Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach

Abstract

Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.

REM disruption and REM Vagal Activity Predict Extinction Recall in Trauma-Exposed Individuals

“…The PSG data analyzed in the present study were recorded during the consolidation night. For regression analyses, we selected the REM measures that have been associated with PTSD, including %REM (Zhang et al 2019), REM density (REMD) (Kobayashi et al 2007), REM latency (REML) (Mellman et al 2014), and REM fragmentation (REMF) (Breslau et al 2004; Habukawa et al 2018; Insana et al 2012; Lipinska and Thomas 2019; Mellman et al 2002; Saguin et al 2021). Percent time spent in each sleep stage (%N1-N3, %REM) was computed as a percentage of total sleep time (TST).…”

The influence of sleep on fear extinction in trauma-related disorders

“…Sleep disorders preceding trauma exposure also elevate risk of PTSD following trauma exposure as has been strikingly illustrated by prospective studies that evaluated military service members pre- and post-deployment. Pre-deployment short sleep, insomnia symptoms and nightmares have been shown to significantly increase the risk of developing PTSD post-deployment ( Gehrman et al., 2013 ; Koffel et al., 2013 ; Saguin et al., 2021 ; van Liempt, 2012 ; van Liempt et al., 2013 ; Wang et al., 2018 ; Wright et al., 2011 ). This finding in military PTSD has recently also been shown in civilians following MVAs ( Neylan et al., 2021 ).…”

“…Sleep biomarkers that might predict development of PTSS or, conversely, predict resilience are of particular clinical interest. REM fragmentation has been frequently suggested to be a key acute posttraumatic symptom that predisposes individuals to PTSD/PTSS ( Colvonen et al., 2019 ; Saguin et al., 2021 ). This abnormality may be an acute symptom transiently present in the weeks post-trauma that normalizes in chronic PTSD ( Mellman et al., 2014 ).…”

Translation, Cross-Cultural Adaptation and Preliminary Validation of a French Version of the Trauma-Related Nightmare Survey (TRNS-FR) in a PTSD Veteran Population

“… 2 There is considerable evidence to suggest a dynamic relationship between TRNs, sleep disturbances, and the onset and chronicity of PTSD. 3 This is why some authors claim that sleep disturbances are the hallmark of the disease. 2 …”

“… 6 Trauma-related nightmares cause a vicious circle inducing sleep fragmentation, hypervigilance, and stress. 3 Post-traumatic stress disorder patients also develop poor sleep habits because of the fear of sleep and the resulting sleep fragmentation is responsible for other comorbidities such as obstructive sleep apnea 7 and substance use disorder. 8 Given that TRNs appear to be a predictive factor for PTSD severity and evolution, 9–11 it would be helpful to differentiate TRNs and idiopathic nightmares on the basis of their intrinsic characteristics (frequency, intensity, content, and degree of replicability with respect to the original trauma).…”