Sleep disturbances in posttraumatic stress disorder: Current knowledge and clinical management

OBJECTIVES: Posttraumatic stress disorder (PTSD) is a psychiatric condition frequently associated with severe sleep disturbances, especially insomnia and trauma-related nightmares (TRNs). These symptoms are among the most frequent and persistent in both civilian and military populations, yet they remain under-assessed and under-treated. This expert review aims to provide a comprehensive and updated overview of the current understanding and management of sleep disturbances in PTSD. MATERIALS AND METHODS: This work is based on a critical synthesis of recent literature, combined with clinical expertise in military psychiatry and sleep medicine. The main areas examined include epidemiological data, diagnostic classifications, clinical characteristics, and therapeutic approaches. RESULTS: Sleep complaints in PTSD are often severe, with TRNs representing a key clinical hallmark. Polysomnographic findings remain non-specific and sometimes inconclusive. A bidirectional relationship is described between PTSD symptoms and sleep disturbances. Therapeutic approaches include both psychotherapeutic and pharmacological interventions, each with strengths and limitations. DISCUSSION: Sleep disturbances in PTSD play a central role in symptom persistence and overall functional impairment. Addressing them may improve both nocturnal symptoms and daytime functioning. In psychiatric populations, treatment of sleep complaints may offer a less stigmatizing entry point into mental health care. CONCLUSIONS: Sleep should be systematically assessed and specifically treated in PTSD. It constitutes a valuable clinical target and a potential lever for improving prognosis and global recovery.