Self-help and support
Best Sleep Habits After Trauma
Practical habits for better sleep after trauma, and what to ask for when insomnia or nightmares do not ease on their own.
The VA's National Center for PTSD puts it simply: almost everyone who has PTSD also has trouble sleeping. A body that has learned to stay on guard does not switch off easily at night, and poor sleep then feeds irritability, trouble concentrating and low mood.
The habits below are a sensible place to start. They are not a cure. When insomnia or nightmares carry on, there are specific treatments for both, and the later entries explain them.
1. Get up at the same time every day
Go to bed and get up at about the same times every day, including weekends. A steady wake time is the anchor that the rest of your sleep settles around.
The CDC says most adults need at least seven hours a night.
2. Make the bedroom quiet, cool and calm
The CDC recommends a quiet, relaxing bedroom at a cool temperature.
After trauma, some people sleep better with a small night-light or a locked door. If a simple safety cue helps you settle, it is a reasonable choice.
3. Put screens away 30 minutes before bed
The CDC suggests turning devices off at least 30 minutes before bed. That matters even more if late-night news or scrolling tends to leave you keyed up.
4. Cut caffeine later in the day
Avoid caffeine later in the day, including coffee, energy drinks, many sodas and some teas.
5. Do not use alcohol or drugs to get to sleep
Alcohol can make you drowsy, but the CDC advises avoiding it before bed. The VA warns that using alcohol, marijuana or street drugs to manage PTSD or sleep problems is linked to a higher risk of suicidal thoughts and attempts.
6. Move during the day, and eat lighter at night
Regular physical activity supports sleep, and the CDC advises avoiding large meals close to bedtime.
7. Build a wind-down routine with a calming skill
Spend the last part of the evening on something that slows you down: slow breathing, a mindfulness exercise or relaxation audio. The VA's free Mindfulness Coach app and the Defense Health Agency's Breathe2Relax app both include these.
8. If insomnia lasts, ask about CBT-I
The VA calls cognitive behavioral therapy for insomnia (CBT-I) the best treatment for insomnia. It usually takes about six sessions and can be done in person, by telehealth or online.
For a self-guided start, the VA's free Insomnia Coach app is a five-week plan based on CBT-I. If you have sleep apnea, bipolar disorder, a seizure disorder, sleepwalking or night terrors, or work shifts, the VA suggests talking with a provider first.
The VA describes insomnia as trouble falling or staying asleep at least three nights a week for several months.
9. Nightmares can be treated: ask about imagery rehearsal therapy
In imagery rehearsal therapy (IRT), you rewrite a recurring nightmare into a new, less distressing version while you are awake, then rehearse the new version each day.
- The American Academy of Sleep Medicine's 2018 position paper recommends IRT for nightmares linked to PTSD. It was the only treatment given that level.
- The VA/DoD 2023 PTSD guideline reached a different conclusion: it found insufficient evidence to recommend for or against IRT.
- Trauma-focused therapy often helps sleep too, but nightmares can persist and may need their own treatment.
10. Rule out sleep apnea
Loud snoring, gasping at night or heavy daytime sleepiness can point to sleep apnea, a breathing problem that disrupts sleep. The VA notes it is common in people with PTSD. Diagnosis needs a sleep study, so raise it with your doctor.
A note on medication
Some prescribers use prazosin for trauma-related nightmares, and guidelines rate it differently. The American Academy of Sleep Medicine's 2018 paper says it "may be used", a lower rating than the sleep academy gave it in 2010. The VA/DoD 2023 PTSD guideline gives it a weak recommendation in favor ("we suggest").
The VA also notes that sleep medications generally give quick but temporary relief, are often meant for short-term use and do not address the cause of sleep problems. Whether any medication is right for you is a decision for you and your prescriber. A counselor cannot make it for you.
When sleep problems are part of something bigger
Lying awake with dark thoughts at 3 a.m. can feel endless. If you are having thoughts of suicide, call or text 988. Veterans can press 1 after dialing, or text 838255.
If nightmares, a racing mind at night or startling awake keep coming back, they may be tied to what happened rather than to your habits. Jim's page on PTSD treatment explains how trauma-focused therapy approaches this.
Questions people ask
What is the best treatment for insomnia after trauma?
Is imagery rehearsal therapy recommended for nightmares?
Should I take something to help me sleep?
Sources
- VA National Center for PTSD — Sleep problems
- CDC — About sleep
- Morgenthaler et al. (2018), AASM position paper on the treatment of nightmare disorder in adults — JCSM
- AASM — New position paper recommends treatment options for nightmare disorder
- Psychiatric News (2018) — Sleep specialists assess treatments for nightmares
- VA/DoD PTSD guideline, full text (PDF)
- VA — Insomnia Coach
- VA — Mindfulness Coach
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Written and clinically reviewed by Jim Denning, MA, LPC. Last reviewed 23 September 2026.
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