Night Terrors & PTSD: Connection & How to Cope

What Is Post Traumatic Stress Disorder (PTSD)?

Post Traumatic Stress Disorder (PTSD) refers to a potentially debilitating disorder that can result from exposure to a single, or multiple, traumatic event(s). As a result of changes to the brain, PTSD results in reliving – rather than remembering – the trauma. Other symptoms of PTSD include: avoidance of reminders of the trauma; negative perceptions of self, others and/or the world; and increased emotional volatility and hypervigilance.¹

Any reminders of the trauma (i.e., time of day, trauma anniversary date, thoughts, certain people, places, objects, etc.) might become a PTSD trigger and cause a flare up of symptoms. Left untreated, PTSD can last for a lifetime and cause significant functioning difficulties in one or more areas of a person’s life.

How PTSD Affects Sleep

Sleep problems are a hallmark of PTSD,² and can lead to multiple awakenings each night which decreases sleep quality. Up to 87% of individuals with PTSD experience sleep disruptions which might include:³

• difficulty falling asleep and staying asleep
• nightmares – which might entail general trauma themes (e.g., threat, attempted escape, powerlessness) or be a direct reenactment/flashback of the trauma;
• night terrors
• sleep-disordered breathing ( e.g., apnea)
• sleep movement disorder

These PTSD-related sleep disruptions can have a negative impact on overall health, quality of life, and ability to function. Sleep disruptions can also prolong and increase the severity of PTSD symptoms.³

What Are Night Terrors?

Night terrors, often called “sleep terrors”, refer to a parasomnia (i.e., a disruptive sleep disorder) that typically happens during non-REM sleep.⁴ These episodes start abruptly with a scream or panicked cry, and are followed by feelings of terror, along with physical fear responses. The person might not fully awaken, and will remember little or none of the dream that precipitated their terror.

Adult night terrors can be a symptom of a Non-Rapid Eye Movement Sleep Arousal Disorder, a Sleep Terror Disorder,¹ or PTSD. Night terrors, like other sleep issues, can interfere with overall sleep quality and thus negatively impact physical and mental health. The prevalence of night terrors in adults is estimated to be 2.2% in the general population.⁵

The physical signs of night terrors include:

• Excessive perspiration
• Labored breathing
• Irregular heartbeat
• Racing heart
• Muscle tension
• Open eyes and dilated pupils
• Frightened facial expression

Nightmares Vs Night Terrors

Although both night terrors and nightmares are characterized by an intense fear and/or anxiety response, there are some very distinct differences between these phenomena. Nightmares are more likely to occur during deep (REM) sleep in the early morning hours, while night terrors are associated with non-REM sleep and thus are more likely to occur in the first few hours of sleep.

Individuals having nightmares will often wake up and recall many specific details of their dream. They are likely to feel physically and emotionally distressed upon awakening. While those having night terrors will usually scream or cry out in their sleep and physically thrash about, but are less likely to fully awaken or recall any details of their dream.

What’s the Connection Between Night Terrors & PTSD?

PTSD symptoms of intrusive trauma-related thoughts, memories, emotions, etc., and hyperarousal (i.e., inability to relax) are thought to play a role in the sleep disturbance that is so common among trauma survivors.⁶ Night terrors are one way in which a person might relive their trauma experience(s) via the physical and emotional experiences of terror while sleeping.

Sleep disruption caused by night terrors or any other PTSD-related sleep issues, appear to exacerbate PTSD symptoms overall⁸ and can slow down recovery after trauma.⁶

Sleepwalking, which is another type of non-REM sleep disorder, typically follows 30-50% of episodes of night terrors.⁹ During sleepwalking a person might engage in simple behaviors (e.g., sitting up, looking around) or more complex behaviors (e.g., trying to escape a threat, talking, driving a car). The risk of injuries, including death, increases with the complexity of sleepwalking behaviors.¹

Examples of Night Terrors in Adults With PTSD

Night terrors are characterized by a set of fear-based physical and emotional reactions that occur abruptly during the first few hours of sleep, and typically last 1 to 10 minutes.¹

Common examples of night terrors in adults with PTSD include:¹

• An abrupt, panicked scream or cry
• Sitting up
• Thrashing about
• Difficulty awakening
• Confusion
• Intense fear
• Sense of overwhelming dread
• Feeling the need to escape
• Dilation of the pupils
• Rapid breathing
• Irregular heartbeat
• Sweating
• Little or no memory of the dream they were having prior to awakening
• Inability to remember the night terror episode the following morning

How to Cope with PTSD-Induced Night Terrors

PTSD night terrors can not only be distressing when they happen, but they can also lead to fear of going to sleep. It is important to recognize that there are steps you can take to reduce the chances of night terrors happening, and learn how to support yourself through them when they happen.

There are some lifestyle changes that you can make to help to increase the chances of restful, calm sleep, such as improving your sleep hygiene. Most importantly however, if PTSD night terrors are disrupting your life, it is important to work with a therapist who specializes in trauma processing, to help to get to the root of your trauma and release it. Additionally, your primary care physician or a psychiatrist might be able to prescribe medication to reduce the frequency of night terrors.

Here are 11 tips for coping with PTSD-induced night terrors:

1. Allow yourself enough time to sleep
2. Avoid drugs and alcohol
3. Avoid caffeine in the afternoon and evening
4. Get regular exercise, to allow your body to release stress
5. Get a night light for your room, or leave a hallway light on, if that provides some comfort
6. Try to make your room secure, so you feel safe enough to sleep (e.g., use a rod or other additional security measure to ensure windows cannot be opened from outside, place shells or stones on the window sill to alert you to an intruder, add a lock on your bedroom door).
7. Some people find that having a pet dog sleep in their room allows them a measure of security, since the dog will alert them to any intrusions
8. Avoid reading distressing stories or watching distressing tv or movies prior to bedtime
9. Take time to meditate or pray before going to sleep
10. Set up a calming night time ritual before bed (e.g., listening to relaxing music, doing some gentle stretches, taking a warm shower/bath, etc)
11. When you awake from a night terror, practice calming breathwork to help yourself feel grounded again

Treatment Options for PTSD & Night Terrors

PTSD related night terrors can impact one’s ability to obtain restful sleep, cause distress related to the thought of sleeping – for you and/or your partner, and negatively impact physical and mental health over the longer term. Fortunately, there are treatment options available, but it might take some time to figure out what works best for you.

A person who is suffering from PTSD and night terrors should first speak to their primary care physician to determine if a sleep study is needed to rule out underlying medical conditions or sleep disorders. If the night terrors are concluded to be a PTSD symptom, then working with professionals (i.e., doctors, psychiatrists, therapists) who specialize in treating PTSD is recommended.

Treatment options for PTSD and night terrors might include:

• Benzodiazepines: Benzodiazepines are medications which have a sedative effect. They are often used to treat panic attacks and can be helpful in inducing muscle relaxation and sleep.¹⁰
• Serotonin reuptake inhibitors (SSRIs): SSRIs, which are often used to treat depression, are also a first-line treatment for symptoms of PTSD.¹⁰
• Hypnosis: Hypnosis for PTSD can help by teaching the mind and body how to relax. Given that night terrors can be triggered by stress, practicing stress-reduction techniques prior to sleep can be helpful.
• Cognitive behavior therapy: CBT for PTSD can assist the individual in processing the trauma so that they no longer respond so automatically and intensely to trauma triggers, and thus can lead to a decrease in PTSD symptoms overall.
• Relaxation therapy: Any type of relaxation and breathwork therapy that teaches the body and mind to remember how to relax, can be helpful in decreasing PTSD symptoms, and to prepare the mind and body for sleep.
• Imagery rehearsal therapy: If the individual is able to recall important aspects of the dream content that led to the night terror, IRT might be helpful. This involves writing out the details of the distressing dream, and then rewriting the ending so that it is positive. The individual then rehearses the new ending in their imagination several times before going to sleep each night, to provide an alternate ending to the mind and body.⁶
• Exposure therapy: In exposure therapy, the therapist teaches you how to correct faulty thinking and behave in more adaptive ways when faced with situations (and trauma triggers) that you fear, rather than trying to avoid or escape them. Through real life and imagined exposure to situations you have been avoiding, you learn you can manage them, and fear/PTSD symptoms diminish.
• Systematic desensitization: During systematic desensitization therapy, you are first taught relaxation techniques which you will then use as you work with your therapist to confront your fears, through imaginary and real-life situations. As you gain mastery over your fears, and learn to develop more realistic expectations, PTSD symptoms will often diminish.
• Eye movement desensitization and reprocessing (EMDR): EMDR uses bilateral stimulation (e.g., tapping on hands, sounds, lights) to assist the mind and body in reliving, processing, and releasing the trauma. EMDR therapy continues until you experience a 0/10 distress level when you think about the trauma experience(s) that had caused you the most distress.
• Comprehensive Resource Model (CRM) – Using guided meditation to create layers of support (e.g., sacred place, spiritual being, spirit animal, grounded body grid) which will allow you to safely step into, and experience the root of your trauma (as experienced physically, emotionally, cognitively, and spiritually). This allows your mind and body to process and release the trauma.

When to Seek Professional Help for PTSD Night Terrors

If PTSD night terrors are causing distress, interfering with sleep, or resulting in difficulty functioning in one or more areas of your life, it is time to seek professional help. Reach out to your doctor, a psychiatrist, or a trauma therapist. An online therapist directory or online psychiatry options might also be a good place to start.

In My Experience

In my experience, once the client is living in a safe environment, and we are able to process and release the root of the trauma, most PTSD symptoms including night terrors are significantly reduced or disappear altogether. The therapeutic approaches that I use, because they have proven most effective with my trauma clients, are the Comprehensive Resource Model (CRM), EMDR, and Trauma and Compassion-Focused CBT. Some clients also benefit from medication.

If you are experiencing PTSD night terrors know that there is hope, and professional help available. Don’t hesitate to speak with your doctor and a therapist who specializes in trauma therapy. (Note: “Trauma informed” is not sufficient when looking for a therapist. You need a therapist who has been specifically trained in trauma processing).