trauma nightmares and sleep disturbance

federal government websites often end in .gov or .mil. the site is secure. the https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. nightmares are reported by 19-71% of patients, depending on the severity of their ptsd and their exposure to physical aggression. additionally, recent findings suggest that sleep disordered breathing (sdb) and sleep movement disorders are more common in patients with ptsd than in the general population and that these disorders may contribute to the brief awakenings, insomnia and daytime fatigue in patients with ptsd.




in terms of treatments, ssris are commonly used to treat ptsd, and evidence suggests that they have a small but significant positive effect on sleep disruption. studies of serotonin-potentiating non-ssris suggest that nefazodone and trazodone lead to significant reductions in insomnia and nightmares, whereas cyproheptadine may exacerbate sleep problems in patients with ptsd. additional medications, including zolpidem, buspirone, gabapentin and mirtazapine, have been found to improve sleep in patients with ptsd. in contrast, evidence suggests that benzodiazepines, tcas and maois are not useful for the treatment of ptsd-related sleep disorders, and their adverse effect profiles make further studies unlikely. cognitive behavioural interventions for sleep disruption in patients with ptsd include strategies targeting insomnia and imagery rehearsal therapy (irt) for nightmares. uncontrolled studies of continuous positive airway pressure for sdb in patients with ptsd show that this treatment led to significant decreases in nightmares, insomnia and ptsd symptoms.

this review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. in light of the critical need for effective treatments, the primary goal of this paper is to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on sleep symptoms in ptsd. the treatment group demonstrated significant improvements in difficulty sleeping and hours of sleep per week relative to the control group. this is the only study of behavioral ptsd treatment to include an objective measure of sleep as a primary outcome. nevertheless, nightmares are one of the most frequently reported and distressing ptsd symptoms (nappi et al., 2010a) and, thus, may be a motivator for treatment engagement. demonstrating superiority to a nonspecific placebo is important to establishing efficacy of a treatment in general (borkovec, 1993; schnurr, 2007)and with irt may be more critical given findings indicative of the equivalent potency (relative to imagery rehearsal and with respect to reducing nightmare frequency)of merely recording one’s nightmares (e.g.,(neidhardt et al., 1992). the only study to examine imaginal exposure of nightmare content in isolation compared this technique to a relaxation group and waitlist control (burgess et al., 1998). intent-to-treat analyses revealed significantly greater decreases in frequency and severity of nightmares, sleep problems, ptsd symptoms, and depression in the errt group relative to waitlist immediately following treatment.

despite its wide dissemination and the prominence of sleep disturbance in ptsd, we are aware of only four published studies examining this treatment in a ptsd sample (deviva et al., 2005; germain et al., 2007; krakow et al., 2001; swanson et al., 2009). interestingly, there is yet to be a rct of cbt-i among ptsd patients that has controlled for nonspecific therapy effects and time and none of the studies reviewed here tracked or controlled for participation in alternative treatments. evidence generally did not support the efficacy of either medication for sleep problems in ptsd with the exception of one study demonstrating large and significant reductions in both subjective and objective sleep difficulties for nefazodone(neylan et al., 2003). a trial of add-on topiramate that is both placebo-controlled and employs validated sleep and nightmare assessments is yet to be conducted and a recent clinical practice review described the evidence for topiramate for posttraumatic nightmares as low grade and sparse(aurora et al., 2010). in this class of drugs, prazosin has been studied most extensively and is emerging as the most empirically supported noradrenergic antagonist for treatment of posttraumatic sleep disturbances. although the extent to which effects can be attributed to prazosin (versus the behavioral sleep intervention, time and other confounding variables) are not clear, findings suggest effects of prazosin upon sleep may, in part, promote recovery among veterans with tbi. though benzodiazepines and sedative hypnotics are commonly used in patients with ptsd (harpaz-rotem et al., 2008; mohamed and rosenheck, 2008), few studies have examined the efficacy of benzodiazepines for treatment of sleep disturbance in ptsd. in contrast to nightmares, insomnia appears to continue after evidence-based treatments for ptsd, and this would be consistent with the four-factor model of insomnia (perlis et al., 2005), especially the conditioned arousal component. two major initiatives are needed to address the issues raised in this review regarding the incomplete state of knowledge on how to best treat nightmares and insomnia in ptsd.

how ptsd affects sleep insomnia: an estimated nine in ten people with ptsd suffer from insomnia. nightmares and night terrors: nightmares and sleep disturbances frequently co-occur with posttraumatic stress disorder (ptsd). insomnia and nightmares are viewed as core symptoms of nightmares are reported by 19-71% of patients, depending on the severity of their ptsd and their exposure to physical aggression. objective measures of sleep, childhood trauma and sleep issues, childhood trauma and sleep issues, excessive sleep after emotional trauma, ptsd sleep problems, complex ptsd and insomnia.

more simply, treating sleep disruption in ptsd is important because sleep disorders and nightmares are core symptoms of post-traumatic stress disorder (ptsd). the relationship seems to be bidirectional, and persistent disturbed sleep problems such as insomnia get in the way of processing memories, which increases vulnerability to a traumatic event when it occurs. in, how to sleep with ptsd nightmares, ptsd sleeping on the floor.

When you try to get related information on trauma nightmares and sleep disturbance, you may look for related areas. childhood trauma and sleep issues, excessive sleep after emotional trauma, ptsd sleep problems, complex ptsd and insomnia, how to sleep with ptsd nightmares, ptsd sleeping on the floor.