Sleep and the Pathogenesis of PTSD
Most, if not all, clinicians in the field of traumatic stress would agree that sleep disturbances are among the most prominent and distressing complaints associated with post-traumatic stress disorder or PTSD. This recognition is formalized in the Diagnostic and Statistic Manual of Mental Disorders IV by the inclusion of nightmares and difficulty initiating and maintaining sleep as symptom criteria. Overall, a pathogenic role for sleep disturbance in PTSD is supported by the prominence of sleep-related symptoms, the association of traumatic incidents with sleep disruption, and the overlap of the effects of sleep deprivation and PTSD symptoms. Although the importance of sleep disturbance in PTSD may seem self evident, there has been uncertainty regarding the objective nature of sleep abnormalities in PTSD. Historically, the deficiency of data allowed for speculative hypotheses. Although uncertainty regarding the role of sleep in PTSD remains, the topic has been the subject of a number of recent investigations by an international group of investigators. Therefore, it seemed timely with the convening of the meeting that inspired this volume, the Second World Conference of the International Society for Traumatic Stress Studies that met in June 1996 in Israel, to address investigations of sleep and PTSD. Researchers who are actively investigating the topic were invited to participate. They included Ehud Klien of Israel who presented a longitudinal study of recent accident victims that included actigraphic and Polysomnographie sleep assessments. Thomas Hurwitz of the United States presented sleep laboratory evaluations of Vietnam combat veterans. Wybrand Op den Weld and J. M. H. de Groen of the Netherlands presented sleep and circadian studies of aging World War II Resistance fighters. Peretz Lavie of Israel presented a study of awakening thresholds from rapid eye movement or REM sleep in PTSD subjects, and this author (Thomas Mellman of the United States) reviewed sleep studies of combat veterans and more acutely affected subjects who had PTSD related to a natural disaster. Richard Ross of the United States could not attend but was involved in conceiving and planning the symposium.
KeywordsPlacebo Fatigue Depression Cholin Rosen
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