Trauma-related nightmares and insomnia, and other sleep disorders, are frequently reported among trauma survivors. The roles of fear of sleep, REM density, and decreased parasympathetic activity are beginning to inform the relationship between trauma exposure and sleep difficulties. Additionally, the potential adaptive role of sleep loss immediately following a traumatic experience is being recognized. Interventions targeting these sleep disturbances show promise in reducing symptoms. Research in understanding the role of sleep on the development, course, and treatment of PTSD is expanding. Longitudinal investigations are needed to further elucidate these relationships and identify treatments most effective in ameliorating symptoms.

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Posttraumatic stress disorder (PTSD) is a trauma-induced debilitating condition, with symptoms that revolve around a declarative memory of a severe stressor. How does the brain process declarative and emotional information of stressors in PTSD? We evaluated the role of NREM sleep spindles in this process after exposure to laboratory stress, in a cohort of human subjects with different levels of PTSD symptoms. Subjects performed two laboratory visits: 1) a stress visit which involved exposure to negatively-valent images in the morning and 2) a control visit. In both visits subjects had a sleep/nap opportunity in the afternoon monitored via electroencephalography (EEG). In the stress visit, self-reported anxiety confirmed elevated stress immediately after stressor exposure (pre-sleep) that decayed to control levels post-sleep. An image recall session took place in the late afternoon. Overall, NREM2 spindle rates were elevated in the stress visit as compared to the control visit. This increase in NREM2 spindle rates, especially over occipital cortex, was significantly greater in subjects with high vs. low PTSD symptoms. However in high-PTSD subjects, NREM2 spindle rates correlated with poorer recall accuracy of stressor images as compared to lower symptomatic individuals while surprisingly correlating with a greater reduction in anxiety levels across sleep. Thus although NREM2 spindles are known to play a role in declarative memory processes, our findings highlight an important role of NREM sleep in favoring sleep-dependent anxiety regulation over memory consolidation after exposure to stressors in PTSD and shed new light on the function of NREM2 spindles in PTSD.

Introduction Animal and human studies indicate that fear conditioning disrupts subsequent sleep, including REM sleep (REMS). REMS is thought to be central to fear information processing. We utilized an afternoon nap protocol to examine the effects of fear-potentiated startle (FPS), a variant of fear conditioning, on subsequent sleep integrity and REMS in trauma-exposed participants with varying levels of PTSD. We also examined the effects of changes in sleep integrity and REMS on subsequent retention and extinction of pre-sleep learning. Methods Participants (N=47) participated in 3 nap visits. The first was an adaptation nap. The second and third nap visits were counterbalanced: a stress-condition nap, during which participants underwent FPS procedures prior to a nap and assessment of retention of fear and safety signal learning and fear extinction after the nap, and a control visit during which participants had a nap opportunity without stressful procedures. Canonical correlation analysis assessed the relationship between FPS responses and change in subsequent sleep relative to a control nap, as well as the relationship between change in sleep from control to stress condition and both subsequent fear and safety learning retention, and subsequent extinction. Results Results demonstrated a relationship between fear learning and change in sleep and supported a relationship between safety signal learning and subsequent REMS, as well as differential conditioning and wake after sleep onset. Sleep did not predict measures of fear retention or extinction. PTSD symptoms did not predict fear learning or sleep measures. Conclusion These findings replicate prior work showing a relationship between safety learning and REMS, suggesting that this is a core mechanism through which stress impacts fear processing. Further research is critical to further understand this effect, and to examine how different aspects of fear learning impact different components of sleep. This study also demonstrates that nap studies can be a valuable approach for studying the stress-sleep relationship. Support (if any) VA Career Development Award to Dr. Richards (5IK2CX000871-05)