns.

How Does C-PTSD Affect Sleep?

Common Sleep Disturbances in People With C-PTSD

There are a number of ways C-PTSD affects sleep, including [2] [3]: 

Insomnia

• Difficulty getting to or maintaining sleep. The most common sleep complaint following trauma exposure and in 35-61% of those with C-PTSD. Often due to hyperarousal, high anxiety, intrusive thoughts, nightmares or fear of falling asleep due to trauma. Insomnia is an important risk factor for developing PTSD. Insomnia symptoms before and following traumatic exposure increase the risk of C-PTSD.

Nightmares

• Recurrent nightmares are specific symptoms of trauma-related disorders. They occur in 67% of people with C-PTSD. These are distinguished from normal nightmares as they must be related to the trauma either in content or in intensity. They may vary in the extent to which they replicate the traumatic event. They may be recurring and can interfere with sleep by inducing anxiety, panic or night sweats.

Flashbacks

• Flashbacks of traumatic experiences frequently happen during waking hours. However, they can disrupt sleep by emerging as vivid, painful images or feelings during sleep. This may result in sleep disruptions or awakenings.

Restless Sleep and Frequent Awakenings

• Tossing and turning with frequent awakenings during the night are common. They may be caused by anxiety, panic, fear and nightmares.

Obstructive Sleep Apnea

• This is a form of breathing-related sleep disorder with repeated full or partial upper airway obstruction during sleep. It is often initially identified through snoring and daytime sleepiness. Untreated, it results in intermittent awakenings disrupting sleep and the ability to experience deeper REM sleep consistently. It can also cause heart, diabetes and stroke.

Daytime Sleepiness

• Excessive daytime drowsiness and chronic tiredness can result from sleep disruptions. People who don’t get restorative sleep can feel tired, drained and exhausted during the day. This affects daily functioning and overall quality of life.

Rapid Eye Movement Sleep Behavior Disorder (RBD)

• REM sleep is usually associated with vivid dreaming and is observed by quick eye movements and relaxed muscles. People with C-PTSD show a greater number of eye movements and muscle motor activity during REM. About 9% of those with C-PTSD have RBD compared to 0.5% to 2% in the general population.

Treatment Options for Complex PTSD

Sleep disturbances often do not improve following trauma-focused treatment, despite improvements in PTSD symptoms. This suggests that sleep symptoms themselves require targeted interventions.

There is little scientific evidence on the effectiveness of long-term drug treatment for insomnia and nightmares. For non-drug interventions, there are challenges due to the current lack of PTSD-treatment concepts that integrate sleep- and trauma-focused therapies.

Nonetheless there are choices, including [2] [3]:

Sleep Medication

There are a variety of options including herbal teas and supplements, and over-the-counter medications usually recommended for no more than short-term relief (2-4 weeks). Side effects typically include daytime drowsiness, dizziness and confusion.

Prescription medications such as Benzodiazepines and Nonbenzodiazepines are not recommended, due to their addictive nature.

Cognitive Behavior Therapy for Insomnia (CBT-I)

This is recommended over medication as the best therapy for sleep disturbances. It improves sleep in 7 out of 10 people who complete it. It reduces how many nightmares people have and the distress related to upsetting dreams.

CBT-I focuses on a person’s beliefs, feelings and behaviors that affect sleep. It usually lasts six sessions with a trained CBT-I therapist, either in person or online to an individual or group. A smartphone app, CBT-I Coach, can help with treatment. It includes a combination of:

• Stimulus control (i.e. using the bed for sleeping only)
• Sleep restriction (i.e. limiting time in bed only to actual sleeping time)
• Cognitive restructuring 
• Sleep hygiene education (i.e. recommendations about healthy sleeping habits)
• Exercises to practice these 

Cognitive Behavioral Therapy for Nightmares (CBT-N)

For treating nightmares, CBT-N is the most well-known. It consists of:

• Sleep psychoeducation
• Rescripting (i.e. having a person rewrite the nightmare to be nondistressing)
• Rehearsal of rescripted nightmares during the day to incorporate in dreams
• Relaxation training

Other Therapeutic Approaches

There are several other approaches which can be helpful, including:

• Imagery Rehearsal Therapy (IRT): Modification of the nightmare into less stressful dream content to replace traumatic content with new positive images
• Exposure, Relaxation and Rescripting Therapy (ERRT): Combines psychoeducational elements with imaginatively altered nightmares
• Exposure Therapy: The person is presented with certain images of the trauma, guided by a therapist using various techniques, to help the person actively confront their fears and not rely on selective avoidance.
• Eye Movement Desensitization and Reprocessing Therapy (EMDR): The traumatizing event is recalled in as much detail as possible with a therapist’s guidance and processed step by step. It uses bilateral stimulation with eye movements and touch while recalling the distressing images. This stimulates new processing and integration of the traumatic experience especially on a sensory-body level.

Complex PTSD Treatment in Utah

Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from Complex PTSD, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.

Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.

Sources

[1] US Department of Veterans Affairs. National Center for PTSD. Sleep Problems and PTSD.

[2] Weber FC, Wetter TC. The Many Faces of Sleep Disorders in Post-Traumatic Stress Disorder: An Update on Clinical Features and Treatment. Neuropsychobiology. 2022;81(2):85-97

[3] So CJ, Miller KE, Gehrman PR. Sleep Disturbances Associated With Posttraumatic Stress Disorder. Psychiatr Ann. 2023 Nov 1;53(11):491-495
Pacheco D and A. Dimitriu. 2024. PTSD and Sleep. Sleepfoundation.org.