Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients.
Peretz Lavie, N Katz, Giora Pillar, Y Zinger
Biological Psychiatry November 15, 1998 DOI: 10.1016/s0006-3223(98)00037-7 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational case-control study Peer reviewed |
|---|---|
| Sample size | 24 |
| Population | 12 patients with chronic war-related PTSD and 12 controls |
| Duration | 4 nights of polysomnographic recordings; awakening thresholds determined during 1 night; dreams collected during 2 nights |
| Measures | Zung Depression Scale, Beck Depression Scale, Impact of Events Scale, State and Trait Anxiety, Symptom Check List questionnaires |
| Topics | PTSD |
| Key findings | PTSD patients had significantly higher awakening thresholds to clicks than controls, despite no significant group differences in sleep data, and thresholds were positively related to depression and anxiety scores. Patients' dreams were significantly more aggressive and hostile, with explicit war-related content in 6 patients, and clinical severity was related to dream aggression-hostility scores and sleep quality variables. |
Abstract
Sleep disturbances are one of the hallmarks of posttraumatic stress disorder (PTSD); however, sleep laboratory studies have provided inconsistent evidence of the existence of objective sleep disturbances in PTSD patients. Reports that awaking thresholds from sleep in war-related PTSD patients were significantly elevated compared to normals are discordant with complaints of insomnia. The present study investigated the relationship between awaking threshold from REM sleep in war-related PTSD patients and their dream recall, dream content, and clinical condition. After informed consent was obtained from 12 PTSD patients and 12 controls, they were investigated by polysomnographic recordings for 4 nights. Awaking thresholds to clicks were determined during 1 night, and dreams were collected during 2 nights. Patients' symptoms were assessed by the Zung and Beck depression scales, Impact of Events Scale, State and Trait Anxiety, and Symptom Check List questionnaires. Although there were no significant differences between sleep data of patients and controls, PTSD patients had significantly higher awaking thresholds. Awaking thresholds were significantly positively related to depression and anxiety scores. Patients' dreams were significantly more aggressive and hostile, and in 6 patients they included explicit war-related contents. The severity of the clinical picture was significantly related to the dreams' scores of aggression-hostility, and to sleep quality variables. Elevated awaking thresholds from sleep are a characteristic finding in chronic war-related PTSD patients, which may help to explain the diverse sleep laboratory findings in this syndrome.
Comparable studies
Other observational and cohort studies on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault | 2008 | Observational cohort | n = 6 |
| An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... | 2017 | Observational study using ambulatory polysomnography | n = 35 |
| Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares | 2004 | Observational cohort | n = 44 |
| Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs | 2001 | Observational study | |
| Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD | 2018 | Retrospective review | n = 37 |
Citations in the library
Cited by 5
- Correlates and Treatments of Nightmares in Adults. Sleep Medicine Clinics December 1, 2009
- Dreaming in posttraumatic stress disorder: A critical review of phenomenology, psychophysiology and treatment. Psychotherapy and Psychosomatics 2007
- Nightmares: from anxiety symptom to sleep disorder. Sleep Medicine Reviews February 1, 2006
- Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs 2006
- Post-traumatic stress disorder and sleep-what a nightmare! Sleep Medicine Reviews April 2000