For example, to the extent trauma-related nightmares or a lack of sleep increase reactivity to emotional cues ( Franzen et al., 2009 Yoo et al., 2007), one’s ability to function in social and occupational roles may be compromised ( Zohar et al., 2005). More simply, treating sleep disruption in PTSD is important because nightmares and insomnia are associated with significant distress and daytime impairment( Clum et al., 2001 Kramer et al., 2003 Neylan et al., 1998 Wittmann et al., 2000 Zammit et al., 1999). These plausible mechanistic processes explain the ways in which nightmares and insomnia can interfere with natural recovery from trauma exposure ( Babson and Feldner, 2010), contribute to the development of PTSD, and compromise response to evidence-based treatments. Some of these include underlying neurobiological alterations ( Germain et al., 2008), compromised generalization of fear extinction secondary to sleep deprivation ( Pace-Schott et al., 2009), disruption of sleep-dependent processing of emotional experiences ( Walker and van Der Helm, 2009), and repeated resensitization to trauma cues during nightmares ( Rothbaum and Mellman, 2001). Multiple processes may explain the role of disturbed sleep in the developmental pathology of PTSD. Although temporal relationships between trauma exposure, PTSD, and sleep disruption are complex ( Babson and Feldner, 2010), emerging evidence lends support to the notion of disrupted sleep as a core component of PTSD ( Spoormaker and Montgomery, 2008), linked mechanistically to its development and maintenance( Germain et al., 2008 Ross et al., 1989). Subjective reports of these symptoms are well documented ( Spoormaker and Montgomery, 2008) and recent studies substantiate their impact upon objectively assessed sleep quality and continuity( Calhoun et al., 2007 Kobayashi et al., 2007 Westermeyer et al., 2007 Woodward et al., 2000).Įffective treatment of posttraumatic sleep symptoms is important for several reasons. Nightmares and insomnia are some of the most ubiquitous, distressing, and chronic symptoms of Posttraumatic Stress Disorder (PTSD). Our ability to treat PTSD-related sleep disturbances may be improved by moving away from considering sleep symptoms in isolation and instead conducting integrative studies that examine sequential or combined behavioral and/or pharmacological treatments targeting both the daytime and nighttime aspects of PTSD. Some behavioral and pharmacological interventions show promise, especially for nightmares, but there is a need for controlled trials that include valid sleep measures and are designed to identify treatment mechanisms. Published studies that examined evidence for therapeutic effects upon sleep were included. This review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. Effective treatments for nighttime PTSD symptoms are critical because sleep disruption may be mechanistically linked to development and maintenance of PTSD and is associated with significant distress, functional impairment, and poor health. Emerging evidence supports the notion of disrupted sleep as a core component of Posttraumatic Stress Disorder (PTSD).
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