Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence
ABSTRACT Emerging evidence supports the notion of disrupted sleep as a core component of Posttraumatic Stress Disorder (PTSD). Effective treatments for nighttime PTSD symptoms are critical because sleep disruption may be mechanistically linked to development and maintenance of PTSD and is associated with significant distress, functional impairment, and poor health. This review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. Published studies that examined evidence for therapeutic effects upon sleep were included. Some behavioral and pharmacological interventions show promise, especially for nightmares, but there is a need for controlled trials that include valid sleep measures and are designed to identify treatment mechanisms. Our ability to treat PTSD-related sleep disturbances may be improved by moving away from considering sleep symptoms in isolation and instead conducting integrative studies that examine sequential or combined behavioral and/or pharmacological treatments targeting both the daytime and nighttime aspects of PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
SourceAvailable from: Wendy M TroxelMilitary medicine 01/2015; 180(1):4-6. DOI:10.7205/MILMED-D-14-00264 · 0.77 Impact Factor
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ABSTRACT: This study examined factors predicting treatment dropout and outcome in 124 male Vietnam War veterans with chronic, severe posttraumatic stress disorder treated in a randomized controlled trial of two cognitive–behavioral group therapies for combat-related nightmares. Though significant bivariate predictors of dropout in the imagery rehearsal condition included non-African American race, use of selective serotonin reuptake inhibitors, more traumas, and lower perceived treatment credibility, none of these variables uniquely predicted dropout in multivariate analyses. In the sleep and nightmare management condition, only low avoidance symptoms predicted dropout. Use of benzodiazepines and higher reexperiencing symptoms predicted posttreatment nightmare frequency in imagery rehearsal; although baseline sleep quality and higher avoidance symptoms predicted posttreatment sleep quality. In sleep and nightmare management, only poorer sleep quality predicted posttreatment nightmares, although poorer baseline sleep quality and higher avoidance symptoms predicted posttreatment sleep quality. Practical and clinical implications, including the use of “socialization” strategies (e.g., patient testimonials, in-depth explanation of treatment rationale), are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)Psychological Trauma Theory Research Practice and Policy 11/2013; 5(6):545. DOI:10.1037/a0030724 · 0.89 Impact Factor
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ABSTRACT: Fear conditioning is considered an animal model of post-traumatic stress disorder. Such models have shown fear conditioning disrupts subsequent rapid eye movement sleep (REM). Here, we provide a translation of these models into humans. Using the fear potentiated startle (FPS) procedure, we examined the effects of fear conditioning and safety signal learning on subsequent REM sleep in healthy adults. We also examined the effects of changes in REM sleep on retention of fear and safety learning. Participants (n = 42 normal controls) spent 3 consecutive nights in the laboratory. The first was an adaptation night. Following the second night, we administered a FPS procedure that included pairing a wrist shock with a threat signal and a safety signal never paired with a shock. The next day, we administered the FPS procedure again, with no wrist shocks to any stimulus, to measure retention of fear and safety. Canonical correlations assessed the relationship between FPS response and REM sleep. Results demonstrated that increased safety signal learning during the initial acquisition phase was associated with increased REM sleep consolidation that night, with 28.4% of the variance in increased REM sleep consolidation from baseline accounted for by safety signal learning. Overnight REM sleep was, in turn, related to overnight retention of fear and safety learning, with 22.5% of the variance in startle retention accounted for by REM sleep. These data suggest that sleep difficulties, specifically REM sleep fragmentation, may play a mechanistic role in post-traumatic stress disorder via an influence on safety signal learning and/or threat-safety discrimination.The Journal of Neuroscience : The Official Journal of the Society for Neuroscience 08/2014; 34(35):11754-60. DOI:10.1523/JNEUROSCI.0478-14.2014 · 6.75 Impact Factor