Sleep and Dreaming in Posttraumatic Stress Disorder

Abstract

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.

Posttraumatic Stress Disorder Severity and Insomnia‐Related Sleep Disturbances: Longitudinal Associations in a Large, Gender‐Balanced Cohort of Combat‐Exposed Veterans

“…In our study, we observed similarly high rates of insomnia and nonrestorative sleep complaints in male and female, combat-exposed veterans with PTSD. Regarding the temporal association between sleep disturbance and PTSD severity, studies have supported similar effects of sleep disturbance on PTSD symptomatology, as reported in the current study in both civilian and military populations (Breslau et al, 2004;Miller et al, 2017). It has also been proposed that treating sleep problems directly is beneficial for both civilians and military populations with PTSD (Brownlow, Harb & Ross, 2016;Koffel et al, 2016).…”

“…Previous studies have failed to adequately address the role of gender in PTSD-related sleep disturbances (Koffel et al, 2016;Miller et al, 2017), although some authors have proposed that female veterans with PTSD may have increased susceptibility to sleep difficulties in light of higher rates of insomnia generally in women (Cox et al, 2017;Miller et al, 2017), although evidence for this hypothesis has been scant. In our study, we observed similarly high rates of insomnia and nonrestorative sleep complaints in male and female, combat-exposed veterans with PTSD.…”

“…From a neurobiological perspective, it has been proposed that chronic sleep loss can lead to emotional dysregulation (Koffel et al, 2016) or heightened autonomic arousal (Miller et al, 2017), which in turn may be a risk factor for PTSD in trauma-exposed individuals (Cox et al, 2017). It has also been proposed that prior sleep disturbance may attenuate the effects of extinction learning, leading to more enduring or severe symptoms in trauma-exposed individuals with concomitant sleep disorders (Brownlow, Harb & Ross, 2015;Miller et al, 2017).…”

“…Despite these clinically important findings, further understanding of the association between disturbed sleep and PTSD severity or progression has been hampered by several conceptual and methodological challenges. First, some authors have noted that because sleep difficulties are intrinsic to the diagnosis of PTSD in both the fourth and fifth editions of the respectively), separating the effects of disturbed sleep from other PTSD symptoms is necessarily challenging (Cox, Tuck, & Oltunji, 2017;Miller, Brownlow, Woodward & Gehrman, 2017). Moreover, given the prominent role of depression, traumatic brain injury (TBI), and other prevalent comorbidities in combat-exposed veterans (Green et al, 2016;Holowka et al, 2014;Rosen et al, 2012) and the significant risk for both PTSD and sleep disturbance associated with each of these comorbidities (Kessler et al, 2011;Sarsour et al, 2010), the role of comorbidities may be central to understanding the association.…”

“…This is a key omission as women in the general population have a higher risk for insomnia-related sleep complaints (Sarsour et al, 2010) and higher rates of prescription drug use for insomnia than men (Bertisch et al, 2014;Kessler et al, 2011). Fourth, few data are available concerning the longitudinal association between sleep disturbance and PTSD severity in military populations (Miller et al, 2017;Pigeon et al, 2013) and whether sleep disturbances predict PTSD outcomes in this population.…”