Sleep Disorders in Patients With Posttraumatic Stress Disorder.
Ali A El-Solh, Usman Riaz, Jasmine Roberts
Chest August 2018 DOI: 10.1016/j.chest.2018.04.007 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Interventions | Cognitive behavioral therapy Hypnotic agents Imagery rehearsal therapy Noradrenergic blocking agents |
| Topics | PTSD |
| Keywords | Insomnia Nightmares Posttraumatic sleep apnea Sleep-disordered breathing Stress disorder |
| Key findings | Argues that sleep disturbances are bidirectionally linked to PTSD and complicate recovery, and that no single treatment has been reliably successful. Imagery rehearsal therapy reduced nightmare intensity and frequency; noradrenergic blocking agents were inconsistent, with one-half of studies reporting treatment failure. The authors propose an integrated stepped care approach combining behavioral and pharmacologic interventions tailored to patients' sleep behaviors. |
Abstract
A growing body of evidence supports a bidirectional relationship between posttraumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments, including psychotherapeutic and pharmacologic interventions, as it relates to PTSD. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable; however, adherence to CPAP therapy presents a substantial challenge. Concomitant insomnia, which engenders psychiatric and medical conditions, including depression, suicide, and alcohol and substance abuse, can be managed with cognitive behavioral therapy. Hypnotic agents are considered an alternative therapy, but concerns about adverse events and lack of high-level evidence supporting their efficacy in PTSD treatment have limited their use to resistant cases or as adjuncts to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational, and marital relations. Imagery rehearsal therapy has shown significant reduction in nightmare intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies, with one-half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients' sleep-maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD.
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 3
- The Psychedelic Future of Post-Traumatic Stress Disorder Treatment Current Neuropharmacology January 5, 2024
- Changes in dreams - the development of a dream-transformation scale in psychoanalyses with chronically depressed, early traumatized patients The Scandinavian Psychoanalytic Review July 3, 2023
- Rêves et cauchemars sont-ils de nouveaux outils en thérapie cognitivo-comportementale ? Journal de Thérapie Comportementale et Cognitive September 1, 2019
Cites 12
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- The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology January 2015
and 7 more in the library