★ PTSDIY · Field Manual ★ Part III ★
Chapter 13
Sleep and nightmares
Recovery happens at night
FM 13-SLP-101Nightly
13-1.Mission brief
Poor sleep makes every PTSD symptom worse, and PTSD makes sleep worse. Breaking that loop is one of the highest-return moves in this manual.
13-2.Intel
Cognitive behavioral therapy for insomnia (CBT-I) is the first-line insomnia treatment, recommended over sleep medication, and works for people with PTSD. Imagery rehearsal therapy reduces nightmare frequency in multiple trials.
13-3.Field procedures — the CBT-I basics
| 01 | Fix your wake timeSame time every day, weekends included. This is the anchor for everything else. | daily |
| 02 | Bed is for sleepNo scrolling, TV or worrying in bed. Your brain should link bed with sleep only. | — |
| 03 | Get up if you can't sleepAwake for what feels like 20 minutes? Get up, do something dull in dim light, return when sleepy. | — |
| 04 | Cut caffeine earlyNo caffeine after early afternoon. Skip alcohol as a sleep aid (Chapter 14). | — |
| 05 | Wind downThirty minutes before bed: lights low, screens off, long-exhale breathing (Chapter 6). | 30 min |
13-4.Field procedures — rewriting a nightmare
| 01 | Write it downPick a recurring nightmare, ideally not the worst one first. | 10 min |
| 02 | Change itRewrite it any way you like: a different ending, a new character, a shift in setting. | 10 min |
| 03 | Rehearse the new versionRead or imagine the rewritten dream for 10–20 minutes a day, while awake. | daily |
13-5.Rules of engagement
Loud snoring, gasping, or waking exhausted after a full night can mean sleep apnea, which is common in veterans and worsens PTSD. Get screened.
13-6.Common faults & corrections
| ✕ | Fault: Sleeping in to catch upCorrection: It weakens tomorrow night. Keep the wake time. |
| ✕ | Fault: Lying in bed fighting itCorrection: Effort is the enemy of sleep. Get up and reset. |
13-7.Call for backup
Ask for CBT-I by name; the VA offers it, plus a free CBT-i Coach app. Prazosin and other medications for nightmares are covered in Chapter 23.
Companion episode — [IN PROGRESS]
PTSDIY · FM 13-SLP-101 · Part III13