S C I E N T I F I C I N V E S T I G A T I O N SD isruptive nocturnal behaviors (DNB) consisting of excessive movements, autonomic hyperarousal, abnormal vocalizations and complex motor behaviors, and nightmares which are replays of traumatic experiences are frequently reported sleep disturbances in combat veterans and trauma survivors with and without posttraumatic stress disorder (PTSD).1-6 Despite their frequent occurrence, there is no established diagnosis that accurately encompasses these sleep disturbances. Lack of diagnostic criteria is likely secondary to the discrepancy between frequent self-reported DNB and the rare occurrence of DNB in laboratory settings. 1,7,8 Thus, the exact nature of DNB in terms of their sleep stage, electromyographic (EMG) characteristics, and physiologic parameters are relatively unknown.Nightmare disorder is reported in up to 80% of patients with PTSD.9 This diagnosis does not acknowledge the presence of the DNB that trauma survivors frequently report.2,4,9 Secondary REM behavior disorder is reported to occur in patients with PTSD when REM without atonia (RWA) is present on a polysomnogram (PSG) and dream enactment behaviors are reported or are present on PSG 4,10 ; however, the onset of DNB and nightmares after an inciting traumatic event and the autonomic hyperactivity reported with trauma associated sleep disturbances are clinical and physiologic abnormalities that are not associated with REM behavior disorder (RBD).

Study Objectives: To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences. Methods: A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG fi ndings from our patients and review prior literature on sleep disturbances in trauma survivors. Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients. Conclusions: We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG fi ndings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma.