Sleep Concern

Trauma haunts my nights

Nightmares, hypervigilance, and fragmented sleep after trauma.

Educational information — not medical advice. Talk to your care team about what's right for you.

Overview

After trauma, sleep can become one of the hardest places to be. Nightmares, hypervigilance, and a nervous system that refuses to feel safe at night can fragment sleep and make the bed a place of dread rather than rest. These sleep problems are not a sign of weakness — they are a recognized part of how trauma affects the nervous system, and they are treatable.

Common Causes

Post-traumatic stress, with nightmares that replay or relate to the trauma.
Hypervigilance — a nervous system that stays on alert, especially in the dark and when lying down.
Conditioned arousal — the bed or nighttime has become associated with threat.
Avoidance of sleep to escape the nightmares, deepening sleep debt.
Coexisting depression or anxiety that further disrupt sleep.

What You May Be Experiencing

Frequent nightmares, often trauma-related, that wake you in distress.
Difficulty falling asleep due to hypervigilance or fear of nightmares.
Fragmented, light sleep with a feeling of never being fully safe.
Avoiding sleep, or sleeping with lights or weapons nearby for safety.
Daytime exhaustion, irritability, and re-experiencing symptoms.

Dr. Morse's Approach

Dr. Morse approaches trauma-related sleep problems with gentleness and respect for the nervous system's protective response. Her plan addresses safety and grounding first — helping the body feel secure enough to sleep — and uses evidence-based approaches like imagery rehearsal therapy for nightmares and trauma-focused therapy for the underlying PTSD. She is clear that the sleep symptoms are part of the trauma response and that treating them, alongside the trauma, is the path forward. She never pushes a patient to 'just relax.'

Treatment Options

Behavioral

Imagery rehearsal therapy for nightmares; grounding and safety practices before bed.

Lifestyle

A calming, predictable wind-down; a sleep environment that feels safe and secure.

Medical

Trauma-focused therapy (e.g., CPT, EMDR); medication for nightmares or sleep under specialist guidance.

Your Night-time Routine

A practical, step-by-step wind-down built around this concern's specific drivers. Follow it consistently for two to three weeks — rhythm, not perfection, is what resets sleep.

1
8:00 PM
A grounding practice: orient to the present, confirm your safety, and soothe the nervous system.
2
8:30 PM
A calming wind-down with low stimulation; avoid media that could trigger arousal.
3
9:00 PM
If nightmares are recurring, practice imagery rehearsal — rewriting the dream to a safe ending.
4
9:30 PM
Create a sleep environment that feels secure; a comfort object or grounding item can help.
5
If you wake from a nightmare
Ground yourself: name where you are, breathe slowly, and use a calming practice before trying to sleep again.

Take this guide home

A printable PDF of this concern's full overview, routine, and treatment options.

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When to Seek Help

If trauma-related nightmares, hypervigilance, or insomnia are disrupting your life, seek professional support. Trauma-focused therapy and targeted treatments for nightmares are effective, and you don't have to manage this alone. If you are in crisis, reach out immediately.

Educational — Not Medical Advice

This content is provided for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for consultation with a qualified healthcare professional. Submitting a question or receiving a reply does not establish a doctor-patient relationship. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition, and discuss any changes to your care with your own care team.

Ready for personalized guidance?

Dr. Morse offers one-on-one and group coaching to help you move from understanding your sleep concern to changing it. Share what you're experiencing and she'll be in touch.

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