This article provides an overview of evidence-based treatments for PTSD and insomnia. The first article in this 4-part guest-authored series—“A double whammy”—explored the potential interrelationship between these two conditions. Not only is sleep disruption a common symptom of PTSD, but the two can interact in a cycle that can make both worse and can be hard to break. Understanding your treatment options and having more knowledge about available treatments can help you engage in productive discussions with your healthcare providers and make informed choices about treatment.
Interventions for PTSD
The most effective treatments for PTSD can reduce or resolve symptoms for many people quickly, within 2–3 months. They involve working with your therapist to help examine how your thoughts impact your feelings and behaviors. Often survivors of trauma have thoughts such as, “It was all my fault” or “No one can be trusted.” These thoughts lead to painful feelings (such as guilt, worry, or anger) and unhealthy behaviors (such as avoiding crowds, using substances to cope, or isolating). Over time these thoughts and behaviors become habits that make it hard to imagine dealing with the trauma any other way. Behavioral treatments that can teach you new ways to cope include:
Prolonged Exposure (PE). With this type of treatment, you can learn how to tolerate memories and frightening situations instead of avoiding them. If you avoid upsetting memories and situations, you might feel better in the short term, but avoidance has long-term consequences such as isolation and always feeling on guard. Your therapist can help you face painful memories and situations in a controlled and predictable manner. This can enable you to tolerate trauma memories and discriminate between situations that are safe versus those that are truly dangerous.
Cognitive Processing Therapy (CPT). With the use of CPT, you can become more aware of what you're telling yourself about the trauma, yourself, and others. This method teaches you how to examine your thoughts in order to decide which are accurate and which are too extreme. As you develop a more balanced and accurate perspective about the trauma, yourself, and others, you can experience improvement in painful emotions such as guilt and anger.
Eye Movement Desensitization and Reprocessing (EMDR). This form of treatment can help you re-process upsetting memories, thoughts, and feelings about the trauma so you can cope with them more effectively. Your therapist will ask you to think about the trauma while you focus on a moving object or sound to help you access new ways to process information and form new associations with traumatic memories so they become less upsetting over time.
Interventions for Insomnia
The most effective treatment for PTSD-related insomnia is Cognitive Behavioral Therapy for Insomnia (CBTI). Your therapist can use CBTI to help you identify which behaviors (tossing and turning in bed or dozing off in the middle of the day) and thoughts (“I won’t be able to fall asleep for hours!”) trigger difficult feelings (worry and frustration) and maintain sleeplessness. CBTI can improve your sleep by:
- Retraining your brain to associate your bed with good sleep.
- Teaching you strategies to help consolidate short fragments of sleep into longer stretches so you get more restful sleep and are more alert and refreshed when you’re awake.
- Reducing sleep-related worry.
Medications may also be an appropriate treatment option for you. If you are interested in medication, ask your primary care manager (PCM) to connect you with someone who can help you choose a medication based on your specific symptoms and potential side effects.
This article by guest experts* from the Center for Deployment Psychology is the second in a series on the complex relationship between PTSD and poor sleep. If you missed it, you might like to read the first article in the series. In the next article of this series, these guest experts from the Center for Deployment Psychology explore how you might decide which intervention(s) to pursue first.
* Diana Dolan, PhD and Carin Lefkowitz, Psy.D.