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PTSD and Sleep

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people after experiencing or witnessing shocking, traumatic, scary, or dangerous events. It is characterized by re-experiencing these events and having intense, disturbing thoughts and feelings.

Sleep Disturbances and PTSD

After experiencing traumatic events it is very common to suffer from some sleep issues and not being able to get a good night’s sleep. Namely, a PTSD patient has an increased risk of suffering from subjective and objective sleep disturbances, insomnia and nightmares, sleep terrors, nocturnal anxiety, sleep avoidance, vocalizations, etc.

Plus, all of the above-mentioned sleep disturbances can also increase symptoms and worsen PTSD. That’s the reason why it is important to keep track of PTSD patients’ sleeping patterns.

Nightmares

Even though nightmares aren’t such a strange thing in general since 85% of the adult population report at least one nightmare a year, when it comes to PTSD patients they are much more common.

Furthermore, the common occurrence of nightmares is also closely connected to having suicidal thoughts which stresses the importance of ‘treating’ nightmares. A combination of medical therapy and behavioral techniques could be one option for treating nightmares. For example, a technique in which patients re-script their nightmares called imagery rehearsal therapy (IRT) can help them unlearn the behavior.

Another option is exposure, re-scripting, and relaxation therapy (ERRT) which combines IRT and CBT (cognitive behavioral therapy). Finally, positive airway pressure (PAP) therapy can also be beneficial for nightmare patients, not only for alleviating obstructive sleep apnea (OSA) symptoms.

Trauma-Associated Sleep Disorder

Trauma-associated sleep disorder is actually a newly introduced parasomnia describing the clinical characteristics of trauma-related nightmares (TRN) in relation to disruptive nocturnal behaviors (DNBs).

Precisely speaking, DNBs feature abnormal movements and vocalizations accompanied by combative behaviors. And, oftentimes DNBs copy nightmare content. Also, these abnormal behaviors result in hyperarousal symptoms such as night sweats, increased heart rate, and quickened breathing.

Patients suffering from a traumatic stress disorder (TSD) should also have their sleeping patterns monitored to determine whether or not the patients have sleep disordered breathing (SDB), insomnia, and OSA.

To treat trauma-associated sleep disorder it is essential that patients get enough sleep, avoid triggers, and promote a safe sleep environment. Other options include a combination of prazosin for nightmares and DNB, behavioral therapy for fighting insomnia, and PAP therapy for obstructive sleep apnea.

Sleep Disordered Breathing

Even though it is not that common as nightmares or insomnia, PTSD patients could suffer from sleep disordered breathing, most commonly in the form of OSA. The reason for this is that experiencing nightmares and suffering from insomnia usually affect the airway and result in upper airway collapsibility and sleep disordered breathing. In general, positive airway pressure (PAP) therapy has proven to be beneficial in treating patients with PTSD and SDB by reducing sleep fragmentation and nightmares.

Insomnia

Finally, insomnia is the most common sleep disorder PTSD patients suffer from and isn’t likely to resolve over time without getting proper treatment. One of the most frequent insomnia treatment options includes cognitive-behavioral therapy (CBT) which not only improves sleep quality but also alleviates daytime PTSD symptoms. Similarly, a mix of CBT and imagery rehearsal therapy (IRT) could improve symptoms in those suffering from comorbid nightmares.

The Bottom Line

In general, patients suffering from post-traumatic stress disorder (PTSD) tend to suffer from different sleep-related issues including the above-mentioned nightmares, trauma-associated sleep disorder, sleep disordered breathing, and insomnia. Also, usual first-line treatments aren’t always helpful which is why these patients should consider a combination of different therapies.

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