PTSD Disrupts Sleep/Wake Cycle

A retrospective study of 1,078 adults with PTSD treated at a sleep center documented round-the-clock sleep/wake disturbances.

The higher their PTSD symptom scores, the more apt they were to report bedtime worries about losing sleep, racing thoughts, watching the clock, and restless legs syndrome.

The same people reported trouble falling asleep, night waking, nightmares, periodic limb movements, and poor sleep. In the daytime, they had more trouble with memory and concentration, felt sleepier and more fatigued, and reported lower quality of life than those with lower PTSD scores. The severity of their symptoms was correlated with sleep factors that promote excess arousal, Barry Krakow, M.D., and colleagues at Maimonides Sleep Arts and Sciences in Albuquerque, N.M., reported at the annual meeting of the Associated Professional Sleep Societies in June.

Changes in the brain during sleep in people with PTSD may maintain or increase activity in arousal-promoting brain centers and reduce activity in sleep-promoting centers, Anne Germain, Ph.D., an associate professor of psychiatry at the University of Pittsburgh School of Medicine, told Psychiatric News.

Such changes do not show up, however, with standard sleep monitoring. In the sleep laboratory, people with PTSD often sleep better and longer than usual and seldom have nightmares, she said. It's a safe environment, with someone “on guard” all night.

Germain and colleagues are using positron emission tomography, along with standard sleep monitoring, and encephalography, to gain a better sense of what is happening in the brains of people with PTSD over the 24-hour day. They will first study veterans of combat in Iraq and Afghanistan with and without PTSD, both asleep and awake. They will then randomly assign veterans with PTSD to receive either prazosin or a placebo, repeat the sleep and waking studies after eight weeks of treatment, and compare findings with the pretreatment assessments.

“I am 100 percent convinced,” Germain said, “that we can improve the efficacy of PTSD treatment by including a sleep component.”

Information about the Pittsburgh studies is posted at <www.veteranssleep.pitt.edu>.