Treatment of sleep disturbances in posttraumatic stress disorder: A review

Abstract

Abstract-Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitivebehavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

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

“…A recent meta-analysis demonstrated that IRT as compared to prazosin, an alpha-aderenergic blocker previously shown to be effective in reducing nightmares [64], produced equivalent reductions in nightmare frequency and associated sleep and trauma symptoms [67]. As such, the American Academy of Sleep Medicine and Veterans Administration/ Department of Defense endorses prazosin for the treatment of PTSD nightmares [64,68] which was further supported by two prazosin meta-analyses published in 2015 [69,70].…”

“…Like psychotherapy, treatment by SSRIs is associated with improved sleep quality [68]. Unfortunately, these medications also have sleep-related side effects, including insomnia and periodic limb movement sleep disorder [68].…”

“…Like psychotherapy, treatment by SSRIs is associated with improved sleep quality [68]. Unfortunately, these medications also have sleep-related side effects, including insomnia and periodic limb movement sleep disorder [68]. Of concern, greater usage of hypnotics is associated with less sleep improvement over the course of CBT for PTSD [88].…”

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

“…Management of comorbid PTSD and TBI generally should follow the VA/DOD CPG for each condition, and following the steps mentioned earlier in order from 1 to 4 is recommended for most clinical situations. Additional recommended resources are companion articles in this issue by Gibson (PTSD and chronic pain) [77] and Schoenfeld et al (PTSD and insomnia) [78].…”

Posttraumatic Stress Disorder, Comorbid Sleep Disturbances and Nocturnal Violence: The Importance of a Holistic Approach to Treatment

“…Neurologic trauma such as Traumatic Brain Injury (TBI) can lead to decreased adherence to therapy as a result of cognitive dysfunction and poor motivation. All of the above conditions are inextricably linked to sleep disturbances which may increase the risk of nocturnal violence [4][5][6][7].…”