Sleep Disruption

Sleep disruption is both a symptom and a cause across virtually every psychiatric condition, particularly central to trauma and chronic stress. Chronic insomnia disorder involves difficulty initiating or maintaining sleep with daytime consequences. Untreated PTSD maintains hyperarousal at night, generating nightmare cycles and fragmented sleep.

Evaluated across sleep onset, maintenance, duration, hygiene, and daytime functioning using tools like the ISI or PSQI. Rebu clinicians assess if insomnia is a primary disorder or driven by depression, PTSD, or anxiety. A sleep study may be recommended to rule out Obstructive Sleep Apnea (OSA) before prescribing sedating medications.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard, first-line treatment. For PTSD-related nightmares, Image Rehearsal Therapy (IRT) has meaningful evidence. Sleep hygiene is necessary but typically insufficient on its own for established insomnia disorder.

Medications may be considered when insomnia is severe and behavioral interventions are insufficient. Low-dose doxepin, ramelteon, suvorexant, and lemborexant are FDA-approved options. Benzodiazepines and Z-drugs are generally not recommended for long-term management, particularly in people with trauma histories.