When you live with PTSD, sleep isn’t always an appreciated break from everyday worries. But there are a few ways to manage nightmares.

Sleep is an important part of how you restore yourself. It’s meant to be a period of rest when the mind and body can both enter a state of relaxation.

But when you experience a traumatic event, your sleep patterns can change, getting in the way of this needed rest and relaxation.

In some instances, traumatic experiences lead to developing symptoms of post-traumatic stress disorder (PTSD).

Among these symptoms, nightmares are a reality for many people.

Nightmares are one of the primary symptoms of PTSD.

In fact, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), distressing dreams or nightmares are included as a symptom of intrusion, a PTSD diagnostic criterion.

Symptoms of intrusion in PTSD also include:

  • distressing thoughts
  • involuntary memories
  • flashbacks
  • psychological distress to trauma stimuli
  • physiological reactions to trauma stimuli

Up to 96% of people living with PTSD may experience nightmares. These emotionally distressing dreams can happen several times a week or more.

If you live with other mental health conditions, the occurrence of nightmares may increase.

Many experts theorize dreams are a part of the sleep process that helps you store memories and learning experiences.

Some 2018 research supports this theory and suggests you experience the most extreme dream activity when your brain is processing emotionally intense experiences.

Because of this, researchers suggest dreams may be a way of dampening the effects of potentially overwhelming situations.

When it comes to PTSD nightmares, however, what you dream can be just as terrifying as the original event.

As with the nature of dreams themselves, the exact link between PTSD and nightmares is unclear.

Some experts believe nightmares in PTSD are the sleeping version of “re-experiencing,” or reliving a traumatic event.

When you’re awake, reexperiencing may occur in the form of a flashback.

These intrusive symptoms have to do with how PTSD changes brain regions involved in fear response and memory recall.

PTSD can create a state of hypersensitivity in the brain, which may increase fixation on traumatic events, keeping them fresh in memory.

When they’re constantly on your mind, you may be more likely to have nightmares about them.

The same brain changes may also impact dreaming.

According to 2015 research in rodents, traumatic stress can create changes in the neural pathways of PTSD-affected brain areas. These altered pathways can cause nightmares by how they impact memory recall and emotional response.

PTSD nightmares aren’t the same as flashbacks, though they share similarities.

Both of these experiences are intrusive symptoms of PTSD, and both are forms of reexperiencing traumatic events.

Flashbacks are dissociative events or momentary lapses in your perception of reality. They can make you feel as though you’re back in the moment, going through everything again.

Your senses can be telling you a flashback is an actual event.

Like flashbacks, nightmares can also feel real, except your brain knows it’s dreaming. This is why you can sometimes wake yourself up from a nightmare.

Also, unlike flashbacks, nightmares can take any shape or form. You may not dream trauma as it happened. Your nightmare may contain only components of the event or overtones of the experience. You could also merge different events together in a dream.

Living with PTSD can be challenging, especially when you can’t feel relief even while sleeping.

Limited data exists on how to consistently manage nightmares, but you may find some relief through:

PTSD treatment

Because PTSD can become debilitating or intrusive, speaking with a mental health professional can be an important first step. You don’t have to work through the symptoms of PTSD on your own.

Medication can help alleviate some of the symptoms, while trauma therapy can support your healing process and help you resolve some of the everyday challenges.

Symptoms like nightmares can improve once you start working on other aspects of PTSD.

Video games

Playing aggressive or violent video games may act as a form of exposure therapy, according to a small study published in 2018 involving military veterans.

While it may feel counterintuitive to play a game related to your trauma, having a sense of control in a game setting could help with PTSD symptoms in reality.

This research is preliminary and limited, so it’s highly advisable that you ask a health professional before trying this method as a form of therapy.

Pain elimination

Research published in 2017 suggests living with chronic physical pain, such as muscle stiffness, sometimes seen in PTSD, may increase the chances you’ll experience nightmares.

Managing pain through supplements, relaxation techniques, physical therapy, and medication may help lower the chances pain will influence nightmare frequency.

Aroma control

Essential oils and aromatherapy are the preferred stress and anxiety relief methods for many.

In fact, 2019 research suggests pleasant odors while sleeping can improve sleep quality when you live with PTSD.

When it comes to nightmares, however, familiar smells (pleasant or unpleasant) may increase the chances you’ll have a nightmare.

A small study from 2019 conducted in Japan found participants exposed to familiar smells were more likely to have nightmares.

Researchers believe this is because the area of the brain related to smell is close to the regions that process emotions and memory.

You may want to start using essential oils during your wake hours. If you find one that helps you relax, it may also work for a better night’s sleep.

When in doubt, consider leaving the smells out.

Journaling about your nightmares

Image rehearsal therapy (IRT) is a form of cognitive behavioral therapy (CBT) sometimes used for nightmares in PTSD.

IRT involves writing down your nightmares but deliberately changing them into more positive versions in your journal.

You then can reread these new versions daily with the intent of replacing the original nightmare theme in your memory moving forward.

Comfortable sleeping temperatures

States of arousal, such as those related to stress and anxiety, have been shown in 2019 research to increase your body’s temperature even while you sleep.

According to a 2016 questionnaire study, elevated brain temperature could disrupt cognitive function, resulting in a higher chance of nightmares.

You might want to try adjusting your room temperature or bedding to cool down during the night.

Sleep routines

Not getting enough sleep or quality sleep can put you in a state of sleep deprivation.

Lack of sleep can mean, when you do sleep, you’re more likely to have increased periods of REM (rapid eye movement), known as REM rebound.

REM is the phase of sleep where dreaming occurs. When you experience REM rebound, you’re also more likely to experience vivid dreams or nightmares.

To ensure the sleep you do get is quality sleep, consider:

  • keeping a regular wind-down routine before bed
  • limiting screen time before sleeping
  • maintaining a calm, quiet atmosphere in your bedroom
  • eliminating light pollution at night
  • muffling random sounds with white noise, like with a fan
  • avoiding large meals too close to bedtime
  • avoiding caffeine and alcohol before bedtime

Nightmares can be a common occurrence when you live with PTSD. These emotionally disruptive dreams can be your brain’s way of processing trauma while asleep.

It’s possible to manage symptoms of PTSD, including nightmares.

While not much is yet understood about the complex relationship between PTSD and nightmares, you can improve this intrusive symptom through PTSD treatment.

Self-care strategies, like journaling and aromatherapy, may also aid you in finding some relief.