Why do veterans with PTSD have nightmares, and how to overcome them?

Are you having nightmares (without knowing it?)

I am one of the lucky ones who was never affected by what I dreamed of at night. Of course, I have had dreams. Pretty much always the same dream. I am on the run. Always. Solution-oriented as I am (I hope) I always had a way out. But it was not a less frightening experience for that reason. Because those who hunted me and shot at me, had one goal: they were going to kill me.


As mentioned, it was a dream and I never classified it as a nightmare. Although I’m a veteran and have experienced a couple of notpleasant things as a nineteen year old soldier. But that’s so long ago, right?


I was not bothered by this. I thought. Until I accidentally mentioned for a veteran friend, that I was so numb in my arms when I woke up in the morning and that I had incipient jaw problems at the same time.


“Ahhh, you have nightmares” he replied.


It turned out that during the night I literally bit my teeth together and clenched my fists so hard that, unaware of it, I was numb in my arms and were on my way to destroy my teeth. I got help from my psychologist and after many years in treatment, both for nightmares and other PTSD related things, I feel better now. But the problems with nightmares among veterans was and is a major problem. No doubt.

Table of content

Why do veterans have nightmares?

Nightmares are one of the 17 symptoms of PTSD. For example, a study comparing Vietnam Veterans to civilians showed that 52% of combat veterans with PTSD had nightmares fairly often. Other research has found even higher rates of nightmares. Of those with PTSD, 71% to 96% may have nightmares. We have reason to believe that the same numbers are more or less equal all over the world. 

The connections between Nightmares and insomnia

Studies have shown that more than 85% of people with war experience and who have PTSD suffer from insomnia. Frequent nightmares or night terrors associated with traumatic experiences can lead to poor sleep, associated with fear of sleeping and aches and pains when awake.






How do I stop having nightmares and get better sleep?

There are many different methods to help people with nightmares and insomnia. Many of these I have written about earlier

Here are some of them:


  • Cognitive behavioral therapy
  • The high-blood pressure drug prazosin has shown in a number of research studies that it can eliminate nightmares.
  • Conversational therapy, which gives the person with nightmares tools to interpret the content of the nightmares and also change the content to make them less bothersome, is effective for many.

It turns out that in order to treat nightmares and insomnia, several different treatment methods are required and often at a great deal of patience. Because treatment that is effective against insomnia is not necessarily effective for nightmares. And the treatments that were effective for nightmares were not necessarily effective for insomnia.

That is, until now.

A relatively new therapy called exposure, relaxation and prescription therapy has been shown to be effective for these sleep problems.

Will Exposure, Relaxation and prescription therapy help?

ERRT has been studied almost exclusively among civilians, but the results have been good. The researchers recognize the need for effective treatments in veterans, and modified the treatment specifically for this group. Results from this modified version of ERRT with veterans are promising.


In short, 19 veterans were given one treatment a week, where the treatment consisted of a mixture of teaching about insomnia and nightmares, techniques for learning to sleep better, conscious exposure to the content of the nightmare, and “rewriting” and practicing the new dream.

After just one week, some veterans saw a reduction in the number of nightmares they experienced as well as the intensity of their dreams. They also saw an increase in overall sleep quality and a decrease in the severity of insomnia.


Surprisingly, those who were depressed saw an improvement in their mood. This may be related to the fact that poor sleep and nightmares are directly linked to depression. The good news is that the results were not temporary. The improvements continued up to two months after the end of treatment.


The limitations are of course that there were few patients in the study and that half of these still had problems with both sleep and nightmares. Without comparing a group that received the treatment with one that did not receive it, it is impossible to know whether the treatment itself led to the improvements or was due to some other unknown factors.

Regardless of the limitations, this study is a great first step in the fight against sleep problems in combat veterans.




Are Nightmares and cardiovascular diseases connected?

A  new study found a surprising association between frequent and severe nightmares and cardiovascular disease in veterans, even after controlling for post-traumatic stress disorder.

Preliminary results show that 32 percent of veterans reported having frequent nightmares and 35 percent reported severe nightmares over the past week. Frequent and severe nightmares were associated with heart problems, high blood pressure, and heart attack after adjusting for age, sex and race. Associations between nightmares and high blood pressure and heart problems remained significant after controlling for PTSD diagnosis, depression diagnosis and status as a smoker.

“Our cross-sectional findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone,” said principal investigator Christi Ulmer, PhD, who has a doctorate in clinical psychology and is a clinical research psychologist at the Durham VA Health Services Research and Development ADAPT Center and assistant professor in the Department of Psychiatry & Behavioral Sciences at Duke University Medical Center.

“If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health.”

The study involved 3,468 veterans with an average age of 38 years. Nightmare frequency and severity was assessed using the Davidson Trauma Scale, with nightmares classified as “frequent” if they occurred at least 2 to 3 times per week and severe if they were at least moderately distressing.

Medical problems were assessed using a medical questionnaire, and PTSD and depression diagnoses were established using a clinical interview. Thirty percent of participants met criteria for current PTSD.

The research was supported by the VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC) and the Department of Veterans Affairs HSR&D ADAPT Center at the Durham VA Health Care System.

(This topic was found on psychiatry.duke.edu)


Can you get PTSD from nightmares?

Unfortunately, yes, or, the presence of nightmares not only influences the development of PTSD but also accelerates the progression of PTSD following trauma exposure. Subjects who reported nightmares prior to trauma exhibited more severe PTSD symptoms after being exposed to a traumatic event than those who did not.

What are PTSD nightmares like?

It is characterized by intrusive thoughts, nightmares, and flashbacks of past traumatic events. You will likely notice that you also have increased arousal, meaning that you are more reactive to your environment. This may be associated with significant anxiety.


I can wake up during the night and have a huge lump of anxiety in my stomach. If I  start the day like this, it will be a minor pleasant day. Instead, I try to go to sleep again. The strange thing is that if I fall asleep, if only for a moment (a few minutes) and wake up again, the lump of anxiety can be gone.


I don’t know why, but of course, I then get up. And the day will be significantly better than if I took with me the anxiety of what is probably the nightmare into the new day.

And as we all know: Anxiety and poor sleep are the source of depression.


That brings me to:


Should you stay awake if you have experienced a traumatic experience?

Music, exercise and computer games can reduce the risk of developing post-traumatic stress disorder.

A study shows that people who sleep after a strong negative emotional impression preserve and reinforce these painful memories to a greater extent than those who stayed awake afterwards. Right after a traumatic event, you should stay awake.

In recent years, people have begun to realize that this may be the case, but it is not many years since, on the contrary, they recommended sleep and rest right after a trauma.

The new study was based on the knowledge that reinforcement of memories takes place while we sleep, according to the press release issued by the University of Massachusetts Amherst about the findings.

– We found that if you see something that upsets you, such as an accident scene, and you later have to look at a picture of this accident – then you will feel that exposure number two is much less upsetting if you have stayed awake after it. first event, than if you lay down to sleep, says one of the researchers, Rebecca Spencer.

– It is exciting to note that it is actually common to become sleepless after witnessing something dramatic, almost as if the brain does not want to sleep on it, she says.


Sleep and get better?

A trauma can give the mental disorder post-traumatic stress, which includes nightmares, lack of concentration, and painful flashbacks in the face of elements reminiscent of the trauma.

In the study of 68 men and as many women – all young and healthy – Spencer and his colleagues saw that those who slept during the hours after seeing outrageous pictures, had the aforementioned enhanced memory effect.

The researchers believe the findings may be significant for people with post-traumatic stress disorder, and for people who have to testify in court about incidents they have seen. The findings are published in the Journal of Neuroscience.


Advanced brain scan studies, but also animal experiments, have made inroads in recent years. They have made it possible to gain better knowledge about which structures in the brain respond most to fear-triggering stimuli.


A summary from 2003, of 11 studies, which had looked at crisis psychology and the so-called debriefing that is routinely offered to people immediately after an incident, then concluded that such help had rarely helped. 

In other words, it is better with normal, everyday routines in a safe situation after a traumatic experience than an invasive debrief.


What is PTSD?

Post-traumatic stress disorder, PTSD, sometimes known as shell shock or combat stress, is an anxiety disorder that can occur in people who have been exposed to particularly frightening and horrific experiences such as aggravated violence, abuse, war and concentration camps, disasters, torture, rape, serious accidents or serious crimes (such as armed

Mobilization, or fight-or-flight, occurs when you need to defend yourself or survive the danger of a combat situation.

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