Sleep Disturbances in Post-Traumatic Stress Disorder

Sleep disturbances are among the most persistent and debilitating symptoms of post-traumatic stress disorder (PTSD), affecting up to 90 % of those diagnosed. Insomnia, nightmares and fragmented sleep compromise restorative processes and impede emotional memory consolidation, notably the extinction of conditioned fear. Underlying mechanisms include dysregulation of the hypothalamic–pituitary–adrenal axis, sympathetic hyperarousal and alterations in limbic and prefrontal circuitry. Disordered rapid eye movement (REM) sleep in particular appears to disrupt synaptic plasticity, reinforcing intrusive recollections and hypervigilance. A self-perpetuating cycle develops as poor sleep exacerbates daytime PTSD symptoms, and heightened trauma responses further degrade sleep quality. This interplay has global relevance across military veterans, survivors of natural disasters, refugees and civilian populations exposed to violence. Therapeutic approaches range from phasic pharmacological interventions targeting nightmares to trauma-focused psychotherapies that achieve parallel improvements in sleep and core PTSD symptoms. Emerging objective monitoring and multimodal treatments promise to break the cycle of distress and restore adaptive sleep patterns, thereby enhancing recovery and reducing long-term morbidity.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Sleep Disturbances in Post-Traumatic Stress Disorder publication trend

The graph below shows the total number of articles in sleep disturbances in post-traumatic stress disorder across all publications each year (not limited to Nature Index journals).

Technical terms

Actigraphy: Non-invasive method using a wearable sensor to record movement and infer sleep–wake patterns over extended periods.

Extinction memory: The process by which conditioned fear responses diminish following repeated exposure to trauma reminders without adverse consequences.

Rapid eye movement (REM) sleep: A sleep stage characterised by rapid eye movements, vivid dreaming and elevated brain activity, essential for emotional memory consolidation.

Heart rate variability: The variation in time intervals between heartbeats, reflecting autonomic nervous system balance during sleep.

Hyperarousal: A state of heightened physiological and psychological tension that disrupts the initiation and maintenance of sleep in PTSD.

References

1. Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine. Journal of Affective Disorders (2023).
2. REM disruption and REM vagal activity predict extinction recall in trauma-exposed individuals. Psychological Medicine (2024).
3. Sleep disturbances and PTSD: a perpetual circle?. European Journal of Psychotraumatology (2012).
4. Disturbed Sleep in PTSD: Thinking Beyond Nightmares. Frontiers in Psychiatry (2021).