The Many Faces of Sleep Disorders in Post-Traumatic Stress Disorder: An Update on Clinical Features and Treatment.
Franziska C Weber, Thomas C. Wetter
Neuropsychobiology September 2, 2021 DOI: 10.1159/000517329 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | PTSD |
| Keywords | Humans Dreams Stress disorders, post-traumatic Sleep wake disorders Sleep disorders Nightmares Trauma-associated sleep disorder |
| Key findings | The authors argue that sleep disorders and nightmares are core, bidirectionally linked features of PTSD, with insomnia, nocturnal anxiety, nightmares, and stressful dreams most prominent and polysomnography showing altered sleep architecture and fragmented REM sleep. They propose multimodal psychological and pharmacological treatment, note limited evidence for long-term drug treatment, and call for PTSD therapies that integrate sleep- and trauma-focused approaches; whether early sleep interventions prevent PTSD remains to be tested. |
Abstract
Sleep disorders and nightmares are core symptoms of post-traumatic stress disorder (PTSD). The relationship seems to be bidirectional, and persistent disturbed sleep may influence the course of the disorder. With regard to sleep quality, insomnia and nocturnal anxiety symptoms, as well as nightmares and stressful dreams, are the most prominent sleep symptoms. Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement sleep. In addition, sleep disorders, such as sleep-related breathing disorders and parasomnias are frequent comorbid conditions. 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. However, there is little empirical evidence on the effectiveness of long-term drug treatment for insomnia and nightmares. For nondrug interventions, challenges arise from the current lack of PTSD-treatment concepts integrating sleep- and trauma-focused therapies. Effective therapy for sleep disturbances may consequently also improve well-being during the day and probably even the course of PTSD. Whether early sleep interventions exert a preventive effect on the development of PTSD remains to be clarified in future studies.
Comparable studies
Other narrative reviews on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic Psychiatry's Brave New World. | 2020 | Review | |
| Reviewing the Potential of Psychedelics for the Treatment of PTSD | 2020 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? | 2018 | Review | |
| Clinical applications of hallucinogens: A review. | 2016 | Review |
Citations in the library
Cited by 5
- Trauma Under Psychedelics: How Psychoactive Substances Impact Trauma Processing bioRxiv Preprint Server March 28, 2024
- Evaluating the Relationship Between Emotion Regulation, Mood and Distressing Dreams Using Daily Sleep Diary Reports in Trauma Survivors Journal of Sleep Research April 3, 2025
- MDMA-Assisted Therapy May Decrease PTSD Symptoms, Dissociation, Depression, and Functional Disability: A Systematic Review and Meta-Analysis Harvard Review of Psychiatry September 8, 2026
- From Insight to Action: How Dreams Foster Self-Reliance Vantage Journal of Thematic Analysis October 31, 2024
- A path model of associations between war-related exposure to trauma, nightmares, fear, insomnia, and posttraumatic stress among Ukrainian students during the Russian invasion. Psychiatry Research October 2023
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- My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? Frontiers in Psychology 2019
- Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder. Frontiers in Psychology 2020
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