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Post-traumatic stress disorder and sleep-what a nightmare!

Giora Pillar, Atul Malhotra, Peretz Lavie

Sleep Medicine Reviews April 2000 DOI: 10.1053/smrv.1999.0095 (opens in new tab)

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Characteristics Review Peer reviewed
Topics Dreaming PTSD
Key findings The review argues that although subjective sleep disturbances are characteristic of PTSD, objective sleep laboratory findings are inconsistent, partly because few studies control for comorbid disorders. Proposed REM sleep abnormalities, including anxiety dreams, increased REM density, and decreased dream recall, are not consistently reflected in REM percentage or REM latency; the authors suggest that coexisting pressure toward and inhibition of REM sleep, or comorbid psychiatric conditions, may account for this variability.

Abstract

According to DSM IV criteria, sleep disturbances are incorporated in the definition of post-traumatic stress disorder (PTSD). These include the re-experiencing symptoms (nightmares, criteria B) and a hyperarousal state (difficulty initiating and maintaining sleep, criteria D). PTSD patients commonly complain of sleep disturbances. Moreover, insomnia, restless sleep and trauma-related dreams might be the primary complaint of some patients. However, although subjective sleep disturbances are considered characteristic of PTSD, sleep laboratory studies have provided inconsistent evidence of objective sleep disorders. A variety of sleep architectures and sleep patterns has been reported in PTSD. However, only a few studies have controlled for comorbidities. Thus, uncertainty exists to what extent the sustained complaints of sleep disturbances in chronic PTSD are specifically related to the impact of exposure to traumatic stress, or rather are a consequence of comorbid disorders. Specific changes in REM sleep suggest a pathophysiologic role of REM sleep abnormality in PTSD (e.g. anxiety dreams, increased REM density, exaggerated startle response, decreased dream recall and elevated awakening thresholds from REM sleep). However, again, studies have failed to show consistent changes in percentage of REM sleep or in REM latency. There might be a coexistence of pressure to REM along with inhibitory forces of REM that result in high variability of REM parameters across patients. Alternatively, changes in REM sleep might reflect the effect of comorbid psychiatric disorders that results in inconsistent findings between patients. The current review tries to address these issues based on recent studies carried out in this field.

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

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