Trauma associated sleep disorder: A parasomnia induced by trauma

Mysliwiec, Vincent; Brock, Matthew S; Creamer, Jennifer; O’Reilly, B. M.; Germain, Anne; Roth, Bernard

doi:10.1016/j.smrv.2017.01.004

Cited by 116 publications

(80 citation statements)

References 79 publications

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“…15 Similar to TBI, individuals with PTSD experience a range of sleep problems, 16 including insomnia, 17,18 nightmares, 18,19 sleep fragmentation, 20 OSA, 21,22 and parasomnias. [23][24][25] Similar to sleep disturbances, both TBI and PTSD are also independently associated with increased pain. [26][27][28][29][30][31][32][33][34][35][36] In fact, the combination of TBI, PTSD, and pain, referred to clinically as the "polytrauma clinical triad," 31,37-39 is very common among Veterans, with recent work reporting a prevalence of approximately 42% from 340 Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans.…”

Section: Increased Sleep Disturbances and Pain In Veterans With Comormentioning

confidence: 99%

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Balba

Elliott

Weymann

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Methods: Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). Results: The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. Conclusions: These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population. stress disorder (PTSD). Among the most prevalent, persistent, and debilitating sequelae in both TBI and PTSD are sleep disturbances and increased pain. Importantly, sleep disturbances and pain also share a reciprocal relationship such that increases in either can independently exacerbate the other. [4][5][6][7] It has been estimated that > 50% of people with TBI experience sleep disturbances, 8-10 including insomnia, 11 hypersomnia, 8 obstructive sleep apnea (OSA), 9 and circadian rhythm sleep disorders. 9,12 Furthermore, current evidence suggests these sleep disturbances can persist for several years postinjury. 13 Sleep disturbances are also a hallmark feature of PTSD BRIEF SUMMARY Current Knowledge/Study Rationale: Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common in Veterans and are independently associated with sleep disturbances and pain, both of which can exacerbate the other and impede rehabilitation. Understanding the relationship between TBI, PTSD, sleep, and pain will help improve treatment and rehabilitation in this vulnerable population. Study Impact: This study demonstrates that Veterans with PTSD and with both PTSD and TBI experience more sleep disturbances, but those with TBI and PTSD report significantly greater current pain intensity. These data help in the limited understanding of how Veterans with comorbid TBI and PTSD differ from Veteran...

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Section: Increased Sleep Disturbances and Pain In Veterans With Comormentioning

confidence: 99%

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Balba

Elliott

Weymann

et al. 2018

Journal of Clinical Sleep Medicine

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“…It is most likely the TSD represents a form of "REM sleep arousal disorder" triggered by nightmares and immediate post-arousal violent dream-enacting behaviors. This perspective is shared in a subsequent report by the authors of the original TSD paper: "Hyperarousal, as opposed to neurodegenerative changes in RBD, is a component of TSD that likely contributes to overriding atonia during REM sleep and the comorbid diagnosis of insomnia" (Mysliwiec et al 2018). The authors propose that TSD incorporates an inciting traumatic experience and clinical features of trauma-related nightmares and disruptive nocturnal behaviors as a novel parasomnia.…”

Section: Trauma-associated Sleep Disorder (Tsd)mentioning

confidence: 97%

The spectrum of disorders causing violence during sleep

Schenck

2019

Sleep Science Practice

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Violent behavior during sleep is a common problem, affecting > 2% of the population > 15 years old as found in two large epidemiologic studies. The differential diagnosis of sleep related injury and violence includes: REM sleep behavior disorder (RBD); NREM sleep parasomnias (sleepwalking, sleep terrors); parasomnia overlap disorder (RBD + NREM sleep parasomnias); obstructive sleep apnea; sexsomnia (sleep related abnormal sexual behaviors); sleep related dissociative disorder; trauma-associated sleep disorder/post-traumatic stress disorder; periodic limb movement disorder; rhythmic movement disorder; nocturnal scratching disorder; nocturnal seizures; and miscellaneous/mixed conditions. Careful clinical interviews, preferably with bed partners participating, and extensive, hospital-based, technologist-attended, overnight video-polysomnography (for one or more nights), is crucial for determining the accurate diagnosis that will guide proper therapy. Most of the disorders mentioned above are classified as parasomnias in the International Classification of Sleep Disorders, 3rd Edition, with parasomnias defined as abnormal behavioral, experiential and/or autonomic nervous system activity during entry into sleep, during any stage of sleep, and during emergence from any stage of sleep. Parasomnias are often manifestations of "state dissociation" in which components of one state of being (wake, REM sleep, NREM sleep) intrude into, and become admixed, with other states of being, with clinical consequences. There are forensic implications related to the parasomnias, with inadvertent and unintentional assaults, murder, and "pseudo-suicide" resulting from aggressive and violent behaviors arising from sleep with suspended awareness and judgement.

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“…6,8,28,29 However, those with TSD do not necessarily have PTSD, and vice-versa. Similarly, the symptoms of RBD are primarily isolated to sleep and not wakefulness.…”

Section: Differences Between Rbd and Tsdmentioning

confidence: 99%

“…One of the most important distinguishing characteristics of TSD is that the trauma related nightmares can occur in both REM and NREM sleep, 29,30 which is not characteristic in other types of parasomnias. Nightmares that occur in NREM sleep may explain the variable level of recall that has been reported in patients with TSD.…”

Section: Differences Between Rbd and Tsdmentioning

confidence: 99%

Trauma-Associated Sleep Disturbances: a Distinct Sleep Disorder?

Rachakonda

Balba

Lim

2018

Curr Sleep Medicine Rep

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Purpose of review This paper describes a newly proposed sleep disorder, trauma-associated sleep disorder (TSD). Whether or not this represents a truly unique condition is controversial. In this paper, we describe the overlapping features and differences between TSD, post-traumatic stress disorder (PTSD) and Rapid Eye Movement (REM) sleep behavior disorder (RBD). Recent findings While REM sleep without atonia (RWA) and dream enactment are part of the diagnostic criteria for both RBD and TSD, only TSD features nightmares that occur both in non-REM and REM. A key difference between TSD and PTSD is the presence of symptoms during wakefulness in the latter, though the relationship between the two disorders is, as of yet, unclear. It is unknown whether or not a relationship exists between TSD and neurodegeneration, thus this needs to be explored further. Summary Additional research, such as application of TSD diagnostic criteria to more diverse population, would help to determine whether or not TSD is a distinct clinical entity, its relationships to PTSD, as well as the association of this condition with the development of neurodegeneration.

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Trauma associated sleep disorder: A parasomnia induced by trauma

Cited by 116 publications

References 79 publications

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

The spectrum of disorders causing violence during sleep

Trauma-Associated Sleep Disturbances: a Distinct Sleep Disorder?

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