Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence

University of California, San Diego and Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC116B, San Diego, CA 92161, United States.
Neuropharmacology (Impact Factor: 5.11). 03/2011; 62(2):576-85. DOI: 10.1016/j.neuropharm.2011.02.029
Source: PubMed


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'.

21 Reads
  • Source
    • "The findings showing that PTSD-intrusion and PTSD-hyperarousal symptoms are connected to poor sleep quality partly support Nappi, Drummond, and Hall (2012)'s proposal that having nightmares is related to the PTSD-reexperience symptom and insomnia is associated with the PTSD symptom-hyperarousal symptom. Nappi et al. (2012) indicated that sleep disruptions are the most distressing symptoms for those with PTSD but few studies have examined the specific mechanism underlying these symptoms following a traumatic event. Even fewer studies used validated measures of sleep quality. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigates the differential mediating pathways of PTSD symptom clusters in the relationship between traumatic events and alcohol use or poor sleep quality in a sample of university students with traumatic life experiences using a path analysis. Gender difference was also examined using multi-group analysis. Male (N = 1471) and female (N = 528) university students completed an online mental health survey consisting of the Life Event Checklist, the Impact of Event Scale-Revised, the CAGE Questionnaire, and the Pittsburgh Sleep Quality Index. Results showed that traumatic events had a direct impact on both alcohol use and poor sleep quality. The indirect impact of traumatic events on alcohol use appeared to be through PTSD-avoidance, and the indirect impact of traumatic events on poor sleep quality appeared to be through PTSD-intrusion and PTSD-hyperarousal. A multi-group analysis showed that male students are 3.25 times more likely to use alcohol in response to traumatic stress than female students. Our findings suggest that there are differential mediating mechanisms of PTSD symptom clusters underlying alcohol use or poor sleep quality following traumatic events, indicating the importance of developing symptom-tailored therapeutic intervention.
    Personality and Individual Differences 10/2015; 85. DOI:10.1016/j.paid.2015.04.035 · 1.95 Impact Factor
  • Source
    • "An emerging literature suggests that posttraumatic stress disorder (PTSD) and sleep are intimately linked in a bi-directional relationship – PTSD compromises normal sleep, which increases the risk of and exacerbates the magnitude of PTSD [1]–[5]. Sleep disturbances occurring after exposure to traumatic events increase the risk for developing PTSD [6], [7], whereas treatment of sleep disturbances alleviates those symptoms [8]–[10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies suggest that sleep plays a role in traumatic memories and that treatment of sleep disorders may help alleviate symptoms of posttraumatic stress disorder. Fear-conditioning paradigms in rodents are used to investigate causal mechanisms of fear acquisition and the relationship between sleep and posttraumatic behaviors. We developed a novel conditioning stimulus (CS) that evoked fear and was subsequently used to study re-exposure to the CS during sleep. Experiment 1 assessed physiological responses to a conditioned stimulus (mild transient hypercapnia, mtHC; 3.0% CO2; n = 17)+footshock for the purpose of establishing a novel CS in male FVB/J mice. Responses to the novel CS were compared to tone+footshock (n = 18) and control groups of tone alone (n = 17) and mild transient hypercapnia alone (n = 10). A second proof of principle experiment re-exposed animals during sleep to mild transient hypercapnia or air (control) to study sleep processes related to the CS. Footshock elicited a response of acute tachycardia (30-40 bpm) and increased plasma epinephrine. When tone predicted footshock it elicited mild hypertension (1-2 mmHg) and a three-fold increase in plasma epinephrine. When mtHC predicted footshock it also induced mild hypertension, but additionally elicited a conditioned bradycardia and a smaller increase in plasma epinephrine. The overall mean 24 hour sleep-wake profile was unaffected immediately after fear conditioning. Our study demonstrates the efficacy of mtHC as a conditioning stimulus that is perceptible but innocuous (relative to tone) and applicable during sleep. This novel model will allow future studies to explore sleep-dependent mechanisms underlying maladaptive fear responses, as well as elucidate the moderators of the relationship between fear responses and sleep.
    PLoS ONE 06/2013; 8(6):e67435. DOI:10.1371/journal.pone.0067435 · 3.23 Impact Factor
  • Source
    • "More broadly, the potential impact of early-life trauma exposure on REM sleep may provide novel insight into biological mechanisms, such as the processing of emotional memories and HPA axis modification, for stress resilience that can be modifiable targets for intervention. Currently, efficacious sleep treatments are being implemented to treat persons who suffer from PTSD (see review [Nappi et al., 2012]). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of sleep in the relations between early-life trauma and the development of adverse psychological trajectories is relatively unknown and was the primary aim of the present study. Military veterans were evaluated for posttraumatic stress disorder, combat exposure, trauma history, sleep quality, disruptive nocturnal behaviors, and a subsample completed overnight polysomnography that yielded objectively measured sleep parameters. When relevant variables were controlled, increased earlier-life traumatic event exposure was associated with increased rapid-eye-movement sleep (REMs) fragmentation, and increased REMs fragmentation was associated with increased later-life disruptive nocturnal behaviors. REMs fragmentation carried an indirect relation between earlier-life trauma and later-life disruptive nocturnal behaviors. Objectively measured sleep parameters were used to describe REMs fragmentation physiology. The current findings elucidate the important role that earlier-life trauma exposure may have in the development of REM sleep physiology, and how this altered sleep physiology may have dynamic influences on subsequent posttraumatic stress symptoms in adulthood.
    Biological psychology 01/2012; 89(3):570-9. DOI:10.1016/j.biopsycho.2012.01.001 · 3.40 Impact Factor
Show more