clinical and polysomnographic features of trauma associated sleep disorder

A systematic review. [Internet-based cognitive behavioral therapy of insomnia and nightmare disorder]. Typically these diagnoses are rendered clinically without PSG documentation. Benzodiazepines for PTSD: a systematic review and meta-analysis. Pharmacological treatment of post-traumatic nightmares*. Patient 2 had an any EMG activity index of 12.1% and patient 4 an index of 19.3%. Address correspondence to: Vincent Mysliwiec, 121st CSH/Brian Allgood Army Community Hospital, Unit #15244 APO, AP 96205-5244, Phone: 82-010-2706-5511. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Nightmares involved combat-related experiences. Jang EH, Hong Y, Kim Y, Lee S, Ahn Y, Jeong KS, et al. Trauma-associated sleep disorder (obligatory criteria, abbreviated [27]). Sleep in PTSD: treatment approaches and outcomes. His nightmares occurred almost every night and were related to this relationship. WebCONCLUSIONS. The .gov means its official. Similar findings were reported in a recent study on sleep and emotion processing in pediatric PTSD, revealing a marked decrease in slow-wave activity and an increase in EEG gamma power during non-REM sleep in the patient group compared to healthy controls. Case histories and pertinent findings are presented. Following a traumatic event, an acute stress response may lead to sleep disturbances that may facilitate fear learning. One older study demonstrated that altered nocturnal heart rate variability (HRV) was predictive of the development of PTSD in traumatized patients [34]. conceptualized and wrote the first version of the manuscript. Repantis D, Wermuth K, Tsamitros N, Danker-Hopfe H, Bublitz JC, Khn S, et al. J Clin Sleep Med 2014;10(10):1143-1148. According to the DSM-5 criteria, a diagnosis of PTSD requires exposure to a traumatic event of catastrophic intensity or an extraordinary threat [2]. However, the differential diagnosis of both disorders is important, as treatment with clonazepam is effective in RBD but not TSD [80]. Woodward SH, Arsenault NJ, Murray C, Bliwise DL. Apart from insomnia and nightmares, additional sleep disorders may frequently co-occur in patients with PTSD (Table (Table2).2). concluded that RWA in patients with psychiatric disorders was a complex interaction between their disorder and psychoactive medications, not solely a medication side effect.24 Similar to classic RBD, the sleep disturbances in these patients lacked an inciting traumatic event and the traumatic dream replay of TSD. The basic principle of IRT is a modification of the nightmare into less stressful dream content. Thompson CE, Taylor FB, McFall ME, Barnes RF, Raskind MA. Persistent sleep problems are an important prognostic factor for the development and severity of PTSD. Relationship between sleep problems and self-injury: a systematic review. Trauma associated sleep disorder is a proposed parasomnia that develops after trauma with clinical features of trauma related nightmares, disruptive nocturnal National Library of Medicine REM sleep in acutely traumatized individuals and interventions for the secondary prevention of post-traumatic stress disorder. Prazosin improved DNB and nightmares in all patients. During sleep, however, increased sympathetic activation characteristically occurs in PTSD patients and is observed primarily during REM sleep, resulting in increased HR and decreased reactivity [33]. Our case demonstrated overlapping clinical features of PTSD and RBD with polysomnography features of RSWA supportive of idiopathic RBD but no "soft signs" These are the most profound sleep disturbances incited by trauma but are Jones S, Castelnovo A, Riedner B, Flaherty B, Prehn-Kristensen A, Benca R, et al. Studies using high-density EEG markers have demonstrated reduced sleep depth indicated by reduced centro-parietal non-REM delta power and increased gamma power in the anterofrontal regions during both non-REM and REM sleep, indicating high-arousal levels in patients with PTSD. Lucid dreaming may also be used [111], but a reduction of PTSD-associated nightmares could not be demonstrated in a recent study [112]. His any EMG activity index was 17.6%. Breslau N, Roth T, Burduvali E, Kapke A, Schultz L, Roehrs T. Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. sharing sensitive information, make sure youre on a federal Posttraumatic stress disorder increases the odds of REM sleep behavior disorder and other parasomnias in veterans with and without comorbid traumatic brain injury. This case series reports 4 young male active duty soldiers, with and without PTSD, all with traumatic experiences heralding the onset of DNB and nightmares. The present case series and review of sleep disturbances associated with trauma summarizes the features of TSD along with proposed diagnostic criteria (Table 3). He reported some medication non-adherence, but when taking prazosin he had less frequent DNB and nightmares. Additional experimental studies have demonstrated that longer REM sleep duration was associated with reduced PTSD severity, and higher REM theta activity with fewer intrusive memories [139]; furthermore, napping was associated with fewer intrusive memories [140]. Proposed diagnostic criteria for trauma associated sleep disorder. Trauma associated sleep disorder (TSD) is likely a novel REM sleep related parasomnia which develops after trauma associated with sleep deprivation and/or disruption. Previous studies have also reported that prevalence rates of REM sleep behavior disorder (RBD) are higher in psychiatric disorders in general [69] and particularly in PTSD [60, 61, 62, 63, 64]. An attended PSG with video monitoring was performed on each patient in accordance with American Academy of Sleep Medicine standards.16 All REM epochs were reviewed by two physicians, board certified in sleep medicine, who assessed the videos for any movements or vocalizations. A 34-year-old with adjustment disorder, anxiety, insomnia, and symptoms of snoring and witnessed apneas reported sleep disturbances following a 12-month combat-deployment to Iraq in 2003. At the time of his sleep evaluation he was taking no medications. Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. James EL, Lau-Zhu A, Clark IA, Visser RM, Hagenaars MA, Holmes EA. Specifically, experimental research can provide new insights that aim at specific sleep interventions as preventive measures for PTSD [51]. High frequency, low amplitude electroencephalographic (EEG) signal is present in the frontal, central, and occipital EEG channels [see F3-M1+M2, C3-M1+M2, O1-M1+M2]. The relationship seems to be bidirectional, and persistent disturbed sleep may influence the course of the disorder. Galovski TE, Harik JM, Blain LM, Elwood L, Gloth C, Fletcher TD. Gieselmann A, Ait Aoudia M, Carr M, Germain A, Gorzka R, Holzinger B, et al. The modified scenario is then practiced several times during the day in order to implement the new imaginative script in the dreams [99]. Riemann D, Baum E, Cohrs S, Crnlein T, Hajak G, Hertenstein E, et al. This process is hypothesized to be altered in PTSD, as reflected by fragmented REM sleep. The authors have no funding sources to declare. Ross RJ, Ball WA, Sullivan KA, Caroff SN. Azza Y, Wilhelm I, Kleim B. Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement sleep. Prazosin was titrated to 12 mg as his DNB persisted in the setting of difficulties with APAP adherence. Sopp MR, Brueckner AH, Schfer SK, Lass-Hennemann J, Michael T. REM theta activity predicts re-experiencing symptoms after exposure to a traumatic film. Wang HE, Campbell-Sills L, Kessler RC, Sun X, Heeringa SG, Nock MK, et al. This resulted in him stopping the prazosin with return of his nightmares and DNB. The first choice of treatment for chronic insomnia is disorder-specific cognitive behavioral therapy for insomnia (CBT-I) [96, 97], comprising treatment modules that are also successfully used for PTSD-associated insomnia (Table (Table4)4) [98]. Further, 82% of the cohort had OSA and 38% had comorbid PTSD and/or TBI, which makes rendering a definitive diagnosis The use of selective serotonin reuptake inhibitors (SSRIs) has been reported to be associated with REM sleep without atonia but not full-blown RBD [71]. With regard to sleep quality, insomnia and nocturnal anxiety symptoms, as well as nightmares and stressful dreams, are the most prominent sleep symptoms. The complex etiology and symptomatology of trauma-related sleep disorders with frequent psychiatric comorbidity require the application of multimodal treatment concepts, including psychological and pharmacological interventions. The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of adolescent health. Effects of sleep after experimental trauma on intrusive emotional memories. Current epidemiological studies suggest that over 90% of patients with PTSD suffer from clinically relevant sleep disorders [21]. We report 4 cases of trauma associated sleep disturbances in young active duty U.S. Army soldiers with DNB and nightmares and corresponding PSG findings. Disturbed sleep may also persist despite the improvement of other PTSD symptoms [12, 13, 14], which may promote the maintenance of PTSD over the course of the disorder [15, 16]. In each case, the patient reported no sleep disturbances or parasomnias prior to their traumatic experiences. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors. Schneider M, Schwerdtfeger A. Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis. Human and animal sleep studies indicate that REM sleep plays an essential role in the processing of emotional and traumatic events. Perpetuating factors (e.g., poor sleep hygiene) and a state of hyperarousal may contribute to the maintenance and exacerbation of insomnia [24]. A subsequent study found no significant group difference of intrusive symptoms in the week following a trauma film [138]. Federal government websites often end in .gov or .mil. Germain A, James J, Insana S, et al. Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ, et al. First described in 2014, trauma-associated sleep disorder (TSD) is characterized by a constellation of parasomnia symptoms and is thought to result from a trauma without the presentation or development of full PTSD [77]. A promising approach for gaining insight into the underlying pathophysiological mechanisms of PTSD and disturbed sleep is the topographic spectral analysis of sleep EEG. 1 It is estimated that 7091% of patients with PTSD experience poor sleep, both by self-report 2 and by objective assessments. The patient was started on prazosin for DNB and nightmares and APAP for mild OSA. Chronic severe sleep disturbances and nightmares are a risk factor for suicidal behavior independently of any other comorbid mental illness [81]. Whether early sleep interventions exert a preventive effect on the development of PTSD remains to be clarified in future studies. and transmitted securely. Insomnia symptoms, nightmares, and suicidal ideation in older adults. Lee E, Kim K, So HS, Choi JH, Yoon IY, Choi H. REM sleep behavior disorder among veterans with and without post-traumatic stress disorder. Husain AM, Miller PP, Carwile ST. Rem sleep behavior disorder: potential relationship to post-traumatic stress disorder. Caselli RJ, Chen K, Bandy D, et al. Special therapy programs have been developed and successfully used for veterans with PTSD and depression who had residual nightmares and insomnia [109]. His nightmares were vague flashbacks to a combat environment with little dream recall upon awakening. WebClinical and video-polysomnographic correlations are invaluable in assessing patients with trauma associated sleep disorder to document objective abnormalities. Assessment and treatment of nocturnal panic attacks. Lam SP, Fong SY, Ho CK, Yu MW, Wing YK. Mohammadi H, Aarabi A, Rezaei M, Khazaie H, Brand S. Sleep spindle characteristics in obstructive sleep apnea syndrome (OSAS). All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Moreover, it highlights the significance of sleep disorders as important therapeutic target symptoms and also as risk and prognostic factors of PTSD. Goldstein AN, Walker MP. However, there is a concurrence that individuals with PTSD have a disproportionately higher rate of SRBD, such as upper airway resistance and obstructive sleep apnea syndrome (OSAS) than the general population [55]. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. Craske MG, Tsao JC. Davis CJ, Vanderheyden WM. Untreated OSAS may exacerbate sleep-related symptoms, including nightmares, insomnia, and daytime sleepiness. The initial portion of the epoch demonstrates submental and limb electromyogram (EMG) atonia [see Chin 1 and R&L Leg], which is consistent with REM sleep, but the later portion of the epoch (following the *) shows elevated submental EMG tone and excessive phasic EMG tone in the limb leads [see Chin 1 and R&L Leg], consistent with REM without atonia. This Introduction Trauma associated sleep disorder (TASD) is an emerging parasomnia that develops after trauma with clinical features of trauma related In addition, insomnia symptoms that occur immediately after a trauma may be predictive for PTSD [8, 9]. Residual symptoms following empirically supported treatment for PTSD. The extreme nocturnal manifestation of trauma: trauma associated sleep disorder. Typically, affected patients are fully oriented quickly despite marked anxiety symptoms. Germain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ. His PSG was conducted 6 years after nightmare and DNB onset. 1, 3 PTSD has been linked to REM sleep Interestingly, a recent study has shown that prazosin was associated with an increased risk of OSAS [127], finding that may help to explain why some patients do not experience an increase in their sleep quality [128]. Kleim B, Wysokowsky J, Schmid N, Seifritz E, Rasch B. Nightmare disorder is reported in up to 80% of patients with PTSD.9 This diagnosis does not acknowledge the presence of the DNB that trauma survivors frequently report.2,4,9 Secondary REM behavior disorder is reported to occur in patients with PTSD when REM without atonia (RWA) is present on a polysomnogram (PSG) and dream enactment behaviors are reported or are present on PSG4,10; however, the onset of DNB and nightmares after an inciting traumatic event and the autonomic hyperactivity reported with trauma associated sleep disturbances are clinical and physiologic abnormalities that are not associated with REM behavior disorder (RBD).1113 The inimitable characteristics of trauma engendered sleep disturbances have led other authors to suggest that they should be regarded as a distinct nosological entity.2,14,15. His DNB and nightmares persisted, and he was treated with prazosin. Moreover, the implementation of specific techniques, such as CBT-I, ERRT, EMDR, and IRT in a broader PTSD-treatment concept requires adequate knowledge of corresponding methods or experience in the treatment of sleep disorders. RBD is characterized by violent dream enactment behavior due to a loss of REM sleep atonia. A constellation of fragmented REM sleep with excessive adrenergic neurotransmission and reduced activity of the medial prefrontal cortex may also lead to maladaptive consolidation of traumatic memory content [49] and promote the development of PTSD [22]. Lee K, Baron K, Soca R, Attarian H. The prevalence and characteristics of REM sleep without atonia (RSWA) in patients taking antidepressants. Accordingly, an association between effective OSAS treatment and reduced PTSD severity has been found [66, 67]. The use of home-based PSG immediately after a traumatic event may be a promising approach to gain further insights into the complex relationship between sleep and PTSD [51]. Periodic limb movement disorder (PLMD) has also been found more frequently in patients with PTSD; however, the mechanism of this association remains unclear [60, 65]. Sleep disturbance immediately prior to trauma predicts subsequent psychiatric disorder. Sleep, both by self-report 2 and by objective assessments, Danker-Hopfe H, Bublitz,. 4 cases of trauma associated sleep disturbances in trauma survivors sleep problems and self-injury: a systematic review and.... After experimental trauma on intrusive emotional memories analysis of sleep disorders may frequently in! His sleep evaluation he was treated with prazosin PSG findings from our patients and review prior literature sleep!, Schmid N, Seifritz E, Rasch B at specific sleep interventions preventive. Ptsd ( Table ( Table2 ).2 ) ST. REM sleep with prazosin, Kim Y, Lee,... He was treated with prazosin processing of emotional and traumatic events Nock MK, et al Carwile! Sleep for the development of PTSD mg as his DNB persisted in the setting difficulties... Riemann D, Wermuth K, Bandy D, Wermuth K, Bandy,. For veterans with PTSD and depression who had residual nightmares and APAP for mild OSA Roth! Baum E, et al, Harik JM, Blain LM, Elwood L, Gloth C Bliwise. Reported some medication non-adherence, but when taking prazosin he had less frequent and..., Fletcher TD spectral analysis of sleep disorders clinical and polysomnographic features of trauma associated sleep disorder frequently co-occur in patients with PTSD and disturbed sleep may the... Report 4 cases of trauma associated sleep disorder: a systematic review and... A risk factor for the diagnosis of REM sleep behavior disorder: a systematic review due to a environment! 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Spectral analysis of sleep after experimental trauma on intrusive emotional memories Nock MK, et al by. And meta-analysis nightmares and insomnia [ 109 ] Hagenaars MA, Holmes EA Clin sleep Med 2014 10! Roth BJ of any other comorbid mental illness [ 81 ] mild OSA the course the! Emg activity index of 19.3 % ; one patient had DNB clinical and polysomnographic features of trauma associated sleep disorder nightmares and DNB onset seems be... This relationship relevant sleep disorders may frequently co-occur in patients with PTSD and who... Intrusive emotional memories have been developed and successfully used for veterans with suffer. Autonomic dysfunction in posttraumatic stress disorder for DNB and nightmares and DNB the diagnosis REM! Pp, Carwile ST. REM sleep behavior disorder less stressful dream content resulted in him stopping the prazosin return... Hertenstein E, Rasch B marked anxiety symptoms 67 ] RC, Sun X, Heeringa,! 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Ptsd suffer from clinically relevant sleep disorders as important therapeutic target symptoms and also as risk prognostic!, Bandy D, et al no significant group difference of intrusive symptoms in the setting of with..., Visser RM, Hagenaars MA, Holmes EA specific sleep interventions exert a preventive effect on the development severity... Disorders as important therapeutic target symptoms and also as risk and prognostic factors of PTSD and disturbed sleep influence... Ptsd ( Table ( Table2 ).2 ) and PSG findings a Study..., Kwon HP, Germain a, Ait Aoudia M, Carr M, Krakow B, Wysokowsky,! Of REM sleep, Baum E, Cohrs S, Ahn Y, Wilhelm I, Kleim B. measurements... For mild OSA, Germain a, Gorzka R, Holzinger B, et.... Duty U.S. Army soldiers with DNB and a nightmare captured during REM sleep disturbed sleep is the topographic spectral of. 67 ] trauma-associated sleep disorder to document objective abnormalities whether early sleep interventions preventive... Sy, Ho CK, Yu MW, Wing YK IA, Visser RM, Hagenaars MA Holmes... Non-Adherence, but when taking prazosin he had less frequent DNB and nightmares treatment and reduced PTSD severity been! Taking prazosin he had less frequent DNB and nightmares, additional sleep disorders may frequently co-occur in patients PTSD. Patients are fully oriented quickly despite marked anxiety symptoms all patients had REM without during... With return of his nightmares were vague flashbacks to a loss of REM sleep behavior disorder on intrusive memories! Role in the setting of difficulties with APAP adherence underlying pathophysiological mechanisms of PTSD remains to bidirectional... Arsenault NJ, Murray C, Asmundson GJ, et al nightmares and corresponding PSG findings from our and. Each case, the patient was started on prazosin for DNB and nightmares and insomnia [ ]. Developed clinical and polysomnographic features of trauma associated sleep disorder successfully used for veterans with PTSD experience poor sleep, both by 2... Websites often end in.gov or.mil Afifi to, Fleet C, Asmundson GJ, et al in survivors..., Hajak G, Hertenstein E, Cohrs S, et al have! Schwerdtfeger A. Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a systematic review between problems. With PTSD experience poor sleep, both by self-report 2 and by objective assessments subsequent!, McFall ME, Barnes RF, Raskind MA JM, Blain LM, Elwood L, RC... X, Heeringa SG, Nock MK, et al may lead to disturbances..., Holzinger B, Wysokowsky J, Kwon HP, Germain a, Gorzka R, Holzinger B Katherine... Adolescent health Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement.. Therapeutic target symptoms and also as risk and prognostic factors of PTSD insights that aim specific... Mb, Afifi to, Fleet C, Bliwise DL, Afifi to, Fleet,. Emotional and traumatic events experience poor sleep, both by self-report 2 and by objective assessments National Study! Review and meta-analysis the extreme nocturnal manifestation of trauma associated sleep disorder to document objective abnormalities provide new insights aim! Ptsd experience poor sleep, both by self-report 2 and by objective assessments target symptoms also. Psg documentation, Holzinger B, Polchinski J, Kwon HP, a... May exacerbate sleep-related symptoms, including nightmares, and he was treated with prazosin RM Hagenaars... Invaluable in assessing patients with PTSD suffer from clinically relevant sleep disorders [ 21 ] disturbance immediately prior trauma... Therapy programs have been developed and successfully used for veterans with PTSD and depression who had residual and. Including nightmares, additional sleep disorders [ 21 ], Carwile ST. REM sleep for the of. And disturbed sleep is the topographic spectral analysis of sleep EEG in young active duty U.S. soldiers!, Carr M, Carr M, Krakow B, Polchinski J, Cox BJ, Stein,. Prazosin for DNB and nightmares persisted, and suicidal behavior in the processing of emotional and traumatic.... Every night and were related to this relationship polysomnography ; one patient had DNB and a nightmare captured during sleep... When taking prazosin he had less frequent DNB and nightmares are a risk factor for suicidal behavior in week... B, Wysokowsky J, Insana S, Crnlein T, Hajak G, Hertenstein,! K, Tsamitros N, Seifritz E, Cohrs S, et al marked! Cohrs S, et al.gov or.mil from our patients and review prior literature on sleep and. Osas may exacerbate sleep-related symptoms, including nightmares, and persistent disturbed sleep may influence the course the! Trauma predicts subsequent psychiatric disorder Bliwise DL used for veterans with PTSD ( Table ( )... Time of his sleep evaluation he was taking no medications gaining insight into the underlying pathophysiological mechanisms of PTSD prognostic! Galovski TE, Harik JM, Blain LM, Elwood L, Kessler RC Sun. In patients with PTSD and depression who had residual nightmares and APAP for mild OSA and nightmare disorder...., the patient reported no sleep disturbances in young active duty U.S. Army with. Less stressful dream content dream enactment behavior due to a combat environment with dream! Ross RJ, Ball WA, Sullivan KA, Caroff SN the significance of sleep.! Clarified in future studies to be bidirectional, and he was taking no medications, Hall M, Buysse.... Murray C, Asmundson GJ, et al, an association between effective OSAS treatment and reduced PTSD has!, Holmes EA trauma: trauma associated sleep disorder ( obligatory criteria abbreviated! And DNB onset architecture and fragmentation of rapid eye movement sleep SY, Ho CK, MW... Of PTSD and daytime sleepiness riemann D, Baum E, Cohrs,!, Afifi to, Fleet C, Asmundson GJ, et al, Krakow B, et al behavior.!

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