Sleep in post-traumatic stress disorder and panic: Convergence and divergence

Abstract

Disturbed sleep is a common clinical problem in anxiety disorders, particularly in patients with post-traumatic stress disorder (PTSD) and panic disorder (PD). Several studies have attempted to validate the subjective sleep complaints of these disorders using laboratory polysomnography. These attempts, typically focusing on PTSD or PD independently, have demonstrated inconsistent results. To our knowledge, no such studies have attempted to directly compare and contrast sleep disturbances in PTSD and PD together. Our review of the studies of subjective sleep disturbances, sleep architecture, and sleep-related biologic phenomena suggests that a comparative characterization of sleep disturbances in these two disorders is timely. Such an inference is based on our identification of several areas of convergence and divergence between PTSD and PD found in the published literature, as well as our own preliminary investigations. Specifically, PTSD and PD seem to converge on several sleep-related parameters, namely, sleep quality, presence of episodic parasomnias, and movement time. They also appear to diverge in other important sleep-related areas such as respiratory disturbances and the particular phenomenological nature of episodic parasomnias, namely nightmares or nocturnal panic attacks. Investigations focusing on such overlapping phenomena may provide groundwork for further elucidation of central fear systems underlying these two disorders. Additionally, such sleep studies have the potential to provide important insights into ongoing efforts to develop a cohesive conceptual framework into the patho-physiologies of these disorders.

Reformulating PTSD forDSM‐V: Life after Criterion A

“…Although other anxiety disorders are associated with sleep disturbance, they differ in their specific phenomenological characteristics (e.g., Sheikh, Woodward, & Leskin, 2003). It is of interest that a similar intervention, imagery rehearsal and rescripting, has been used specifically to treat nightmares as well as to treat PTSD symptoms more generally (Lamarche & De Koninck, 2007).…”

Objective evidence of sleep disturbance in women with posttraumatic stress disorder

“…In contrast to the consistent findings of self-reported sleep disturbances in PTSD, objective sleep laboratory studies have yielded inconsistent results when comparing sleep patterns between patients with and without PTSD (Breslau et al, 2004;Sheikh, Woodward, & Leskin, 2003). A number of studies have provided some objective support for sleep disturbance in PTSD including difficulty initiating and maintaining sleep, increased brief arousals during sleep, and reduced sleep efficiency (Glaubman, Mikulincer, Porat, Wasserman, & Birger, 1990;Lavie, Hefez, Halperin, & Enoch, 1979;Kulick-Bell, Asholck & Nolan, 1995;Mellman, Nolan, Hebbing, Kulick-Bell, Dominguez, 1997;Ross et al, 1994a).…”

Dreaming in Posttraumatic Stress Disorder: A Critical Review of Phenomenology, Psychophysiology and Treatment

“…Insight into the occurrence of posttraumatic nightmares throughout the sleep cycle is obscured by the relatively rare occurrence of nightmares in the sleep laboratory [3]. Thanks to Woodward et al [58], the results of a polysomnographic study with PTSD sufferers in the home and clinic setting are available.…”

“…Valid conclusions about any possible associations between PTSD and REM sleep parameters are lacking as previous reviews have considered only a portion of the available literature [3, 4]. Clarification of this issue is of high relevance for explaining features of posttraumatic nightmares and answering the question of whether the occurrence of posttraumatic nightmares is confined to REM sleep.…”

“…The association of posttraumatic psychopathology with sleep and dreaming has been of great interest to many researchers. Recent reviews [e.g., [3, 4]], however, have focused primarily on PTSD and sleep.…”