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

ArticleinJournal of Traumatic Stress 17(3):257-68 · July 2004with9 Reads
Impact Factor: 2.72 · DOI: 10.1023/B:JOTS.0000029269.29098.67 · Source: PubMed

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.

    • "Previous research has acknowledged a strong relationship between childhood trauma and the development of dissociative symptomatology as a defence mechanism, in which nightmares are considered one of its adaptive coping strategies in trauma (Agargun et al. 2003). One of the most common post-traumatic sleep disturbances are nightmares (Krakow et al. 2004; Langston 2007). They are described as vivid dreams that normally last 4–15 min and end when a person awakes due to the rapid return to full alertness, together with the feelings of fear and anxiety and recalling the dream vividly, which usually leads to sleep disruption or difficulty in returning to sleep (Abdel-Khalek 2010; American Academy of Sleep Medicine 2005; American Psychiatric Association 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this article is to address the issue of nightmares in the deaf population, given that there are no documented studies on this matter to the best of our knowledge. The study of nightmares in the deaf population is of high relevance given their specific characteristics (impossibility of verbalisation) and the lack of studies with this population. Nightmares are dreams of negative content that trigger an awakening associated with a rapid return to a full state of alert and a persistent feeling of anxiety and fear, which may cause significant distress. Various studies show that the deaf population has dreams with more negative imagery and emotions, are more exposed to interpersonal traumas and have higher rates of dissociation, than hearing people. These concepts seem to be connected given that, in the presence of traumatic events, dissociation may act as a defence mechanism and nightmares may operate as an adaptive coping strategy.
    Full-text · Article · Dec 2015 · SpringerPlus
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    • "However, this is a special population , which limits generalizations to typical psychiatric settings. In addition, in one of these studies atypical symptoms included choking or gasping during sleep (Krakow et al., 2004), a symptom that in fact suggests the presence of breathing events. The lack of association between EDS or respiratory events and OSA suggests that the diagnostic criteria of mild OSA in psychiatric patients need further elaboration. "
    [Show abstract] [Hide abstract] ABSTRACT: Psychiatric diseases and symptoms are common among patients with obstructive sleep apnea (OSA). However, only a few studies have examined OSA in psychiatric patients. At the outpatient clinic of the Uusikaupunki Psychiatric Hospital, Finland, we used a low referral threshold to a diagnostic sleep study. An ambulatory cardiorespiratory polygraphy was performed in 114 of 221 patients. 95 patients were referred by the psychiatric clinic and 19 were examined in other clinical settings. We reviewed the medical files and retrospectively assessed the prevalence of OSA and the effect of gender, age, obesity, hypertension, type 2 diabetes, alcohol abuse, and symptoms suggesting OSA. 58 of the 221 patients (26.2%), 30 of 85 men (35.3%) and 28 of 136 women (20.6%), had OSA as determined by an apnea-hypopnea index (AHI) of 5/h or more. 20 patients (12 men and 8 women) had moderate or severe OSA (AHI ≥ 15/h). 46 patients (including 11 patients with moderate or severe OSA) were identified in the psychiatric clinic. In univariate analysis, a high body mass index, male gender, hypertension, snoring, and a history of witnessed apneas during sleep were associated with the presence of OSA. In multivariate analysis, a history of witnessed apneas did not remain significant. Age, type 2 diabetes, alcohol abuse, excessive daytime sleepiness (EDS), and fatigue did not associate with the presence of OSA. Our findings suggest that in psychiatric outpatients OSA is common but underdiagnosed. Presentation is often atypical, since many patients with OSA do not report witnessed apneas or EDS.
    No preview · Article · Sep 2015 · Journal of Psychiatric Research
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    • "Sleep disturbances related to PTSD typically refers to insomnia (both onset and maintenance) and posttraumatic nightmares. Both subjective report and objective data on sleep quality and continuity based on, for example, polysomnography (PSG), suggest that most people with PTSD also suffer from at least 1 form of sleep problem (Germain, 2013; Krakow et al., 2001b; Krakow et al., 2004). Indeed, a meta-analytic review study of 20 PSG studies found that those with PTSD have increased stage 1 (light) sleep and rapid eye movement (REM) density, and decreased slow-wave sleep, compared to those without the diagnosis (Kobayashi, Boarts, & Delahanty, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Sleep disturbances are frequently reported in patients with posttraumatic stress disorder (PTSD). There is evidence that sleep disturbance is not only a secondary symptom but also a risk factor for PTSD. Sleep-specific psychological treatments provide an alternative to conventional trauma-focused psychological treatments. The current meta-analysis evaluated the efficacy of sleep-specific cognitive-behavioral therapy (CBT) in mitigating PTSD, sleep, and depressive symptoms. A total of 11 randomized controlled trials were included in the meta-analytic comparisons between sleep-specific CBT and waiting-list control groups at posttreatment. Random effects models showed significant reduction in self-report PTSD and depressive symptoms and insomnia severity in the sleep-specific CBT group. The corresponding effect sizes, measured in Hedges' g, were 0.58, 0.44, and 1.15, respectively. The effect sizes for sleep diary-derived sleep onset latency, wake after sleep onset, and sleep efficiency were 0.83, 1.02 and 1.15, respectively. The average study attrition rate of sleep-specific CBT was relatively low (12.8%), with no significant difference from the control group (9.4%). In conclusion, sleep-specific CBT appears to be efficacious and feasible in treating PTSD symptoms. Due to the relatively small number of randomized controlled trials available, further research is warranted to confirm its efficacy and acceptability, especially in comparison to trauma-specific psychological treatments.
    Full-text · Article · Sep 2015 · Clinical psychology review
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