Sleep Problems, Insomnia & Nightmares Fact Sheet
National Alliance on Mental Illness

Causes of Sleep Problems

  • Medical problems such as pain, depression, side effects of medicines, or trouble breathing
  • Circadian rhythm disorder, a shift in the body’s normal 24-hour activity cycle
  • Lifestyle factors such as a changing sleep schedule, lack of exercise, or too much caffeine
  • Sleep settings such as a poor mattress, noise, or a room that’s too hot or too cold
  • Stress such as problems at work, money worries, or family events

Assessment & Treatment

  • The first step in treating sleeping problems is to understand what may be causing the sleep problem. Talk with your doctors. They may suggest a sleep study, an intensive exam of whether medical problems (such as sleep apnea) are part of your sleep problem.
  • Treatment for sleep disorders can include medicines and working with a sleep specialist to learn ways to improve sleep.

Insomnia Symptoms

How do you know if you have insomnia? People with insomnia will often experience:

  • Difficulty falling asleep
  • Frequent awakenings during the night
  • Early morning awakenings
  • Insufficient sleep
  • Daytime exhaustion
  • Forgetfulness
  • Depression
  • Grouchiness or nervousness
  • Lack of concentration

Tips to Improve Sleep & Manage Insomnia

  • Avoid naps—instead, exercise for 20 minutes most days, 4 to 5 hours before bedtime.
  • Get about 20 minutes of bright sunlight every day.
  • Don’t use caffeine within 6 hours before bedtime and don’t use much during the day.
  • Avoid nicotine and alcohol, especially near bedtime and during the night.
  • Avoid eating and drinking late at night.
  • Have a relaxing bedtime routine such as a warm bath.
  • Try to go to bed at the same time every night and wake up at the same time every morning.
  • Have a quiet, dark, cool sleeping environment and a comfortable bed.
  • Use the bed only for sleep and sex and go to bed only when you are sleepy.
  • If you can’t sleep after about 30 minutes in bed, get up and go to another room until you’re tired.
  • Keep a log if you are still not sleeping better after several weeks.
  • See a healthcare provider for any physical or mental problems.
  • Talk to your provider about medications and other substances that interfere with sleep.
  • Tell your healthcare provider about all over-the-counter medications and products, including herbal supplements that you are taking.


It is not unusual to have nightmares during times of stress. For combat veterans, these nightmares may include combat scenes.
If you have frequent and distressing nightmares, please talk to your medical or mental health provider. Frequent nightmares may be a sign of a more serious problem.

Tips for Coping with Nightmares

  • The morning after a nightmare, spend some time thinking about what might be causing increased stress in your life. Even positive stress (such as getting married, a new job, moving) can cause anxiety that may result in nightmares.
  • Practice some form of relaxation every night before bed. Try imagining yourself in a calming or relaxing place, practice deep slow breathing, or listen to soothing music or sounds.
  • Make your bedroom as soothing and comfortable as possible. Think about leaving a dim light or nightlight on to help you recognize your surroundings more quickly if you wake up from a nightmare.


Resources for Sleep Problems and Insomnia


San Diego VA Health Care System
Please contact your Primary Care Provider or member of the OEF/OIF Care Team for treatment options available at the San Diego VA.

Primary Care Line:
(858) 552-7475

OEF/OIF Care Team Contacts:

Mission Valley & Chula Vista:
Bridget Salzman, MSW
(619) 400-5271

La Jolla:
Rikka Bonnette, LCSW
(858) 642-3615

Patrick O’Shea, MSW
(760) 643-2079


Take an online workshop with interactive exercises to evaluate your own sleeping and hear from other Veterans and Service members dealing with similar issues.

National Sleep Foundation

The National Sleep Foundation is a scientific not-for-profit organization dedicated to improving sleep health and safety through education, public awareness, and advocacy.


Helpguide’s mission is to provide mental health information you can trust. Website includes advice and tips for getting a good night’s sleep as well as information on other sleep issues.

Make the Connection

Veterans talk about nightmares, flashbacks, and trouble sleeping.