Sleep Disturbances in PTSD: Nightmares, Insomnia and Treatment

PTSD and sleep disturbances frequently overlap in clinical practice. In this episode of Mayo Clinic Sleep Medicine, Dr. Michael Silber speaks with Dr. Bhanu Kolla about the evaluation and management of sleep-related symptoms associated with post-traumatic stress disorder (PTSD). The discussion addresses PTSD-related nightmares, including the role of prazosin and psychotherapeutic approaches, as well as dream enactment behavior and trauma-associated sleep disorder. The panel also reviews insomnia in patients with PTSD, including cognitive behavioral therapy for insomnia (CBT-I), and considers whether early treatment of sleep disturbance after trauma could influence subsequent PTSD risk. Additional topics include the relationship between PTSD and obstructive sleep apnea, other comorbid sleep disorders, and emerging research involving MDMA and psychedelic-assisted approaches for PTSD. The discussion emphasizes areas where evidence is established, where clinical uncertainty remains, and where additional research is needed.  Dr. Bhanu Kolla is a professor of psychiatry at Mayo Clinic College of Medicine and Science and a board-certified specialist in sleep medicine and addiction medicine.