REM Sleep and the Early Development of Posttraumatic Stress Disorder

Mellman, Thomas A.; Bustamante, Victoria; Fins, Ana I.; Pigeon, Wilfred R.; Nolan, B.

doi:10.1176/appi.ajp.159.10.1696

Cited by 365 publications

(305 citation statements)

References 37 publications

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“…However, REM sleep architecture appeared non-disrupted in individuals with chronic PTSD [42]. These findings are consistent with previous literature in treatment-seeking, non-minority [43], and military populations [44]. Trauma-exposed individuals without PTSD, compared to those with PTSD, exhibit elevated right frontal theta power (4-8 Hz) during REM sleep.…”

Section: Rdoc Framework-based Correlates Of Trauma and Sleepsupporting

confidence: 89%

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

Kelly

Killgore

Haynes

2016

Curr Sleep Medicine Rep

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Posttraumatic stress disorder (PTSD) is associated with sleep disturbances, including insomnia, nightmares, sleep-disordered breathing, and REM abnormalities. Recent studies have expanded our knowledge of the neurobiology of trauma and sleep. In addition, intervention research has provided valuable information about how sleep treatments affect PTSD symptoms and how PTSD treatments affect sleep symptoms. This review of recent literature aims to move away from the categorical approach that currently dominates our conceptualization of trauma response and sleep disorders. Possible mechanisms of both trauma and sleep disturbance are posed within the framework put forth by the National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) project. By examining domains of dysfunction that cut across disorders, RDoC may guide future research and treatment of the maladaptive neurobiological and behavioral correlates of both trauma and sleep disturbances.

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Section: Rdoc Framework-based Correlates Of Trauma and Sleepsupporting

confidence: 89%

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

Kelly

Killgore

Haynes

2016

Curr Sleep Medicine Rep

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“…Although the present study focused on insomnia, the role of restless REM sleep in emotion regulation appears highly relevant to other realms of psychiatry. Restless REM sleep is present in MDD (18) and PTSD (19,20). Importantly, insomnia impedes the effectiveness of depression intervention (4), whereas treatment of insomnia improves remission from MDD (3).…”

Section: Discussionmentioning

confidence: 99%

“…We use the term "restless REM sleep" here to refer to REM sleep with a high number of phasic events, including arousals and eye movements. These phasic events commonly occur not only in insomnia (5) but also in depression (18) and posttraumatic stress disorder (PTSD) (19,20). If restless REM sleep interferes with the overnight resolution of emotional distress, it could contribute to its accumulation, appearing as a chronically hyperaroused state.…”

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confidence: 99%

Slow dissolving of emotional distress contributes to hyperarousal

Wassing

Benjamins

Dekker

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

141

121

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The mechanisms underlying hyperarousal, the key symptom of insomnia, have remained elusive, hampering cause-targeted treatment. Recently, restless rapid-eye-movement (REM) sleep emerged as a robust signature of sleep in insomnia. Given the role of REM sleep in emotion regulation, we hypothesized that restless REM sleep could interfere with the overnight resolution of emotional distress, thus contributing to accumulation of arousal. Participants (n = 1,199) completed questionnaires on insomnia severity, hyperarousal, self-conscious emotional distress, and thought-like nocturnal mentation that was validated to be a specific proxy for restless REM sleep (selective fragmentation: R = 0.57, P < 0.001; eye movement density: R = 0.46, P < 0.01) in 32 polysomnographically assessed participants. The experience of distress lasting overnight increased with insomnia severity (β = 0.29, P < 10 −23 ), whereas shortlasting distress did not (β = −0.02, P = 0.41). Insomnia severity was associated with hyperarousal (β = 0.47, P < 10 −63 ) and with the thought-like nocturnal mentation that is specifically associated with restless REM sleep (β = 0.31, P < 10 −26 ). Structural equation modeling showed that 62.4% of the association between these key characteristics of insomnia was mediated specifically by reduced overnight resolution of emotional distress. The model outperformed all alternative mediation pathways. The findings suggest that restless REM sleep reflects a process that interferes with the overnight resolution of distress. Its accumulation may promote the development of chronic hyperarousal, giving clinical relevance to the role of REM sleep in emotion regulation in insomnia, depression, and posttraumatic stress disorder.B oth insomnia and affective disorders are among the most prevalent and burdening health concerns facing our society. Targeted prevention of affective disorders in people at risk, as well as identification of mechanisms of conversion, could be the most viable approach to mitigate their increasing global burden (1). For the prevention of new-onset or recurrent affective disorder, insomnia may be the major risk factor that can be targeted best (2, 3). About 13% of people with insomnia develop major depression disorder (MDD) within a year (2). Moreover, remission rates after cognitive behavioral therapy are 21% lower for depressed patients with abnormal sleep compared with patients with relatively intact sleep (4). It therefore appears highly relevant to understand the mechanisms involved in the role of insomnia in disturbed emotion regulation (2). The present study addresses the roles of restless rapid-eye-movement (REM) sleep (5) and chronic physiological arousal (6), which are characteristic of both insomnia and MDD.Although sleep contributes to the more robust consolidation of emotional memories, relative to neutral memories (7, 8), their later recall is not associated with anywhere near the same magnitude of subjective emotional distress, autonomic arousal, and amygdala activation (7, 9-11). REM sleep p...

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“…An early report of 3 cases with "acute combat fatigue" described "markedly disrupted sleep" and "rare or absent rapid eye movement (REM) episodes" (51). Mellman et al (52) reported PSG findings from PSG recordings conducted within a month of trauma in 21 recently injured patients and 10 healthy controls. REM eye movement density was elevated in the recently trauma exposed, injured patients compared with healthy controls but were similar among those who did and did not develop PTSD.…”

Section: Sleep In Posttraumatic Stress Disordermentioning

confidence: 99%