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Understanding PTSD Nightmares and Flashbacks

PTSD nightmares and flashbacks are complex and difficult to live with. Learn all about them and how PTSD nightmares and flashbacks are treated on HealthyPlace.

PTSD nightmares and flashbacks keep people trapped in the trauma they survived (PTSD Causes: Causes of Post-Traumatic Stress Disorder). Giarratano (2004) explains that living with PTSD is like living in two worlds at once: the trauma world and the now world. The trauma survivor lives and tries to function in the now world, but nightmares and flashbacks keep him/her simultaneously stuck in the world of the trauma. Understanding PTSD nightmares and flashbacks can help people leave the trauma world behind.

What are PTSD Nightmares and Flashbacks?

PTSD nightmares and flashbacks are part of the intrusion effects of PTSD. With both, distressing memories repeatedly and disruptively intrude into the person’s life and functioning.

PTSD nightmares involve terrifying dreams that plague survivors at night, while PTSD flashbacks are recurrent, involuntary memories of the trauma that torment people during waking hours. Both nightmares and flashbacks are disruptive to someone’s life in the now world.

Understanding PTSD Nightmares

Nightmares are common among trauma survivors experiencing PTSD. Between 71 and 96 percent of people living with PTSD have nightmares multiple times per week; when people also have other mental disorders such as depression or anxiety, the likelihood of nightmares increases (National Center for PTSD, 2015).

Whether they directly replay the trauma or include patchy elements of the trauma, PTSD nightmares are frightening because they involve both emotional and physiological reactions. These intrusive experiences cause

  • Fear
  • Anxiety
  • Helplessness
  • Panic (sweating, pounding heart, difficulty breathing, thrashing about)
  • Screaming or crying in sleep

As horrible as PTSD nightmares are in the moment, their negative effects don’t stop there. PTSD nightmares can have devastating consequences for someone’s sleep. When dealing with PTSD nightmares, someone has

  • More REM sleep activity than normal
  • More night-time awakenings and longer periods of being awake
  • Decreased amount of deep, restorative sleep
  • Decreased total sleep time
  • Problems functioning well in all areas of life (work, school, relationships, etc.) during the day

PTSD nightmares have other harmful consequences. Nightmares

  • Keep someone in the trauma world of fear and heightened arousal
  • Can make people avoid sleep because sleep has become as scary as being awake
  • Can lead to substance use as an attempt to escape

The nightmares of PTSD are about so much more than vivid, disturbing imagery in dreams. Nightmares are emotional and physiological, and they become a quality-of-life issue.

Understanding PTSD Flashbacks

Flashbacks are strong, overwhelming memories that involve all of the senses, and they are reinforced by crushing emotions. A PTSD flashback keeps someone rooted in the trauma world because it is a living memory.

In PTSD, the memory of the trauma is never far away, so it doesn’t take much to make a memory intrude into someone’s now world. Sometimes, flashbacks are triggered by something, anything that is in some way reminiscent of the trauma. A reminder wraps itself around the person, intrudes into his/her mind, and takes over all senses and emotions so that he/she is reliving the trauma as if it were happening now.

Sometimes, flashbacks happen without triggers. When a person is already stressed, anxious, fatigued, or emotionally upset he/she is more easily sucked back to the trauma. It’s almost as if the person’s fragile or volatile emotional state is the trigger that pulls them deep into the disturbing memory.

Treating PTSD Nightmares and Flashbacks

Treating the nightmares and flashbacks of PTSD is possible, but it can be a slow process (Treating Anxiety Related Sleep Disorder). Therapy can help someone end these intrusion symptoms that negatively affect his/her quality of life.

Ideally, treating nightmares and flashbacks is a component of overall PTSD treatment. Some specific treatment approaches for PTSD nightmares and flashbacks include:

  • Image Rehearsal Therapy (IRT) for nightmares involves, during the day, changing the ending of the nightmare and replaying this over and over so that eventually the new dream will replace the PTSD nightmare
  • The medication, Prazosin, for nightmares (sometimes)
  • Exposure to traumatic imagery to desensitize one’s reaction to flashbacks
  • Stress reduction and relaxation techniques
  • Orientation techniques to ground someone in the now world during a flashback or after a nightmare

PTSD nightmares and flashbacks take over someone’s body and emotions and plant him/her in the middle of the trauma world. Understanding PTSD nightmares and flashbacks can help someone stay rooted in the now world.


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next: Living with PTSD Can Be a Nightmare
~ all articles on ptsd
~ all articles on ptsd and stress disorders

Last Updated: 30 August 2016
Reviewed by Harry Croft, MD

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