Current Psychiatry Reports

, 21:80 | Cite as

Trauma Associated Sleep Disorder: Clinical Developments 5 Years After Discovery

  • Matthew S. BrockEmail author
  • Tyler A. Powell
  • Jennifer L. Creamer
  • Brian A. Moore
  • Vincent Mysliwiec
Sleep Disorders (P Gehrman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep Disorders


Purpose of Review

We review recent and growing evidence that provides support for a novel parasomnia, trauma associated sleep disorder (TASD). Based on these findings, we further develop the clinical and polysomnographic (PSG) characteristics of TASD. We also address factors that precipitate TASD, develop a differential diagnosis, discuss therapy, and propose future directions for research.

Recent Findings

Nightmares, classically a REM phenomenon, are prevalent and underreported, even in individuals with trauma exposure. When specifically queried, trauma-related nightmares (TRN) are frequently associated with disruptive nocturnal behaviors (DNB), consistent with TASD. Capture of DNB in the lab is rare but ambulatory monitoring reveals dynamic autonomic concomitants associated with disturbed dreaming. TRN may be reported in NREM as well as REM sleep, though associated respiratory events may confound this finding. Further, dream content is more distressing in REM. Therapy for this complex disorder likely requires addressing not only the specific TASD components of TRN and DNB but comorbid sleep disorders.


TASD is a unique parasomnia developing after trauma. Trauma-exposed individuals should be specifically asked about their sleep and if they have nightmares with or without DNB. Patients who report TRN warrant in-lab PSG as part of their evaluation.


Trauma associated sleep disorder Trauma-related nightmares Disruptive nocturnal behaviors Nightmares 


Compliance with Ethical Standards


The opinions and assertions in this manuscript are those of the authors and do not represent those of the Department of the Air Force, Department of the Army, Department of Defense, or the US government.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


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

  1. 1.
    Crocq MA, Crocq L. From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues Clin Neurosci. 2000;2(1):47–55.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Plutarch. Plutarch’s lives: translated from the original Greek, with notes, critical and historical, and a life of Plutarch. New York: Derby & Jackson; 1859.Google Scholar
  3. 3.
    Features RA. Historia Magazine. Published September 29, 2017. Accessed 9 April 2019.
  4. 4.
    Horwitz T. Did civil war soldiers have PTSD? Published January 1, 2015. Accessed 19 April 2019.
  5. 5.
    Bartemeier LH, Kubie LS, Menninger KA, Romano J, Whitehorn JC. Combat exhaustion. J Nerv Ment Dis. 1946;104(05):489–525.CrossRefGoogle Scholar
  6. 6.
    Lurie I, Levav I. Sleep disorders among Holocaust survivors. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 381–94.CrossRefGoogle Scholar
  7. 7.
    •• Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med. 2014;10(10):1143–8. This is the initial case series of trauma associated sleep disorder. PubMedPubMedCentralGoogle Scholar
  8. 8.
    Mysliwiec V, Brock MS, Thomas AL, Creamer JL. The extreme nocturnal manifestation of trauma: trauma associated sleep disorder. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 215–25.CrossRefGoogle Scholar
  9. 9.
    Woodward SH, Arsenault NJ, Murray C, Bliwise DL. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol Psychiatry. 2000;48(11):1081–7.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Hurwitz TD, Mahowald MW, Kuskowski M, Engdahl BE. Polysomnographic sleep is not clinically impaired in vietnam combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1998;44(10):1066–73. Scholar
  12. 12.
    • Creamer JL, Brock MS, Matsangas P, Motamedi V, Mysliwiec V. Nightmares in United States military personnel with sleep disturbances. J Clin Sleep Med. 2018;14(3):419–26. This report describes characteristics of nightmares in an active duty military population and compares trauma related nightmares to non-trauma related nightmares. PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    • Feemster JC, Smith KL, McCarter SJ, St louis EK. Trauma associated sleep disorder: a posttraumatic stress/REM sleep behavior disorder mash-up? J Clin Sleep Med. 2019;15(2):345–9. This is a report of a case consistent with trauma associated sleep disorder in a relatively older individual with PTSD but without signs/symptoms of REM sleep behavior disorder. PubMedCrossRefGoogle Scholar
  14. 14.
    Greenberg R, Pearlman CA, Gampel D. War neuroses and the adaptive function of REM sleep. Br J Med Psychol. 1972;45(1):27–33.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaminer H, Lavie P. Sleep and dreaming in Holocaust survivors. Dramatic decrease in dream recall in well-adjusted survivors. J Nerv Ment Dis. 1991;179(11):664–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Kramer M, Schoen LS, Kinney L. Psychological and behavioral features of disturbed dreamers. Psychiatr J Univ Ott. 1984;9(3):102–6.PubMedGoogle Scholar
  17. 17.
    •• Phelps AJ, Kanaan RAA, Worsnop C, Redston S, Ralph N, Forbes D. An ambulatory polysomnography study of the post-traumatic nightmares of posttraumatic stress disorder. Sleep. 2018;41(1). This is the first ambulatory PSG study of trauma-related nightmares. Google Scholar
  18. 18.
    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):110–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Hefez A, Metz L, Lavie P. Long-term effects of extreme situational stress on sleep and dreaming. Am J Psychiatry. 1987;144(3):344–7.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Van der Kolk B, Blitz R, Burr W, Sherry S, Hartmann E. Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans. Am J Psychiatry. 1984;141(2):187–90.PubMedCrossRefGoogle Scholar
  21. 21.
    • Woodward SH, Michel G, Santerre C. The psychophysiology of PTSD nightmares. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 233–42. This book chapter describes reports findings from an ambulatory PSG investigation of nightmares in PTSD patients and summarizes the psychophysiology of trauma related nightmares. CrossRefGoogle Scholar
  22. 22.
    Schlosberg A, Benjamin M. Sleep patterns in three acute combat fatigue cases. J Clin Psychiatry. 1978;39(6):546–9.PubMedGoogle Scholar
  23. 23.
    Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V. Prevalence, and impact of short sleep duration in redeployed OIF soldiers. Sleep. 2011;34(9):1189–95.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Khazaie H, Ghadami MR, Masoudi M. Sleep disturbances in veterans with chronic war-induced PTSD. J Inj Violence Res. 2016;8(2):99–107.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Lavie P, Hertz G. Increased sleep motility and respiration rates in combat neurotic patients. Biol Psychiatry. 1979;14(6):983–7.PubMedGoogle Scholar
  26. 26.
    Woodward SH, Leskin GA, Sheikh JI. Movement during sleep: associations with posttraumatic stress disorder, nightmares, and comorbid panic disorder. Sleep. 2002;25(6):681–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Vasdev S, Cunningham J, Shapiro C. Sleep Changes in PTSD. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 201–8.CrossRefGoogle Scholar
  28. 28.
    • Mysliwiec V, Brock MS, Creamer JL, O'Reilly BM, Germain A, Roth BJ. Trauma associated sleep disorder: a parasomnia induced by trauma. Sleep Med Rev. 2018;37:94–104. This theoretical review summarizes previous reports of cases consistent with trauma associated sleep disorder and develops a neurobiological hypothesis of this parasomnia. PubMedCrossRefGoogle Scholar
  29. 29.
    Nardo D, Högberg G, Jonsson C, Jacobsson H, Hällström T, Pagani M. Neurobiology of sleep disturbances in PTSD patients and traumatized controls: MRI and SPECT findings. Front Psychiatry. 2015;6:134.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Davis M, Whalen PJ. The amygdala: vigilance and emotion. Mol Psychiatry. 2001;6(1):13–34.PubMedCrossRefGoogle Scholar
  31. 31.
    Kim JJ, Jung MW. Neural circuits and mechanisms involved in Pavlovian fear conditioning: a critical review. Neurosci Biobehav Rev. 2006;30(2):188–202.PubMedCrossRefGoogle Scholar
  32. 32.
    Ledoux JE, Iwata J, Cicchetti P, Reis DJ. Different projections of the central amygdaloid nucleus mediate autonomic and behavioral correlates of conditioned fear. J Neurosci. 1988;8(7):2517–29.PubMedCrossRefGoogle Scholar
  33. 33.
    Amorapanth P, Ledoux JE, Nader K. Different lateral amygdala outputs mediate reactions and actions elicited by a fear-arousing stimulus. Nat Neurosci. 2000;3(1):74–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Geracioti TD, Baker DG, Ekhator NN, et al. CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry. 2001;158(8):1227–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Mellman TA, Kumar A, Kulick-bell R, Kumar M, Nolan B. Nocturnal/daytime urine noradrenergic measures and sleep in combat-related PTSD. Biol Psychiatry. 1995;38(3):174–9.PubMedCrossRefGoogle Scholar
  36. 36.
    • Baird T, Mcleay S, Harvey W, et al. Sleep disturbances in Australian Vietnam veterans with and without posttraumatic stress disorder. J Clin Sleep Med. 2018;14(5):745–52. This cross-sectional cohort study reports a wide range of sleep disturbances in veterans with PTSD and advocates for detailed sleep assessment and consideration of PSG in this population. PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Fisher C, Byrne J, Edwards A, Kahn E. A psychophysiological study of nightmares. J Am Psychoanal Assoc. 1970;18(4):747–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Frauscher B, Iranzo A, Gaig C, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012;35(6):835–47.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Gehrman P, Seelig AD, Jacobson IG, et al. Predeployment sleep duration and Insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. Sleep. 2013;36(7):1009–18.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Talbot LS, Maguen S, Metzler TJ, et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep. 2014;37(2):327–41.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Rizzo M, Robertson B, Collen JF. Distinct disorder? Or mash up of several? J Clin Sleep Med. 2009;15(2):181–2.CrossRefGoogle Scholar
  42. 42.
    Kobayashi I, Lavela J, Mellman TA. Nocturnal autonomic balance and sleep in PTSD and resilience. J Trauma Stress. 2014;27(6):712–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Van Boxtel GJ, Cluitmans PJ, Raymann RJ, Ouwerkerk M, Denissen AJ, Dekker MK, et al. Heart rate variability, sleep, and the early detection of post-traumatic stress disorder. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 253–63.CrossRefGoogle Scholar
  44. 44.
    Mellman TA, Knorr BR, Pigeon WR, Leiter JC, Akay M. Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biol Psychiatry. 2004;55(9):953–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Woodward SH, Leskin GA, Sheikh JI. Sleep respiratory concomitants of comorbid panic and nightmare complaint in post-traumatic stress disorder. Depress Anxiety. 2003;18(4):198–204.PubMedCrossRefGoogle Scholar
  46. 46.
    Buckley TC, Holohan D, Greif JL, Bedard M, Suvak M. Twenty-four-hour ambulatory assessment of heart rate and blood pressure in chronic PTSD and non-PTSD veterans. J Trauma Stress. 2004;17(2):163–71.PubMedCrossRefGoogle Scholar
  47. 47.
    Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165–75.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Colvonen PJ, Masino T, Drummond SP, Myers US, Angkaw AC, Norman SB. Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. J Clin Sleep Med. 2015;11(5):513–8.PubMedPubMedCentralGoogle Scholar
  49. 49.
    • Miller KE, Jamison AL, Gala S, Woodward SH. Two independent predictors of nightmares in posttraumatic stress disorder. J Clin Sleep Med. 2018;14(11):1921–7. This study reports that elevated respiratory event index and lower sleep period respiratory sinus arrhythmia are predictive of nightmares in patients with PTSD. PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Di Pauli F, Stefani A, Holzknecht E, et al. Dream content in patients with sleep apnea: a prospective sleep laboratory study. J Clin Sleep Med. 2018;14(1):41–6.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    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.PubMedCrossRefGoogle Scholar
  52. 52.
    Tamanna S, Parker JD, Lyons J, Ullah MI. 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.PubMedPubMedCentralGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    Jović V, Varvin S, Rosenbaum B, Fischmann T, Opačić G, Hau S. Sleep studies in Serbian victims of torture: analysis of traumatic dreams. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 395–409.CrossRefGoogle Scholar
  55. 55.
    Sheikh JI, Woodward SH, Leskin GA. Sleep in post-traumatic stress disorder and panic: convergence and divergence. Depress Anxiety. 2003;18(4):187–97.PubMedCrossRefGoogle Scholar
  56. 56.
    Koffel E, Khawaja IS, Germain A. Sleep disturbances in posttraumatic stress disorder: updated review and implications for treatment. Psychiatr Ann. 2016;46(3):173–6.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Kobayashi I, Boarts JM, Delahanty DL. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007;44(4):660–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Cohen DJ, Begley A, Alman JJ, et al. Quantitative electroencephalography during rapid eye movement (REM) and non-REM sleep in combat-exposed veterans with and without Post-traumatic Stress Disorder. J Sleep Res. 2013;22(1):76–82.PubMedCrossRefGoogle Scholar
  59. 59.
    Woodward SH, Murburg MM, Bliwise DL. PTSD-related hyperarousal assessed during sleep. Physiology & behavior. 2000 Jul 1;70(1-2):197-203.Google Scholar
  60. 60.
    Cowdin N, Kobayashi I, Mellman TA. Theta frequency activity during rapid eye movement (REM) sleep is greater in people with resilience versus PTSD. Exp Brain Res. 2014;232(5):1479–85.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Duval M, Zadra A. Frequency and content of dreams associated with trauma. Sleep Med Clin. 2010;5(2):249–60.CrossRefGoogle Scholar
  62. 62.
    Nielsen T, Levin R. Nightmares: a new neurocognitive model. Sleep Med Rev. 2007;11(4):295–310.PubMedCrossRefGoogle Scholar
  63. 63.
    Kravitz M, Mccoy BJ, Tompkins DM, et al. Sleep disorders in children after burn injury. J Burn Care Rehabil. 1993;14(1):83–90.PubMedCrossRefGoogle Scholar
  64. 64.
    Wood JM, Bootzin RR, Rosenhan D, Nolen-hoeksema S, Jourden F. Effects of the 1989 San Francisco earthquake on frequency and content of nightmares. J Abnorm Psychol. 1992;101(2):219–24.PubMedCrossRefGoogle Scholar
  65. 65.
    Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013;36(2):167–74.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Babson KA, Feldner MT. Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. J Anxiety Disord. 2010;24(1):1–15.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Pace-Schott EF, Germain A, Milad MR. Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory. Biol Mood Anxiety Disord. 2015;5:3.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Kanady JC, Talbot LS, Maguen S, et al. Cognitive behavioral therapy for insomnia reduces fear of sleep in individuals with posttraumatic stress disorder. J Clin Sleep Med. 2018;14(7):1193–203.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Seelig AD, Jacobson IG, Smith B, et al. Sleep patterns before, during, and after deployment to Iraq and Afghanistan. Sleep. 2010;33(12):1615–22.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA. Obstructive sleep apnea syndrome: are we missing an at-risk population? J Clin Sleep Med. 2005;1(4):381–5.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Nielsen T, Paquette T. Dream-associated behaviors affecting pregnant and postpartum women. Sleep. 2007;30(9):1162–9.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Insana SP, Kolko DJ, Germain A. Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans. Biol Psychol. 2012;89(3):570–9.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Jones RM. The new psychology of dreaming. New York: Grune and Stratton; 1970.Google Scholar
  74. 74.
    Van der Helm E, Yao J, Dutt S, Rao V, Saletin JM, Walker MP. REM sleep depotentiates amygdala activity to previous emotional experiences. Curr Biol. 2011;21(23):2029–32.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Kleim B, Wysokowsky J, Schmid N, Seifritz E, Rasch B. Effects of sleep after experimental trauma on intrusive emotional memories. Sleep. 2016;39(12):2125–32.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Yehuda R. Biological factors associated with susceptibility to posttraumatic stress disorder. Can J Psychiatr. 1999;44(1):34–9.CrossRefGoogle Scholar
  77. 77.
    Auxéméry Y. Posttraumatic stress disorder (PTSD) as a consequence of the interaction between an individual genetic susceptibility, a traumatogenic event and a social context. Encephale. 2012;38(5):373–80.PubMedCrossRefGoogle Scholar
  78. 78.
    Yehuda R, Halligan SL, Bierer LM. Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring. J Psychiatr Res. 2001;35(5):261–70.PubMedCrossRefGoogle Scholar
  79. 79.
    True WR, Rice J, Eisen SA, et al. A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. Arch Gen Psychiatry. 1993;50(4):257–64.PubMedCrossRefGoogle Scholar
  80. 80.
    Koenen KC, Lyons MJ, Goldberg J, et al. A high-risk twin study of combat-related PTSD comorbidity. Twin Res. 2003;6(3):218–26.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Mehta D, Binder EB. Gene × environment vulnerability factors for PTSD: the HPA-axis. Neuropharmacology. 2012;62(2):654–62.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Lonsdorf TB, Weike AI, Nikamo P, Schalling M, Hamm AO, Ohman A. Genetic gating of human fear learning and extinction: possible implications for gene-environment interaction in anxiety disorder. Psychol Sci. 2009;20(2):198–206.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Voisey J, Swagell CD, Hughes IP, et al. The DRD2 gene 957C>T polymorphism is associated with posttraumatic stress disorder in war veterans. Depress Anxiety. 2009;26(1):28–33.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Lee HJ, Lee MS, Kang RH, et al. Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder. Depress Anxiety. 2005;21(3):135–9.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Skelton K, Ressler KJ, Norrholm SD, Jovanovic T, Bradley-Davino B. PTSD and gene variants: new pathways and new thinking. Neuropharmacology. 2012;62(2):628–37.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Chantarujikapong SI, Scherrer JF, Xian H, et al. A twin study of generalized anxiety disorder symptoms, panic disorder symptoms and post-traumatic stress disorder in men. Psychiatry Res. 2001;103(2-3):133–45.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    • Thordardottir EB, Hansdottir I, Valdimarsdottir UA, Shipherd JC, Resnick H, Gudmundsdottir B. The manifestations of sleep disturbances 16 years post-trauma. Sleep. 2016;39(8):1551–4. This study reports findings consistent with trauma associated sleep disorder in a population over a decade after the trauma occurred and provides insight into the variable impact of trauma on children and adults. PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Sateia MJ. International classification of sleep disorders-third edition. American Academy of Sleep Medicine; 2014.Google Scholar
  89. 89.
    Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146(6):697–707.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Raskind MA, Peskind ER, Hoff DJ, et al. A parallel group placebo-controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928–34.PubMedCrossRefGoogle Scholar
  91. 91.
    Iranzo A, Frauscher B, Santos H, et al. Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder. Sleep Med. 2011;12(3):284–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Glue P, Barak Y. Prazosin for post-traumatic stress disorder. N Engl J Med. 2018;378(17):1649.PubMedGoogle Scholar
  93. 93.
    Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001;16(4):622–30.PubMedCrossRefGoogle Scholar
  94. 94.
    Ju YE, Larson-prior L, Duntley S. Changing demographics in REM sleep behavior disorder: possible effect of autoimmunity and antidepressants. Sleep Med. 2011;12(3):278–83.PubMedCrossRefGoogle Scholar
  95. 95.
    Lee K, Baron K, Soca R, Attarian H. The prevalence and characteristics of REM sleep without Atonia (RSWA) in patients taking antidepressants. J Clin Sleep Med. 2016;12(3):351–5.PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Iranzo A, Santamaría J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep. 2005;28(2):203–6.PubMedCrossRefGoogle Scholar
  97. 97.
    D'agostino A, Manni R, Limosani I, Terzaghi M, Cavallotti S, Scarone S. Challenging the myth of REM sleep behavior disorder: no evidence of heightened aggressiveness in dreams. Sleep Med. 2012;13(6):714–9.PubMedCrossRefGoogle Scholar
  98. 98.
    Li SX, Lam SP, Zhang J, et al. A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder. Sleep Med. 2016;21:114–20.PubMedCrossRefGoogle Scholar
  99. 99.
    Ronzoni G, Del Arco A, Mora F, Segovia G. Enhanced noradrenergic activity in the amygdala contributes to hyperarousal in an animal model of PTSD. Psychoneuroendocrinology. 2016;70:1–9.PubMedCrossRefGoogle Scholar
  100. 100.
    Raskind MA, Peterson K, Williams T, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170(9):1003–10.PubMedCrossRefGoogle Scholar
  101. 101.
    Raskind MA, Peskind ER, Chow B, et al. Trial of prazosin for post-traumatic stress disorder in military veterans. N Engl J Med. 2018;378(6):507–17.PubMedCrossRefGoogle Scholar
  102. 102.
    Collen JF, Lettieri CJ, Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea. J Clin Sleep Med. 2012;8(6):667–72.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Garcia-rill E. Disorders of the reticular activating system. Med Hypotheses. 1997;49(5):379–87.PubMedCrossRefGoogle Scholar
  104. 104.
    Husain AM, Miller PP, Carwile ST. Rem sleep behavior disorder: potential relationship to post-traumatic stress disorder. J Clin Neurophysiol. 2001;18(2):148–57.PubMedCrossRefGoogle Scholar
  105. 105.
    Lu J, Sherman D, Devor M, Saper CB. A putative flip-flop switch for control of REM sleep. Nature. 2006;441(7093):589–94.PubMedCrossRefGoogle Scholar
  106. 106.
    Raskind MA, Millard SP, Petrie EC, 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.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Mcgrane IR, Leung JG, St Louis EK, Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med. 2015;16(1):19–26.PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Morgenthaler TI, Auerbach S, Casey KR, et al. Position paper for the treatment of nightmare disorder in adults: an american academy of sleep medicine position paper. J Clin Sleep Med. 2018;14(6):1041–55.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    El-solh AA. Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nat Sci Sleep. 2018;10:409–20.PubMedPubMedCentralCrossRefGoogle Scholar
  110. 110.
    Krakow B, Hollifield M, Johnston L, 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.PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Levrier K, Marchand A, Billette V, Guay S, Belleville G. Imagery rehearsal therapy (IRT) combined with cognitive behavioral therapy (CBT). Cog Beh Ther and Clin App. 2018. Scholar
  112. 112.
    Germain A, Campbell R, McKeon A. Sleep disturbances and sleep assessment methods in PTSD. In: Vermetten E, Germain A, Neylan TC, editors. Sleep and combat-related post traumatic stress disorder. New York: Springer; 2018. p. 193–200.CrossRefGoogle Scholar
  113. 113.
    Ebdlahad S, Nofzinger EA, James JA, Buysse DJ, Price JC, Germain A. Comparing neural correlates of REM sleep in posttraumatic stress disorder and depression: a neuroimaging study. Psychiatry Res. 2013;214(3):422–8.PubMedCrossRefGoogle Scholar
  114. 114.
    Germain A, James J, Insana S, et al. A window into the invisible wound of war: functional neuroimaging of REM sleep in returning combat veterans with PTSD. Psychiatry Res. 2013;211(2):176–9.PubMedCrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Matthew S. Brock
    • 1
    Email author
  • Tyler A. Powell
    • 1
  • Jennifer L. Creamer
    • 2
  • Brian A. Moore
    • 3
    • 4
  • Vincent Mysliwiec
    • 1
  1. 1.Department of Sleep MedicineSan Antonio Uniformed Services Health Education ConsortiumSan AntonioUSA
  2. 2.Sleep Medicine CenterMartin Army Community HospitalFort BenningUSA
  3. 3.University of Texas Health Science Center at San AntonioSan AntonioUSA
  4. 4.University of Texas at San AntonioSan AntonioUSA

Personalised recommendations