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Sleep and Dreaming in Posttraumatic Stress Disorder

  • Disaster Psychiatry: Trauma, PTSD, and Related Disorders (MJ Friedman, Section Editor)
  • Published:
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Abstract

Purpose of Review

Sleep disturbances are core features of posttraumatic stress disorder (PTSD). This review aims to characterize sleep disturbances, summarize the knowledge regarding the relationships between trauma exposure and sleep difficulties, and highlight empirically supported and/or utilized treatments for trauma-related nightmares and insomnia.

Recent Findings

Trauma-related nightmares and insomnia, and other sleep disorders, are frequently reported among trauma survivors. The roles of fear of sleep, REM density, and decreased parasympathetic activity are beginning to inform the relationship between trauma exposure and sleep difficulties. Additionally, the potential adaptive role of sleep loss immediately following a traumatic experience is being recognized. Interventions targeting these sleep disturbances show promise in reducing symptoms.

Summary

Research in understanding the role of sleep on the development, course, and treatment of PTSD is expanding. Longitudinal investigations are needed to further elucidate these relationships and identify treatments most effective in ameliorating symptoms.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Sinha SS. Trauma-induced insomnia: a novel model for trauma and sleep research. Sleep Med Rev. 2016;25:74–83.

    Article  PubMed  Google Scholar 

  2. Neylan TC, Marmar CR, Metzler TJ, Weiss DS, Zatzick DF, Delucchi KL, et al. Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatr. 1998;155(7):929–33.

    Article  CAS  PubMed  Google Scholar 

  3. Mysliwiec V, Brock MS, Creamer JL, O’Reilly B, Germaine A, Roth B. Trauma associated sleep disorder: a parasomnia induced by trauma. Sleep Med Rev. 2017;

  4. Mellman TA, David D, Kulick-Bell R, Hebding J, Nolan B. Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew. Am J Psychiatr. 1995;152(11):1659–63.

    Article  CAS  PubMed  Google Scholar 

  5. Davis JL, Byrd P, Rhudy JL, Wright DC. Characteristics of chronic nightmares in a trauma-exposed treatment-seeking sample. Dreaming. 2007;17(4):187–98.

    Article  Google Scholar 

  6. Ross R, Ball W, Sullivan K, Caroff S. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatr. 1989;146(6):697–707.

    Article  CAS  PubMed  Google Scholar 

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  8. Krakow BJ, Ulibarri VA, Moore BA, McIver ND. Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research. Sleep Med Rev. 2015;24:37–45.

    Article  PubMed  Google Scholar 

  9. Brown TM, Boudewyns PA. Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder. J Trauma Stress. 1996;9(1):129–36.

    Article  CAS  PubMed  Google Scholar 

  10. Babson KA, Feldner MT. Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. Journal of anxiety disorders. 2010;24(1):1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12(3):169–84. doi:10.1016/j.smrv.2007.08.008.

    Article  PubMed  Google Scholar 

  12. Nappi CM, Drummond SP, Hall JM. Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence. Neuropharmacology. 2012;62(2):576–85. doi:10.1016/j.neuropharm.2011.02.029.

    Article  CAS  PubMed  Google Scholar 

  13. Phelps AJ, Forbes D, Creamer M. Understanding posttraumatic nightmares: an empirical and conceptual review. Clin Psychol Rev. 2008;28(2):338–55. doi:10.1016/j.cpr.2007.06.001.

    Article  PubMed  Google Scholar 

  14. Leskin GA, Woodward SH, Young HE, Sheikh JI. Effects of comorbid diagnoses on sleep disturbance in PTSD. J Psychiatr Res. 2002;36(6):449–52.

    Article  PubMed  Google Scholar 

  15. Robert G, Zadra A. Measuring nightmare and bad dream frequency: impact of retrospective and prospective instruments. J Sleep Res. 2008;17(2):132–9.

    Article  PubMed  Google Scholar 

  16. Kobayashi I, Delahanty DL. Gender differences in subjective sleep after trauma and the development of posttraumatic stress disorder symptoms: a pilot study. J Trauma Stress. 2013;26(4):467–74.

    Article  PubMed  Google Scholar 

  17. Schredl M, Reinhard I. Gender differences in nightmare frequency: a meta-analysis. Sleep Med Rev. 2011;15(2):115–21.

    Article  PubMed  Google Scholar 

  18. King MW, Street AE, Gradus JL, Vogt DS, Resick PA. Gender differences in posttraumatic stress symptoms among OEF/OIF veterans: an item response theory analysis. J Trauma Stress. 2013;26(2):175–83. doi:10.1002/jts.21802.

    Article  PubMed  Google Scholar 

  19. Blagrove M, Haywood S. Evaluating the awakening criterion in the definition of nightmares: how certain are people in judging whether a nightmare woke them up? J Sleep Res. 2006;15(2):117–24.

    Article  PubMed  Google Scholar 

  20. Woodward SH, Arsenault NJ, Murray C, Bliwise DL. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol Psychiatry. 2000;48(11):1081–7.

    Article  CAS  PubMed  Google Scholar 

  21. Lee R, Suh S. Nightmare distress as a mediator between nightmare frequency and suicidal ideation. Dreaming. 2016;26(4):308.

    Article  Google Scholar 

  22. Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000;41(6):469–78.

    Article  CAS  PubMed  Google Scholar 

  23. Koffel E, Polusny MA, Arbisi PA, Erbes CR. Pre-deployment daytime and nighttime sleep complaints as predictors of post-deployment PTSD and depression in National Guard troops. Journal of anxiety disorders. 2013;27(5):512–9.

    Article  PubMed  Google Scholar 

  24. Gehrman P, Seelig AD, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD et al. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. Sleep. 2013;36(7):1009-1018.

  25. Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, Moore D. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. J Clin Psychol. 2011;67(12):1240–58.

    Article  PubMed  Google Scholar 

  26. Koren D, Arnon I, Lavie P, Klein E. Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents. Am J Psychiatr. 2002;159(5):855–7.

    Article  PubMed  Google Scholar 

  27. Klein E, Koren D, Arnon I, Lavie P. Sleep complaints are not corroborated by objective sleep measures in post-traumatic stress disorder: a 1-year prospective study in survivors of motor vehicle crashes. J Sleep Res. 2003;12(1):35–41.

    Article  PubMed  Google Scholar 

  28. Engdahl BE, Eberly RE, Hurwitz TD, Mahowald MW, Blake J. Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder. Biol Psychiatry. 2000;47(6):520–5.

    Article  CAS  PubMed  Google Scholar 

  29. Mellman TA, Nolan B, Hebding J, Kulick-Bell R, Dominguez R. A polysomnographic comparison of veterans with combat-related PTSD, depressed men, and non-ill controls. Sleep. 1997;20(1):46–51.

    Article  CAS  PubMed  Google Scholar 

  30. Fuller KH, Waters WF, Scott O. An investigation of slow-wave sleep processes in chronic PTSD patients. J Anxiety Disord. 1994;8(3):227–36.

    Article  Google Scholar 

  31. • Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, et al. Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969–90. doi:10.1037/bul0000053. This review summarized the polysomnography data and highlights that PTSD is linked with poorer sleep continuity, less sleep depth, and REM sleep disturbances across studies with PTSD samples.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Woodward SH, Bliwise DL, Friedman MJ, Gusman DF. Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD. J Trauma Stress. 1996;9(1):137–43.

    Article  CAS  PubMed  Google Scholar 

  33. Werner KB, Griffin MG, Galovski TE. Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder. Psychiatry Res. 2016;240:234–40.

  34. van Wyk M, Thomas KGF, Solms M, Lipinska G. Prominence of hyperarousal symptoms explains variability of sleep disruption in posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy. 2016;8(6):688–96. doi:10.1037/tra0000115.

    Article  Google Scholar 

  35. American Academy of Sleep Medicine. International classification of sleep disorders, 2nd ed.: diagnostic and coding manual. Westchester: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  36. Lettieri CJ, Williams SG, Collen JF. OSA syndrome and posttraumatic stress disorder: clinical outcomes and impact of positive airway pressure therapy. Chest. 2016;149(2):483–90. doi:10.1378/chest.15-0693.

    Article  PubMed  Google Scholar 

  37. Reist C, Gory A, Hollifield M. Sleep-disordered breathing impact on efficacy of prolonged exposure therapy for posttraumatic stress disorder. J Trauma Stress. 2017;30:186–189.

    Article  PubMed  Google Scholar 

  38. • Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165–75. doi:10.5664/jcsm.4466. This systematic review highlights the increased rates of OSA in those diagnosed with PTSD, with estimates about 50%.

    PubMed  PubMed Central  Google Scholar 

  39. Ross RJ, Ball WA, Dinges DF, Kribbs NB. Motor dysfunction during sleep in posttraumatic stress disorder. Sleep: Journal of Sleep Research & Sleep Medicine. 1994;17:195–202.

    Article  Google Scholar 

  40. Eban-Rothschild A, Giardino WJ, de Lecea L. To sleep or not to sleep: neuronal and ecological insights. Curr Opin Neurobiol. 2017;44:132–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lima SL, Rattenborg NC, Lesku JA, Amlaner CJ. Sleeping under the risk of predation. Anim Behav. 2005;70(4):723–36.

    Article  Google Scholar 

  42. Hartmann E. Who develops PTSD nightmares and who doesn’t. In: Cohen DB, editor. Dreams and trauma. Cambridge: Harvard University Press; 1996. p. 100–13.

    Google Scholar 

  43. Wellman LL, Ross RJ, Sanford LD. Sleep disturbances in PTSD, a multidimensional approach to post-traumatic stress disorder-from theory to practice. In: El-Baalbaki G, editor. InTech; 2016. doi: https://doi.org/10.5772/64189.

  44. Feld GB, Born J. Sculpting memory during sleep: concurrent consolidation and forgetting. Curr Opin Neurobiol. 2017;44:20–7.

    Article  CAS  PubMed  Google Scholar 

  45. • Cohen S, Kaplan Z, Zohar J, Cohen H. Preventing sleep on the first resting phase following a traumatic event attenuates anxiety-related responses. Behav Brain Res. 2017;320:450–6. doi:10.1016/j.bbr.2016.10.039. This study of an analogue trauma in animal model found that sleep deprivation during the first rest phase following trauma exposure led to a reduction in PTSD-like symptoms.

    Article  PubMed  Google Scholar 

  46. Porcheret K, Holmes E, Goodwin G, Foster R, Wulff K. Psychological effect of an analogue traumatic event reduced by sleep deprivation. Sleep. 2015;38(7):1017–25.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Menz MM, Rihm JS, Salari N, Born J, Kalisch R, Pape H, et al. The role of sleep and sleep deprivation in consolidating fear memories. NeuroImage. 2013;75:87–96.

    Article  CAS  PubMed  Google Scholar 

  48. Kobayashi I, Boarts JM, Delahanty DL. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007;44(4):660–9.

    Article  PubMed  Google Scholar 

  49. Mellman TA, Kobayashi I, Lavela J, Wilson B, Hall Brown TS. A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population. Sleep. 2014;37(8):1321–6.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mellman TA, Bustamante V, Fins AI, Pigeon WR, Nolan B. REM sleep and the early development of posttraumatic stress disorder. Am J Psychiatr. 2002;159(10):1696–701.

    Article  PubMed  Google Scholar 

  51. Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry. 1995;152(1):110.

    Article  CAS  PubMed  Google Scholar 

  52. Simor P, Horváth K, Gombos F, Takács KP, Bódizs R. Disturbed dreaming and sleep quality: altered sleep architecture in subjects with frequent nightmares. Eur Arch Psychiatry Clin Neurosci. 2012;262(8):687–96.

    Article  PubMed  Google Scholar 

  53. Tanev KS, Orr SP, Pace-Schott EF, Griffin M, Pitman RK, Resick PA. Positive association between nightmares and heart rate response to loud tones: relationship to parasympathetic dysfunction in PTSD nightmares. J Nerv Ment Dis. 2017;205(4):308–12.

    Article  PubMed  Google Scholar 

  54. Pace-Schott EF, Germain A, Milad MR. Effects of sleep on memory for conditioned fear and fear extinction. Psychol Bull. 2015;141(4):835.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner TD, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA. 2001;286(5):537–45.

    Article  CAS  PubMed  Google Scholar 

  56. Mellon RC, Papanikolau V, Prodromitis G. Locus of control and psychopathology in relation to levels of trauma and loss: self-reports of Peloponnesian wildfire survivors. J Trauma Stress. 2009;22(3):189.

    Article  PubMed  Google Scholar 

  57. Bonn-Miller MO, Babson KA, Vandrey R. Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug Alcohol Depend. 2014;136:162–5.

    Article  PubMed  Google Scholar 

  58. Vandrey R, Babson KA, Herrmann ES, Bonn-Miller MO. Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. International review of psychiatry (Abingdon, England). 2014;26(2):237–47. doi:10.3109/09540261.2014.901300.

    Article  Google Scholar 

  59. Babson KA, Boden MT, Harris AH, Stickle TR, Bonn-Miller MO. Poor sleep quality as a risk factor for lapse following a cannabis quit attempt. J Subst Abus Treat. 2013;44(4):438–43.

    Article  Google Scholar 

  60. American Psychological Association. Clinical Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2017.

  61. Department of Veterans Affairs, Defense Do. VA/DOD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. 2017.

  62. Krakow B, Kellner R, Pathak D, Lambert L. Imagery rehearsal treatment for chronic nightmares. Behav Res Ther. 1995;33(7):837–43.

    Article  CAS  PubMed  Google Scholar 

  63. Krakow B, Zadra A. Imagery rehearsal therapy: principles and practice. Sleep Medicine Clinics. 2010;5(2):289–98.

    Article  Google Scholar 

  64. Harb GC, Phelps AJ, Forbes D, Ross RJ, Gehrman PR, Cook JM. A critical review of the evidence base of imagery rehearsal for posttraumatic nightmares: pointing the way for future research. J Trauma Stress. 2013;26(5):570–9.

    Article  PubMed  Google Scholar 

  65. Krakow B, Sandoval D, Schrader R, Keuhne B, Mcbride L, Yau C, et al. Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. J Adolesc Health. 2001;29(2):94–100.

    Article  CAS  PubMed  Google Scholar 

  66. Germain A, Nielsen T. Impact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patients. Behav Sleep Med. 2003;1(3):140–54.

    Article  PubMed  Google Scholar 

  67. Forbes D, Phelps AJ, McHugh AF, Debenham P, Hopwood M, Creamer M. Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. J Trauma Stress. 2003;16(5):509–13.

    Article  PubMed  Google Scholar 

  68. Lu M, Wagner A, Van Male L, Whitehead A, Boehnlein J. Imagery rehearsal therapy for posttraumatic nightmares in U.S. veterans. J Trauma Stress. 2009;22(3):236–9. doi:10.1002/jts.20407.

    Article  PubMed  Google Scholar 

  69. Cook JM, Harb GC, Gehrman PR, Cary MS, Gamble GM, Forbes D, et al. Imagery rehearsal for posttraumatic nightmares: a randomized controlled trial. J Trauma Stress. 2010;23(5):553–63.

    Article  PubMed  Google Scholar 

  70. Davis JL. Treating post-trauma nightmares: a cognitive behavioral approach. New York: Springer Publishing Company; 2009.

    Google Scholar 

  71. Davis JL, Rhudy JL, Pruiksma KE, Byrd P, Williams AE, McCabe KM, et al. Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. J Clin Sleep Med. 2011;7(6):622–31. doi:10.5664/jcsm.1466.

    PubMed  PubMed Central  Google Scholar 

  72. Davis JL, Wright DC. Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. J Trauma Stress. 2007;20(2):123–33. doi:10.1002/jts.20199.

    Article  PubMed  Google Scholar 

  73. Rhudy JL, Davis JL, Williams AE, McCabe KM, Byrd PM. Physiological–emotional reactivity to nightmare-related imagery in trauma-exposed persons with chronic nightmares. Behav Sleep Med. 2008;6(3):158–77.

    Article  PubMed  Google Scholar 

  74. Pruiksma KE, Cranston CC, Rhudy JL, Micol RL, Davis JL.Randomized controlled trial to dismantle Exposure, Relaxation and Rescripting Therapy (ERRT) for trauma-related nightmares. Psychol Trauma. 2016.

  75. Balliett NE, Davis JL, Miller KE. Efficacy of a brief treatment for nightmares and sleep disturbances for veterans. Psychological Trauma: Theory, Research, Practice, and Policy. 2015;7(6):507–15. doi:10.1037/tra0000055.

    Article  Google Scholar 

  76. Long ME, Hammons ME, Davis JL, Frueh BC, Khan MM, Elhai JD, et al. Imagery rescripting and exposure group treatment of posttraumatic nightmares in Veterans with PTSD. J Anxiety Disord. 2011;25(4):531–5.

    Article  PubMed  Google Scholar 

  77. Pruiksma K, Molino A, Taylor D, Resick P, Peterson A. Case study of cognitive behavioral therapy for comorbid PTSD, insomnia, and nightmares. Comprehensive guide to post-traumatic stress disorders. 2016: 2249–58.

  78. Riemann D, Perlis ML. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13(3):205–14.

    Article  PubMed  Google Scholar 

  79. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10(1):45–56.

    CAS  PubMed  Google Scholar 

  80. Bootzin RR, Epstein D, Wood JM. Stimulus control instructions. Case studies in insomnia. Springer; 1991; 19–28.

  81. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204.

    Article  PubMed  Google Scholar 

  82. Koffel EA, Koffel JB, Gehrman PR. A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Med Rev. 2015;19:6–16.

    Article  PubMed  Google Scholar 

  83. Gellis LA, Gehrman PR. Cognitive behavioral treatment for insomnia in veterans with long-standing posttraumatic stress disorder: a pilot study. J Aggress Maltreat Trauma. 2011;20(8):904–16.

    Article  Google Scholar 

  84. Talbot LS, Maguen S, Metzler TJ, Schmitz M, McCaslin SE, Richards A, et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep. 2014;37(2):327–41.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Troxel WM, Germain A, Buysse DJ. Clinical management of insomnia with brief behavioral treatment (BBTI). Behav Sleep Med. 2012;10(4):266–79.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Germain A, Richardson R, Stocker R, Mammen O, Hall M, Bramoweth AD, et al. Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial. Behav Res Ther. 2014;61:78–88.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Seyffert M, Lagisetty P, Landgraf J, Chopra V, Pfeiffer PN, Conte ML, et al. Internet-delivered cognitive behavioral therapy to treat insomnia: a systematic review and meta-analysis. PLoS One. 2016;11(2):e0149139.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  88. Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia—a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1–10.

    Article  PubMed  Google Scholar 

  89. Germain A, Shear MK, Hall M, Buysse DJ. Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behav Res Ther. 2007;45(3):627–32.

    Article  PubMed  Google Scholar 

  90. Harb GC, Cook JM, Gehrman PR, Gamble GM, Ross RJ. Post-traumatic stress disorder nightmares and sleep disturbance in Iraq war veterans: a feasible and promising treatment combination. J Aggress Maltreat Trauma. 2009;18(5):516–31.

    Article  Google Scholar 

  91. Swanson LM, Favorite TK, Horin E, Arnedt JT. A combined group treatment for nightmares and insomnia in combat veterans: a pilot study. J Trauma Stress. 2009;22(6):639–42. doi:10.1002/jts.20468.

    PubMed  Google Scholar 

  92. Bishop TM, Britton PC, Knox KL, Pigeon WR. Cognitive behavioral therapy for insomnia and imagery rehearsal in combat veterans with comorbid posttraumatic stress: a case series. Military behavioral health. 2016;4(1):58–64.

    Article  PubMed  Google Scholar 

  93. Ulmer CS, Edinger JD, Calhoun PS. A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2011;7(1):57.

    Google Scholar 

  94. Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al. Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. J Psychosom Res. 2012;72(2):89–96.

    Article  PubMed  Google Scholar 

  95. Margolies SO, Rybarczyk B, Vrana SR, Leszczyszyn DJ, Lynch J. Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. J Clin Psychol. 2013;69(10):1026–42.

    Article  PubMed  Google Scholar 

  96. Gutner CA, Casement MD, Stavitsky Gilbert K, Resick PA. Change in sleep symptoms across cognitive processing therapy and prolonged exposure: a longitudinal perspective. Behav Res Ther. 2013;51(12):817–22. doi:10.1016/j.brat.2013.09.008.

    Article  PubMed  Google Scholar 

  97. Brownlow JA, McLean CP, Gehrman PR, Harb GC, Ross RJ, Foa EB. Influence of sleep disturbance on global functioning after posttraumatic stress disorder treatment. J Trauma Stress. 2016;29(6):515–21.

    Article  PubMed  Google Scholar 

  98. DeViva JC, Zayfert C, Pigeon WR, Mellman TA. Treatment of residual insomnia after CBT for PTSD: case studies. J Trauma Stress. 2005;18(2):155–9.

    Article  PubMed  Google Scholar 

  99. Tamanna S, Parker JD, Lyons J, Ullah M. The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). J Clin Sleep Med. 2014;10(6):631–6.

    PubMed  PubMed Central  Google Scholar 

  100. BaHammam AS, Al-Shimemeri SA, Salama RI, Sharif MM. Clinical and polysomnographic characteristics and response to continuous positive airway pressure therapy in obstructive sleep apnea patients with nightmares. Sleep Med. 2013;14(2):149–54.

    Article  PubMed  Google Scholar 

  101. Orr JE, Smales C, Alexander TH, Stepnowsky C, Pillar G, Malhotra A, et al. Treatment of OSA with CPAP is associated with improvement in PTSD symptoms among veterans. J Clin Sleep Med. 2017;13(1):57–63. doi:10.5664/jcsm.6388.

    Article  PubMed  PubMed Central  Google Scholar 

  102. • El-Solh AA, Vermont L, Homish GG, Kufel T. The effect of continuous positive airway pressure on post-traumatic stress disorder symptoms in veterans with post-traumatic stress disorder and obstructive sleep apnea: a prospective study. Sleep Med. 2017;33:145–50. This study indicated that treating OSA may lead to significant improvements in PTSD symptoms and nightmare variables, particularly for those most adherent to use.

    Article  PubMed  Google Scholar 

  103. Jeffreys M, Capehart B, Friedman MJ. Pharmacotherapy for posttraumatic stress disorder: review with clinical applications. Journal of Rehabilitation Research & Development. 2012;49(6):703–15. doi:10.1682/jrrd.2011.09.0183.

    Article  Google Scholar 

  104. • Detweiler MB, Pagadala B, Candelario J, Boyle JS, Detweiler JG, Lutgens BW. Treatment of post-traumatic stress disorder nightmares at a Veterans Affairs Medical Center. Journal of Clinical Medicine. 2016;5(12):117. This study examined the efficacy of pharmacological treatments for PTSD nightmares in Veterans and active duty military soldiers. Evidence showed that risperidone, clonidine, quetiapine, mirtazapine, and terazosin had successful partial to full nightmare cessation in greater than 50% of the trials.

    Article  PubMed Central  Google Scholar 

  105. Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, et al. Best practice guide for the treatment of nightmare disorder in adults. Journal Of Clinical Sleep Medicine: JCSM: Official Publication Of The American Academy Of Sleep Medicine. 2010;6(4):389–401.

    Google Scholar 

  106. Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson CE, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatr. 2003;160(2):371–3.

    Article  PubMed  Google Scholar 

  107. George KC, Kebejian L, Ruth LJ, Miller CW, Himelhoch S. Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder. Journal of Trauma & Dissociation. 2016;17(4):494–510.

    Article  Google Scholar 

  108. Raskind MA, Millard SP, Petrie EC, Peterson K, Williams T, Hoff DJ, et al. Higher pretreatment blood pressure is associated with greater posttraumatic stress disorder symptom reduction in soldiers treated with prazosin. Biol Psychiatry. 2016;80(10):736–42.

    Article  CAS  PubMed  Google Scholar 

  109. • Khachatryan D, Groll D, Booij L, Sepehry AA, Schütz CG. Prazosin for treating sleep disturbances in adults with posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. Gen Hosp Psychiatry. 2016;39:46–52. This study found that prazosin showed medium to large effects on overall PTSD symptomatology and sleep disturbance in particular, although cited several limitations with these studies.

    Article  PubMed  Google Scholar 

  110. Hudson SM, Whiteside TE, Lorenz RA, Wargo KA. Prazosin for the treatment of nightmares related to posttraumatic stress disorder: a review of the literature. The primary Care Companion to CNS disorders. 2012.

  111. V. A. Office of Research Development. Cooperative Studies Program #563 - Prazosin and Combat Trauma PTSD (PACT). ClinicalTrials.gov: Bethesda (MD): National Library of Medicine; 2013.

  112. Friedman MJ, Bernardy NC. Considering future pharmacotherapy for PTSD. Neurosci Lett. 2017;649:181–5. doi:10.1016/j.neulet.2016.11.048.

    Article  CAS  PubMed  Google Scholar 

  113. Schneier FR, Campeas R, Carcamo J, Glass A, Lewis-Fernandez R, Neria Y, et al. Combined mirtazapine and SSRI treatment of PTSD: a placebo-controlled trial. Depression and anxiety. 2015;32(8):570–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Warner M, Dorn M, Peabody C. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry. 2001;34(04):128–31.

    Article  CAS  PubMed  Google Scholar 

  115. Hertzberg MA, Feldman ME, Beckham JC, Davidson JR. Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design. J Clin Psychopharmacol. 1996;16(4):294–8.

    Article  CAS  PubMed  Google Scholar 

  116. Bernardy NC, Friedman MJ. Pharmacological management of posttraumatic stress disorder. Current Opinion in Psychology. 2017;14:116–21.

    Article  PubMed  Google Scholar 

  117. Krystal JH, Davis LL, Neylan TC, Raskind MA, Schnurr PP, Stein MB, et al. It is time to address the crisis in the pharmacotherapy of posttraumatic stress disorder: a consensus statement of the PTSD Psychopharmacology Working Group. Biol Psychiatry. 2017.

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Acknowledgements

A portion of the writing of this manuscript was supported by the Department of Veterans Affairs, Office of Academic Affiliations, NCPTSD D&T Division VA-Sponsored Fellowship in PTSD Research and Treatment. The views expressed here are the authors’ and do not necessarily represent the views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA

    Katherine E. Miller & Steve Woodward

  2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Katherine E. Miller & Steve Woodward

  3. Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, USA

    Janeese A. Brownlow & Philip R. Gehrman

  4. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA

    Philip R. Gehrman

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  1. Katherine E. Miller
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  2. Janeese A. Brownlow
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  3. Steve Woodward
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  4. Philip R. Gehrman
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Correspondence to Philip R. Gehrman.

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This article is part of the Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders

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Miller, K.E., Brownlow, J.A., Woodward, S. et al. Sleep and Dreaming in Posttraumatic Stress Disorder. Curr Psychiatry Rep 19, 71 (2017). https://doi.org/10.1007/s11920-017-0827-1

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  • DOI: https://doi.org/10.1007/s11920-017-0827-1

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