An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder

Phelps, Andrea; Kanaan, Richard A A; Worsnop, Christopher; Redston, Suzy; Ralph, Naomi; Forbes, David

doi:10.1093/sleep/zsx188

Cited by 64 publications

(44 citation statements)

References 22 publications

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“…Such dreams often lead to awakening, in which case they are defined as nightmares. Nightmares are characterized by autonomic arousal, and the nightmares that occur in PTSD, which may emerge from non-REM sleep, as well as REM sleep, is associated with leg movements and/or respiratory events (Phelps et al, 2018). Nightmares are highly deleterious in PTSD, reducing the quality of life (El-Solh, 2018).…”

Section: Discussionmentioning

confidence: 99%

Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats

Grafe

O’Mara

Branch

et al. 2020

Front. Syst. Neurosci.

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Exposure to severe stress has immediate and prolonged neuropsychiatric consequences and increases the risk of developing Posttraumatic Stress Disorder (PTSD). Importantly, PTSD develops in only a subset of individuals after exposure to a traumatic event, with the understanding of this selective vulnerability being very limited. Individuals who go on to develop PTSD after a traumatic experience typically demonstrate sleep disturbances including persistent insomnia and recurrent trauma-related nightmares. We previously established a repeated social defeat paradigm in which rats segregate into either passively or actively coping subpopulations, and we found that this distinction correlates with measures of vulnerability or resilience to stress. In this study, we examined differences between these two behavioral phenotypes in sleep changes resulting from repeated social defeat stress. Our data indicate that, compared to control and actively coping rats, passively coping rats have less slow-wave sleep (SWS) for at least 2 weeks after the end of a series of exposures to social defeat. Furthermore, resilient rats show less exaggerated motor activation at awakenings from rapid eye movement (REM) sleep and less fragmentation of REM sleep compared to control and passively coping rats. Together, these data associate a passive coping strategy in response to repeated social defeat stress with persisting sleep disturbances. Conversely, an active coping strategy may be associated with resilience to sleep disturbances. These findings may have both prognostic and therapeutic applications to stress-associated neuropsychiatric disorders, including PTSD.

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Section: Discussionmentioning

confidence: 99%

Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats

Grafe

O’Mara

Branch

et al. 2020

Front. Syst. Neurosci.

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“…The increase in autonomic activation in the presence of nightmares was even more pronounced when nightmares were compared against neutral dreams within the group of nightmare sufferers. A recent study in PTSD patients found no increase in heart rate within REM periods while experiencing nightmares (Phelps et al, ), but they neither included REM periods of a control group nor compared these REM periods with REM periods without nightmares. Furthermore, investigation of heart rate offers no insight into the pattern of autonomic arousal in terms of sympathetic and parasympathetic influences or differences.…”

Section: Discussionmentioning

confidence: 99%

Nightmares do result in psychophysiological arousal: A multimeasure ambulatory assessment study

et al. 2019

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Individuals who frequently experience nightmares report compromised sleep quality, poor daytime mood, and functioning. Previous research has aimed at linking these impairments with altered sleep architecture, but results were inconclusive. One plausible explanation is that only a few studies recorded markers of autonomic nervous system activity. For the first time, this study collected such markers under ecologically valid conditions with ambulatory assessment. In 19 individuals with frequent nightmares (≥1 nightmare/week) and 19 healthy control participants (<1 nightmare/month), measures indicating autonomic activation (heart rate, heart rate variability, respiration cycle length, electrodermal fluctuations, EEG arousals, saliva cortisol, REM density) were collected while applying ambulatory polysomnographic assessment during 3 consecutive nights. When nightmare participants reported a nightmare, we analyzed the last 5 min of REM sleep before awakening and compared these data to their non‐nightmares as well as to the dream episodes of control participants. Overall, there were no general differences in autonomic activation of nightmare sufferers compared to control participants. However, when nightmare participants experienced nightmares, autonomic activation was markedly increased compared to their own non‐nightmares and, to some extent, to control participant’s dreams. Significant intraindividual differences were found for all autonomic measures except in participant’s EEG arousals and cortisol levels. Group differences were found in EEG arousals and heart rate. In conclusion, ambulatory polysomnography demonstrates that nightmares are accompanied by increased autonomic activation. Results support the notion of impaired self‐reported sleep quality caused by one’s autonomic response rather than altered sleep pattern.

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“… 20 These changes are associated with respiratory or leg movement events and increase in heart rate on awakening. 21 Nonetheless, PSG may be warranted when obstructive sleep apnea is suspected as improvement in sleep quality and nightmares frequency has been reported after continuous positive airway pressure treatment. 22 …”

Section: Approach To Managementmentioning

confidence: 99%

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

El-Solh

2018

NSS

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Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.

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An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder

Abstract: Post-traumatic nightmares of PTSD occur in both REM and non-REM sleep and are commonly associated with other sleep disturbances. These findings have important treatment implications.

Cited by 64 publications

References 22 publications

Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats

Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats

Nightmares do result in psychophysiological arousal: A multimeasure ambulatory assessment study

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

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