When the Body Won't Let You Rest: How Trauma Shows Up in Dreams and Sleep

by Jessica Anne Pressler LCSW

If you're reading this in the early hours of the morning because sleep has become something you dread rather than welcome—I want you to know something first: you are not alone. And what you're experiencing is not a sign of weakness, failure, or something being fundamentally wrong with you.

Sleep disturbances are one of the most common ways that unresolved trauma continues to speak to us. And while it can feel isolating to lie awake while the rest of the world sleeps, or to wake gasping from dreams that feel more real than the room around you, please know that your body is doing exactly what it learned to do to keep you safe.

You're in Good Company

Sleep disturbances are commonly reported by patients with PTSD, with estimates showing up to 80–90% experiencing insomnia symptoms and 50–70% experiencing nightmares. If you've ever felt like you're the only one struggling to rest, these numbers tell a different story—one where so many of us are navigating the same dark waters.

Sleep disturbance has been described as a hallmark of PTSD. This isn't a minor inconvenience or something to simply "push through." It's a core part of the experience—and it deserves attention and care.

Why Your Body Won't Let You Rest

Here's something important to understand: your sleep difficulties aren't random. They make sense when you understand what trauma does to the nervous system.

A common symptom that arises from traumatic experiences is hyperarousal (also called hypervigilance). Hyperarousal is the body's way of remaining prepared. It is characterized by sleep disturbances, muscle tension, and a lower threshold for startle responses and can persist years after trauma occurs.

Your nervous system learned, at some point in your life, that the world wasn't safe. So it adapted. It became watchful, alert, ready to respond at a moment's notice. This was actually a brilliant survival mechanism—your body protecting you the best way it knew how.

PTSD involves a dysregulation of the body's stress response system, creating a state of hyperarousal—a persistent "on alert" status where the brain and body remain vigilant for potential threats. This heightened state directly interferes with the brain's ability to transition into and maintain sleep.

The challenge is that your body doesn't always distinguish between then and now. In hyperarousal, you're not usually dealing with a threat that's right in front of you. Often, the thing you're worried about happened a long time ago.

So when you can't fall asleep, or you wake at every small sound, or your body refuses to fully relax into rest—that's not you failing at something basic. That's your protective system still doing its job, even when it no longer needs to.

What This Might Look Like for You

Sleep disturbances after trauma can show up in many ways. You might recognize some of these:

The struggle to fall asleep: For many trauma survivors, hypervigilance can delay the onset of sleep. It can also prevent them from sleeping deeply and can leave a person feeling unrefreshed after a night's sleep. Your body simply cannot relax enough to surrender to sleep. Your internal alarm system is still scanning, still watching, still waiting.

Waking throughout the night: Children with PTSD had higher sleep fragmentation compared to controls, with changes in sleep microarchitecture. This applies to adults too—waking frequently, unable to achieve the deep, restorative sleep your body desperately needs. If you wake feeling exhausted despite being in bed for hours, this may be why.

Nightmares and distressing dreams: PTSD is often associated with vivid, distressing dreams that relive traumatic experiences, leading to significant sleep disruption. Individuals with PTSD often report recurrent nightmares that are emotionally intense and disturbing. In most instances, nightmares are described as replicative in nature where the trauma is being re-enacted. Awakenings are often accompanied by an intense and prolonged sensation of fear or anxiety which causes delayed return to sleep.

Dreading bedtime: Perhaps one of the cruelest aspects is when sleep itself becomes something to fear. People with PTSD may avoid going to sleep. Nightmares and flashbacks—feeling like the trauma is happening again—can create fear or feeling as if going to bed is unsafe. The bed that should be a sanctuary can start to feel like a battleground.

If any of this sounds familiar, please be gentle with yourself. You're not doing anything wrong. Your body is trying to protect you—it just hasn't yet learned that it's safe to rest.

The Exhausting Cycle

Here's what can make this so hard: poor sleep doesn't just result from trauma—it can also make recovery more difficult. Prospective, longitudinal studies have established that sleep disturbances represent a risk factor for the development and course of PTSD, suggesting that sleep is an important neurobiological mechanism in the etiology and maintenance of this disorder.

It has been theorized that insomnia amplifies and perpetuates trauma-related nightmares through the decreased inhibition of the amygdala by the medial prefrontal cortex, which results from sleep deprivation.

In simpler terms: when we're exhausted, the fear centre of our brain becomes more reactive, while the calming, rational part has fewer resources. This can create a painful loop where not sleeping makes everything harder, and everything being harder makes it even more difficult to sleep.

If you're caught in this cycle, please know it's not your fault. And there are ways to gently begin interrupting it.

What's Happening in Your Nervous System

Hypervigilance is linked to a dysregulated nervous system which can often be caused by traumatic events or complex PTSD. Normally, the nervous system releases stress signals in certain situations as a defense mechanism. In some cases, the nervous system becomes chronically dysregulated, causing a release of stress signals that are inappropriate to the situation.

When someone experiences trauma, the autonomic nervous system can become dysregulated, leading to a heightened state of hyperarousal or hypervigilance. This keeps the body in a persistent fight-or-flight state, making it difficult to relax.

The exhaustive nature of hypervigilance often interferes with our ability to fall asleep and maintain restful sleep, as it excessively stimulates the sympathetic nervous system, triggering the fight or flight response.

Your nervous system isn't malfunctioning—it's doing exactly what it was designed to do when faced with threat. The work of healing is about gently teaching it that the threat has passed.

For Those Who Experienced Early Trauma

Childhood trauma profoundly impacts the development and functioning of the nervous system, often resulting in long-lasting changes that can influence an individual's health throughout life. Trauma can lead to a reduction in hippocampal volume, impairing memory and learning, while increasing amygdala activity heightens fear responses and hypervigilance.

If you experienced trauma early in life, sleep difficulties may feel like they've always been with you—because in some ways, they have. Your nervous system developed under conditions that taught it vigilance was necessary for survival.

This isn't a character flaw. This isn't you being "too sensitive" or "dramatic." This is biology responding to environment. And the beautiful thing about our brains is that they can change. The same adaptability that allowed your nervous system to learn hypervigilance also means it can learn safety.

There Are Paths Toward Healing

If you've been struggling with sleep for a long time, you might have started to believe that this is just how it will always be. I want to gently challenge that belief. Healing is possible, and there are evidence-based approaches that can help.

Trauma-focused therapy addresses the root causes. EMDR (Eye Movement Desensitization and Reprocessing), while recalling distressing memories with bilateral stimulation, can help reduce their emotional intensity.

Treatments specifically for nightmares can be remarkably effective. Psychotherapies specifically targeting post-traumatic nightmares, such as Imagery Rehearsal Therapy, have shown effectiveness on both sleep disturbances and PTSD symptomatology. During the daytime, you write out your nightmare, and then you change the ending so that the problem is resolved. One of the reasons your brain makes nightmares is it's actually trying to process memories and emotions during REM sleep, but with PTSD the processing system can get overwhelmed. When you write the new ending, your brain knows how to finish the dream.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is highly effective. The best treatment for insomnia is Cognitive Behavioral Therapy for Insomnia, or CBT-I. This talk therapy is recommended over medication because it is more effective—CBT-I has been shown to work in multiple research studies—and has fewer side effects than medication. CBT-I improves sleep in 7 out of 10 people who complete it.

Nervous system regulation practices can help shift your body out of chronic hyperarousal. Deep, slow breathing stimulates the parasympathetic nervous system and promotes relaxation. Body-based practices such as yoga, Tai Chi, and Qi Gong help activate the parasympathetic nervous system, fostering relaxation and bodily awareness. Practicing mindfulness within these activities enhances emotional regulation and self-awareness.

Creating a sense of safety in your sleep environment can make a real difference. Creating a sleep sanctuary particularly addresses the hypervigilance component of PTSD: a cool, dark, quiet room, security measures that provide peace of mind, and removal of electronics from the bedroom.

You Deserve Compassion—Especially from Yourself

Hypervigilance is not a personal failing or sign of weakness. Rather, it's a deeply understandable response to trauma that became stuck.

If your nights have been difficult—for weeks, months, or years—please offer yourself the same kindness you would give to someone you love. You did not choose this. Your body learned to stay alert because, at some point, that's what survival required. That adaptation served you.

Now, with support and time, you can begin to teach your nervous system something new: that rest is possible. That you are safe enough to sleep. That the night doesn't have to be your enemy.

You don't have to work through the symptoms of PTSD on your own. Speaking with a mental health professional can be an important first step. Symptoms like nightmares can improve once you start working on other aspects of PTSD.

Healing doesn't happen overnight (if you'll forgive the pun). But it does happen. And you deserve every moment of peaceful sleep that's waiting for you on the other side.

Resources (These resources were recommended to me.)

National Center for PTSD (U.S. Department of Veterans Affairs) https://www.ptsd.va.gov/understand/related/sleep_problems.asp Comprehensive information on sleep problems and PTSD, including treatment options and self-help strategies.

PTSD UK https://www.ptsduk.org/how-can-you-reduce-nightmares-from-ptsd/ Practical guidance on reducing nightmares and improving sleep for trauma survivors.

Sleep Foundation: PTSD and Sleep https://www.sleepfoundation.org/mental-health/ptsd-and-sleep Evidence-based information about the relationship between trauma and sleep, with management strategies.

Sleep Foundation: How Trauma Can Affect Dreams https://www.sleepfoundation.org/dreams/how-trauma-can-affect-dreams Understanding why trauma affects our dream life and what can help.

Therapy in a Nutshell (Emma McAdam, Licensed Marriage and Family Therapist) https://therapyinanutshell.com/night-terrors/ Accessible explanations of nightmares and night terrors with practical treatment information.

Psych Central: Nightmares in PTSD https://psychcentral.com/ptsd/ptsd-nightmares Understanding PTSD nightmares and coping strategies.

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References

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Center for Substance Abuse Treatment (US). (2014). Understanding the Impact of Trauma. In Trauma-Informed Care in Behavioral Health Services (Treatment Improvement Protocol Series, No. 57). Substance Abuse and Mental Health Services Administration.

Cleveland Clinic. (2025). Hyperarousal: When Protective Instincts Do More Harm Than Good. https://my.clevelandclinic.org/health/symptoms/hyperarousal

Germain, A. (2016). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 170(4), 372-382.

Khiron Clinics. (2025). The Link Between Trauma, Nightmares, and Sleep Paralysis. https://khironclinics.com/blog/the-link-between-trauma-nightmares-and-sleep-paralysis/

Maher, M.J., Rego, S.A., & Asnis, G.M. (2006). Sleep disturbances in patients with post-traumatic stress disorder: Epidemiology, impact and approaches to management. CNS Drugs, 20(7), 567-590.

Mysliwiec, V., et al. (2023). Trauma-Associated Sleep Disorder. Sleep Medicine Clinics, 19(1), 93-99.

Sahu, N., Patil, P.S., et al. (2024). Understanding and Treating Nightmares: A Comprehensive Review of Psychosocial Strategies for Adults and Children. Cureus, 16(9), e70044.

So, C.J., et al. (2024). Sleep Disturbances Associated With Posttraumatic Stress Disorder. Psychiatric Clinics of North America. PMC10825808.

Spoormaker, V.I., & Montgomery, P. (2008). Disturbed sleep in post-traumatic stress disorder: Secondary symptom or core feature? Sleep Medicine Reviews, 12(3), 169-184.