Sleep Disturbances in the Wake of Traumatic Events

Lavie, Peretz

doi:10.1056/nejmra012893

Cited by 328 publications

(257 citation statements)

References 84 publications

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“…This is suggested by the presence of several sleep-related hyperarousal symptoms, including increased awakenings, wake after sleep onset and insomnia, as well as nightmares in stages other than REM sleep and at times other than the habitual last third of the night, for example, Stage 2 nightmares occurring early in the sleep episode (van der Kolk et al, 1984). It is also suggested by the expression of motor activity in sleep, including more frequent REM-related twitches in leg muscles, more periodic leg movements in sleep in all stages, more frequent gross body movements, and more REM-related motor activity and vocalizations (Lavie, 2001). Hefez, Metz, and Lavie (1987) reported that explosive motor activity could be elicited from any stage of sleep in a patient with war-related PTSD.…”

Section: Pathogenic Changes In Posttraumatic Nightmaresmentioning

confidence: 99%

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Levin

Nielsen

2007

Psychological Bulletin

527

557

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Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion.Keywords: nightmares, distress, neurophysiology of fear memory, posttraumatic stress disorder, psychopathology Nightmares are the most common form of disturbed dreaming. Vivid, with emotions escalating at times to the brink of terror, they are manifestations of the dramatic autonomic and cognitive fluctuations that can arise during rapid eye movement (REM) sleep and, under certain circumstances, during Stage 2 sleep. Nightmares can be simple and benign or so emotionally severe that they beg for comparison with psychotic episodes (C. Fisher, Byrne, Edwards, & Kahn, 1970;Hartmann, 1984;Sullivan, 1962). Occasional nightmares are almost ubiquitous in the general population. However, frequent distressing nightmares are more common than generally thought, affecting 4%-10% of individuals by conservative estimates. Nightmares are also extremely common following trauma exposure. Posttraumatic nightmares may depict traumarelated content and, in cases of chronic posttraumatic stress disorder (PTSD), may at times replicate the trauma with great distress (for review, see Mellman & Pigeon, 2005).There has been a proliferation of experimental work on posttraumatic and nontraumatic nightmares in the past 15 years, the vast majority of which has examined the psychopathological correlates of individuals with frequent nightmares. Furthermore, recent advances in neuroscience have greatly expanded our understanding of dreaming and related brain functions (Maquet, 2000;Maquet et al., 2000) as well as the pathogenic mechanisms implicated in fear conditioning and the development of PTSD (LeDoux, 2000;Ohman & Mineka, 2001). However, despite the clear implications of these developments for understanding nightmares, there are still no comprehensive models of nightmare etiology and no conceptual frameworks for understanding the link between posttraumatic and nontraumatic nightm...

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Section: Pathogenic Changes In Posttraumatic Nightmaresmentioning

confidence: 99%

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Levin

Nielsen

2007

Psychological Bulletin

527

557

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“…All but a few of the studies are focused on the chronic phase of the disorder and many include only male war veterans. These studies have been mixed in terms of finding objective indices of impaired sleep initiation and maintenance (43)(44).…”

Section: Sleep In Posttraumatic Stress Disordermentioning

confidence: 99%

Sleep and Anxiety Disorders

Mellman

2008

Sleep Medicine Clinics

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“…[18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%.…”

Section: Introductionmentioning

confidence: 99%

Nightmares in United States Military Personnel With Sleep Disturbances

Creamer

Brock

Matsangas

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes I NTRO DUCTI O NNightmares are defined by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. 1 Occasional nightmares are part of a normal adaptive response to life stressors and are not pathologic, with 85% of adults reporting at least one nightmare per year. 2 The prevalence of clinically significant nightmares, which occur at least once per week, is estimated between 0.9% and 6.8%. [3][4][5][6][7][8][9] In the largest study to date (69,813 adults), the prevalence of nightmares was 3.5% in men and 4.8% in women. 10 Participants from the World War II generation had a significantly higher prevalence of 7.2% in men and 7% in women. Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%. 22,23 Addressing nightmares as a distinct sleep disorder following a BRIEF SUMMARY Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nig...

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Sleep Disturbances in the Wake of Traumatic Events

Cited by 328 publications

References 84 publications

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model.

Sleep and Anxiety Disorders

Nightmares in United States Military Personnel With Sleep Disturbances

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