Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance

Sleep & Human Health Institute, 6739 Academy NE, Suite 380, Albuquerque, New Mexico 87109, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 07/2004; 17(3):257-68. DOI: 10.1023/B:JOTS.0000029269.29098.67
Source: PubMed

ABSTRACT Eight months after the Cerro Grande Fire, 78 evacuees seeking treatment for posttraumatic sleep disturbances were assessed for chronic nightmares, psychophysiological insomnia, and sleep-disordered breathing symptoms. Within this sample, 50% of participants were tested objectively for sleep-disordered breathing; 95% of those tested screened positive for sleep-disordered breathing. Multiple regression analyses demonstrated that these three sleep disorders accounted for 37% of the variance in posttraumatic stress symptoms, and each sleep disorder was significantly and independently associated with posttraumatic stress symptoms severity. The only systematic variable associated with posttraumatic stress symptoms of avoidance was sleep-disordered breathing. The findings suggest that three common sleep disorders relate to posttraumatic stress symptoms in a more complex manner than explained by the prevailing psychiatric paradigm, which conceptualizes sleep disturbances in PTSD merely as secondary symptoms of psychiatric distress.

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    • "In addition, utilizing a measure of sleep apnea will be important in future studies since this sleep disorder may contribute both to fatigue/lassitude and to psychological disorders like PTSD (Krakow et al., 2004). It would also be interesting to obtain objective measures of sleep disturbances (e.g., actigraphy and EEG) at baseline to see if these variables are related to increased risk for the development of internalizing disorders. "
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    ABSTRACT: There is growing evidence that disturbed sleep is a risk factor for the development of a number of psychiatric diagnoses including depression, PTSD and substance use. The goal of this study was to use a subset of participants from a larger prospective longitudinal study to examine whether preexisting daytime and nighttime sleep disturbances predict depression, PTSD and substance use in US National Guard Soldiers deployed to Iraq. Data on daytime and nighttime sleep complaints, baseline symptoms and personality variables were gathered prior to deployment to Iraq. Measures of psychopathology were collected at three time points post-deployment over the course of two years using both questionnaires and interviews. Multiple regressions were used to predict diagnoses and symptoms of depression, PTSD and substance use. Pre-deployment daytime and nighttime sleep complaints contributed significantly to the prediction of PTSD and depression up to two years after deployment, but not substance use. This study suggests that daytime and nighttime sleep complaints are a risk factor for internalizing disorders including PTSD and depression.
    Journal of anxiety disorders 07/2013; 27(5):512-519. DOI:10.1016/j.janxdis.2013.07.003 · 2.68 Impact Factor
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    • "Furthermore, 50Á70% of PTSD patients report recurrent nightmares (Kilpatrick et al., 1998; Leskin, Woodward, Young, & Sheikh, 2002; Neylan et al., 1998). Apart from those sleep disturbances listed in the clinical description of PTSD, periodic limb movements (PLMs) and sleep-disordered breathing (SDB) also often co-occur in PTSD patients: SDB has been found in 50Á90% of PTSD patients in different study populations (Krakow et al., 2001, 2002, 2004), and clinically significant increases in PLMs have been found in different PTSD populations of veterans and sexual assault survivors , compared to the non-PTSD control groups (Brown & Boudewyns, 1996; Krakow et al., 2000; Mellman, Kulick-Bell, Ashlock, & Nolan, 1995; Ross et al., 1994). "
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    ABSTRACT: Sleep disturbance is a common characteristic of patients with post-traumatic stress disorder (PTSD). Besides the clinical descriptions of nightmares and insomnia, periodic limb movements (PLMs) are reported to co-occur in PTSD. Although the causal relationship between sleep disturbance and PTSD is not fully understood, sleep disturbance is an independent risk factor for the development and reactivation of PTSD. In contrast, the link between PTSD and REM sleep behaviour disorder (RBD) is less clear. A case report is presented to illustrate differential diagnosis and time course of sleep disturbance in the context of PTSD. A 63-year-old man who had been successfully treated for PTSD but who suffered the re-occurrence of disturbed sleep due to RBD and PLM, which was misdiagnosed as reactivation of PTSD. RBD can mimic PTSD-related nightmares. Accurate diagnosis of sleep disturbance in PTSD is relevant for treatment and prognostic evaluation.
    European Journal of Psychotraumatology 04/2013; 4. DOI:10.3402/ejpt.v4i0.18714 · 2.40 Impact Factor
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    • "OSAS was not more prevalent in patients with PTSD compared to TCs and HCs, contrary to previous uncontrolled studies that suggested indices between 60 and 90% in PTSD (Krakow, Germain, et al., 2000; Krakow et al., 2004, 2006; Yesavage et al., 2010). "
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    ABSTRACT: Sleep facilitates the consolidation of fear extinction memory. Nightmares and insomnia are hallmark symptoms of posttraumatic stress disorder (PTSD), possibly interfering with fear extinction and compromising recovery. A perpetual circle may develop when sleep disturbances increase the risk for PTSD and vice versa. To date, therapeutic options for alleviating sleep disturbances in PTSD are limited. WE CONDUCTED THREE STUDIES TO EXAMINE THE RELATIONSHIP BETWEEN SLEEP AND POSTTRAUMATIC SYMPTOMS: (1) a prospective longitudinal cohort study examining the impact of pre-deployment insomnia symptoms and nightmares on the development of PTSD; (2) a cross-sectional study examining subjective sleep measures, polysomnography, endocrinological parameters, and memory in veterans with PTSD, veterans without PTSD, and healthy controls (HCs); (3) a randomized controlled trial (RCT) (n=14) comparing the effect of prazosin and placebo on sleep disturbances in veterans with PTSD. In addition to these studies, we systematically reviewed the literature on treatment options for sleep disturbances in PTSD. Pre-deployment nightmares predicted PTSD symptoms at 6 months post-deployment; however, insomnia symptoms did not. Furthermore, in patients with PTSD, a correlation between the apnea index and PTSD severity was observed, while obstructive sleep apnea syndrome was not more prevalent. We observed a significant increase in awakenings during sleep in patients with PTSD, which were positively correlated with adrenocorticotropic hormone (ACTH) levels, negatively correlated with growth hormone (GH) secretion, and the subjective perception of sleep depth. Also, heart rate was significantly increased in PTSD patients. Interestingly, plasma levels of GH during the night were decreased in PTSD. Furthermore, GH secretion and awakenings were independent predictors for delayed recall, which was lower in PTSD. In our RCT, prazosin was not associated with improvement of any subjective and objective sleep parameters. Only a few RCTs have been published. They show promising results for atypical antipsychotics and prazosin, the latter especially on nightmare reduction. Disturbed sleep due to nightmares increases the risk for PTSD. PTSD in turn leads to increased sleep fragmentation, decreased GH secretion, and frequent nightmares, which may again compromise fear extinction, synaptic plasticity, and recovery. This suggests that disturbed sleep is a precipitating and perpetuating factor in PTSD symptomatology, creating a perpetual circle. This dissertation suggests that activity of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system (SNS) is involved in disturbed sleep in patients with PTSD.
    European Journal of Psychotraumatology 10/2012; 3. DOI:10.3402/ejpt.v3i0.19142 · 2.40 Impact Factor
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