Prevalence and correlates of sleep problems in adult Israeli Jews exposed to actual or threatened terrorist or rocket attacks (original) (raw)
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Sleep and posttraumatic stress disorder: a review
Clinical Psychology Review, 2003
Research seeking to establish the relationship between sleep and posttraumatic stress disorder (PTSD) is in its infancy. An empirically supported theory of the relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to critically review this literature, and to draw together the disparate theoretical perspectives that have been proposed to account for the empirical findings. After a brief overview of normal human sleep, the literature specifying the relation between sleep disturbance and PTSD is summarized. This includes studies of the prevalence of sleep disturbance and nightmares, content of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal threshold during sleep, body movement during sleep, and breathing-related sleep disorders. In addition, studies of the treatment of sleep disturbance in individuals with PTSD are reviewed. We conclude that the role of sleep in PTSD is complex, but that it is an important area for further elucidating the nature and treatment of PTSD. Areas for future research are specified. In particular, a priority is to improve the methodology of the research conducted.
Sleep and Combat-Related Post Traumatic Stress Disorder
2018
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Sleep in Lifetime Posttraumatic Stress Disorder
Archives of General Psychiatry, 2004
Background: Sleep complaints are common in posttraumatic stress disorder (PTSD) and are included in the DSM criteria. Polysomnographic studies conducted on small samples of subjects with specific traumas have yielded conflicting results. We therefore evaluated polysomnographic sleep disturbances in PTSD. Methods: A representative cohort of young-adult community residents followed-up for 10 years for exposure to trauma and PTSD was used to select a subset for sleep studies for 2 consecutive nights and the intermediate day. Subjects were selected from a large health maintenance organization and are representative of the geographic area except for the extremes of the socioeconomic status range. The subset for the sleep study was selected from the 10year follow-up of the cohort (n = 913 [91% of the initial sample]). Eligibility criteria included (1) subjects exposed to trauma during the preceding 5 years; (2) others who met PTSD criteria; and (3) a randomly preselected subsample. Of 439 eligible subjects, 292 (66.5%) participated, including 71 with lifetime PTSD. Main outcomes included standard polysomnographic measures of sleep induction, maintenance, staging, and fragmentation; standard measures of apnea/hypopnea and periodic leg movement; and results of the multiple sleep latency test. Results: On standard measures of sleep disturbance, no differences were detected between subjects with PTSD and control subjects, regardless of history of trauma or major depression in the controls. Persons with PTSD had higher rates of brief arousals from rapid eye movement (REM) sleep. Shifts to lighter sleep and wake were specific to REM and were significantly different between REM and non-REM sleep (F 1,278 =5.92; P=.02). Conclusions: We found no objective evidence for clinically relevant sleep disturbances in PTSD. An increased number of brief arousals from REM sleep was detected in subjects with PTSD. Sleep complaints in PTSD might represent amplified perceptions of brief arousals from REM sleep.
Sleep of chronic post-traumatic patients
Journal of Traumatic Stress, 1990
The purpose of the present study was to investigate the sleep of people diagnosed as suffering from chronic Post-Traumatic Stress Disorder (PTSD). The sleep of seven chronic post-traumatic patients with no known physical injuries was compared with that of seven matched control subjects. The post-traumatic patients had poorer sleep: decreased sleep efficiency, increase in number of awakenings, and decreased SWS, as well as longer REAl latency. It was also found that their complaints correlated with relevant sleep-monitored measures. The findings add further support for the inclusion of sleep difficulties in the definition of the Post-Traumatic Stress Disorder.
Personality and Individual Differences, 2016
Unusual sleep and dream experiences-such as elevated dream recall, nightmares, hypnagogic hallucinations, flying dreams, or waking dreams-constitute a trait of atypical nocturnal cognitions that has been associated with life stress and psychopathological distress, as well as terrorism-related stress. In the present study, this trait was explored as a predictor of psychopathological distress following Israel's 2012 "Operation Pillar of Defense" by employing a prospective-longitudinal design. Fifty-three participants, for whom baseline data on psychopathology, sleep, and dreaming were previously assessed, were contacted again in the week following the conclusion of the Operation. They filled out questionnaires regarding sleep experiences, psychopathological distress, the degree of exposure to terrorism, dissociative experiences, and sleep quality. An elevation in psychopathological symptoms, from pre-to post-Operation measurements, was predicted by degree of exposure to terrorism, but also by pre-Operation sleep experiences. This effect of unusual dreaming in prospectively predicting psychopathological reactions to terrorism-related stress was also replicated when reanalyzing existing longitudinal data from a previous study on exposure to terrorism. These novel findings point to the importance of individual differences in nocturnal cognition as clinical indicators of risk for stress reactivity and psychopathology in the face of traumatic stress.
Sleep disorders in combat-related PTSD
Sleep and Breathing, 2014
Purpose We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deploymentrelated PTSD and to determine whether any clinical features differentiated those with sleep disorders. Methods Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders. Results One hundred thirty patients were included (91.5 % male, mean age of 35.1±10.6 years, mean body mass index (BMI) 28.9±4.4 Kg/m 2 ). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4±1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1±22.8 events/hour and a mean oxygen saturation nadir of 84.2±5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p<0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS. Conclusions Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.
Objective: Sleep disturbances, including trouble falling and remaining asleep and recurrent nightmares, are symptoms of posttraumatic stress. A growing body of literature indicates that sleep disturbance may also convey vulnerability for the continuation of other symptoms of posttraumatic stress, including fear, anxiety, and heightened arousal. However, longitudinal research, which could help understand how these relationships unfold over time, has been limited. Method: The longitudinal relationships between sleep disturbance and posttraumatic stress were investigated in 779 Palestinian adults randomly selected and interviewed twice during the period from April 2008 to November 2008, amid ongoing violent political turmoil. The recruitment method produced a representative sample and excellent retention. Cross-panel structural equation modeling was used to examine relationships between sleep and distress across two study periods. Results: Results indicated that initial sleep problems were associated with increased posttraumatic stress disorder (PTSD), depression, and intrapersonal resource loss at follow-up 6 months later, but initial PTSD, depression, and intrapersonal resource loss were not associated with increased sleep problems at follow-up. Conclusions: Sleep problems may confer vulnerability to longer-term distress in the presence of ongoing political violence. Future research should examine whether interventions targeting trauma-related sleep problems may improve prevention and treatment for PTSD and related disorders.
2007
P sleep disturbance exemplifies the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV-TR) nosological paradigm, “Sleep Disorder Related to Another Mental Disorder.” According to the DSM-IV-TR criteria (see Figure 1), this disorder “involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-wake regulation” (p. 597) (1). Trauma survivors frequently experience prominent symptoms of insomnia and Clinical Sleep Disorder Profiles in a Large Sample of Trauma Survivors: An Interdisciplinary View of Posttraumatic Sleep Disturbance