Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors

Abstract

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).

Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment

“…11 These DNBs include night sweats, dysphoric dreams, simple and complex motor behaviors or vocalizations, including dream enactment. More recently, Mysliwiec and colleagues 12 described trauma-associated sleep disorder (TASD) involving trauma-related nightmare enactment associated with specific polysomnographic features, but distinct from REM behavior disorder. Together, these observations suggest profound disturbances of both REM and NREM sleep in adults with PTSD.…”

Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

“…DNB include parasomnia-like episodes that are often reported by adults with PTSD, in addition to nightmares related to traumatic events. These episodes include panic attacks, night sweats, disturbing dreams unrelated to traumatic events, acting out dreams, and/or other complex vocal or motor behaviors (e.g., see Mysliviec et al, 2014; Husain et al, 2001; and Ohayon and Shapiro, 2000). The PSQI-A assesses the self-reported frequency of seven DNB and has been shown to have high validity.…”

Trauma-Associated Sleep Disturbances: a Distinct Sleep Disorder?

“…The most common types of sleep disturbances are insomnia and nightmares 2 but other sleep abnormalities have also been reported such as severely fragmented sleep, 3 early morning awakenings, 4,5 autonomic hyperarousal, 6 sleep talking and violently acting out of dreams. 6,7 These types of parasomnias have been reported in other populations, but there is currently a debate on whether clinicians should adopt a newly proposed parasomnia specific to these trauma-associated sleep disturbances. Mysliwiec and colleagues have made a strong case for the newly defined parasomnia, aptly named Trauma associated Sleep Disorder (TSD); however, many of these symptoms overlap with other disorders, most notably Posttraumatic Stress Disorder (PTSD) and Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD).…”

“…Mysliwiec and colleagues have made a strong case for the newly defined parasomnia, aptly named Trauma associated Sleep Disorder (TSD); however, many of these symptoms overlap with other disorders, most notably Posttraumatic Stress Disorder (PTSD) and Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD). 6 In this article we review the current understanding, clinical characteristics and pathophysiology of these disorders.…”