Plain-language definitions grounded in the clinical and regulatory literature.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
Mental Health Condition
What it isA psychiatric condition that develops after exposure to actual or threatened death, serious injury, or sexual violence. Sleep disruption, including nightmares and insomnia, is a core symptom.
Why it mattersSleep disturbance is among the most persistent PTSD symptoms and frequently outlasts other treatment responses. It also amplifies daytime symptoms, addressing sleep is often the most effective entry point for treatment.
Think of it like thisThink of PTSD as a threat-detection system stuck in the on position. The brain rehearses danger constantly, including during sleep, which is why nightmares are so common and why nighttime feels unsafe.
A psychiatric disorder defined by DSM-5 criteria following exposure to a qualifying traumatic event, characterized by intrusion symptoms (including trauma-related nightmares), avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity (including sleep disturbance).
MechanismPTSD-associated sleep disturbance involves multiple mechanisms: REM-sleep abnormalities, hyperarousal driven by elevated noradrenergic tone from the locus coeruleus, amygdala hyperreactivity to threat-related stimuli during sleep, and disrupted fear-extinction processes that normally occur during REM. Reduced sleep spindle density may impair memory reconsolidation needed for trauma processing.
Scientific ConsensusSleep disturbance is a core feature of PTSD and highly prevalent in veterans. Trauma-focused psychotherapies (CPT, PE, EMDR) and SSRIs are first-line treatments. Prazosin, an alpha-1-adrenergic antagonist, reduces trauma-related nightmares for many but not all patients.
Active DebateThe optimal first-line approach for PTSD-associated sleep disturbance: trauma-focused therapy, sleep-focused therapy (CBT-I, IRT for nightmares), or pharmacological. The role of cannabis and cannabinoids in PTSD treatment remains contested.
Emerging ResearchTrauma-associated sleep disorder as a distinct parasomnia separate from PTSD and RBD. Targeted memory reactivation during REM sleep to enhance fear extinction. Closed-loop acoustic stimulation to enhance slow-wave sleep in PTSD.
Key ResearchKrakow et al. established imagery rehearsal therapy for PTSD nightmares. Raskind et al. established prazosin for trauma nightmares. Mysliwiec et al. (2017) defined trauma-associated sleep disorder. Bajor et al. (2022) provide current evidence-based psychopharmacology guidance.
— Current evidence-based psychopharmacology including sleep-focused treatments
— Foundational paper proposing TSD as distinct from PTSD and RBD
Sleep disorders, PTSD, and the invisible wounds of service can feel isolating. If you or someone you know is in crisis or experiencing thoughts of self-harm, help is available right now. The Veterans Crisis Line provides free, confidential support 24 hours a day, 7 days a week to veterans, service members, and their families.
If you are in crisis or experiencing thoughts of self-harm, call the Veterans Crisis Line at