Now, researchers are proposing a unique new sleep disorder — Trauma Associated Sleep Disorder, or TSD — to characterize sleep disturbances in trauma survivors.

What is trauma associated sleep disorder?

Trauma survivors often report having nightmares and disruptive nocturnal behaviors. Currently, there is no diagnosis that accurately captures the sleep disturbances experienced by trauma survivors.

TSD is a proposed sleep disorder that includes the following symptoms:

• Nightmares that are replays of traumatic experiences
• Disruptive nocturnal behaviors, such as vocalizations, screaming, sleepwalking, or combative behaviors that may injure bed partners, such as punching, kicking, or significant restlessness

These behaviors are similar to what is observed in REM sleep behavior disorder (RBD). However, people with RBD are usually older and may have Parkinson’s Disease or other similar disorders.

People with symptoms of TSD may also have symptoms of posttraumatic stress disorder (PTSD).

Researchers studied four cases of TSD in young, active-duty army soldiers. In each case, they did not have sleep disturbances before their traumatic experiences. Evaluation in a sleep lab allowed researchers to document their nightmares and nocturnal behaviors.

TSD is not yet classified as an official sleep disorder at this time. Researchers are gathering and reviewing evidence to better understand the symptoms experienced by trauma survivors.

How is TSD diagnosed and treated?

To make a diagnosis, a sleep doctor would ask you about your nightmares, nocturnal behaviors, and your risk for PTSD. You may be asked:

• When did your nightmares begin and how frequently do they occur?
• What are your nightmares about?
• What type of nocturnal behaviors are you experiencing?
• When did your nocturnal behaviors begin and how often do they occur?
• Are your nocturnal behaviors triggered by anything?
• Have you or your bed partner experienced any injuries resulting from your nocturnal behaviors?
• Did you experience trauma recently or in the past that may influence your dreams and nocturnal behaviors?
• Are you taking any new medications?

It may be recommended that you keep a sleep diary to better understand what is disturbing your sleep. If your doctor believes that you may have RBD, you may be recommended to undergo a sleep study.

Treating TSD may be similar to treating nightmare disorder. If you also have PTSD, treatment may be recommended for that as well.

Be mindful of your safety at night. Keep weapons away from the bed. Consider adding padding to bedside tables to prevent injuries.

In summary, combat veterans and trauma survivors may experience nightmares or disruptive nighttime behaviors. These behaviors may be indicative of TSD, a proposed sleep disorder. If your sleep is disrupted by these symptoms, seek help from your primary care doctor at Veterans Affairs or use the AASM sleep center directory to find an accredited sleep center near you.

Medical review by Reeba Mathew, MD FCCP

Authored by:

Kate Robards

The post Proposed sleep disorder for trauma survivors, veterans appeared first on Sleep Education.

Changes in sleep schedules during deployment, the stress of combat, injuries, and challenges related to post-deployment reintegration into society can all play a role in veterans experiencing nightmares.

How common are nightmares?

It’s estimated that 2-8% of adult civilians have weekly nightmares that affect sleep quality or cause daytime symptoms.

This number is much higher in veterans. According to the U.S. Department of Veterans Affairs, as many as 71-96% of veterans with post-traumatic stress disorder (PTSD) may have nightmares.

PTSD plays a major role in nightmares. Studies have suggested that as many as 34% of veterans have PTSD. Nightmares are one of the major symptoms that can affect the lives of veterans with PTSD.

Are there different types of nightmares?

Nightmares fall into two categories: idiopathic or secondary.

• Idiopathic nightmares usually only appear during a short period of time when you are experiencing high stress of emotional instability. This type of nightmare usually ends after the stressor is resolved.
• Secondary nightmares are related to a medical condition (such as trauma), a mood or psychiatric disorder (such as anxiety, depression, or personality disorder), substance abuse or medication use/withdrawal, or a sleep disorder (such as obstructive sleep apnea (OSA), REM sleep behavior disorder, or nocturnal seizures).

For veterans, past trauma may influence dreams and trigger nightmares. While most nightmares tend to occur in the final third of the night, nightmares that arise from trauma may occur in earlier sleep stages.

How are nightmares treated?

In most cases, treatment for nightmares is not necessary. However, if you have nightmare disorder and experience severe sleep disturbances and daytime sleepiness, treatment by a behavioral sleep medicine specialist is recommended.

These specialists may use several different types of techniques to treat nightmares. They can help you understand what is causing your nightmares and process traumatic events.

There are certain medications that may also be effective in reducing nightmares.

There may be other alternatives that help reduce nightmares, too.

A 2013 study suggested that CPAP therapy reduced nightmares in veterans with PTSD and sleep apnea. The study of 43 patients found that the mean number of nightmares per week fell significantly when patients used a CPAP device.

New technologies to help ease nightmares are being tested. One college student developed an app to reduce nightmares after he saw his father, a veteran with PTSD, struggle. The app detects biometric signals indicative of a nightmare. It buzzes to rouse a sleeper long enough to disrupt a nightmare without fully waking.

While technologies like this are still in their infancy, there are solutions to help veterans who experience frequent, traumatic nightmares. Seek help from your primary care doctor at Veterans Affairs or use the AASM sleep center directory to find an accredited sleep center near you.

Medical review by Virginia Skiba, MD

Authored by:

Kate Robards

The post Nightmares are more than just bad dreams for veterans appeared first on Sleep Education.

What sleep disorders are veterans likely to experience?

Veterans are exposed to stressful situations during military service. The stress of training, deployment, and returning to civilian life can impact sleep. The most common sleep disorders experienced by veterans include:

• Insomnia is the most common sleep complaint. It occurs when you have trouble falling asleep or staying asleep even though you had the opportunity to get a full night of sleep. Insomnia can affect your mood and make other medical conditions more difficult to manage.
• Nightmares may lead to sleep loss and, as a result, daytime sleepiness. Stress, anxiety, an irregular sleep routine or being overtired can increase your risk for nightmares. Having the same nightmare repeatedly over time can also be common after severe stress or a traumatic event.
• Obstructive sleep apnea, or OSA, is a common and serious sleep disorder that causes you to stop breathing during sleep. OSA can have a negative impact on your health. It may increase your risk of high blood pressure, heart disease, stroke, diabetes, and depression.

How are veterans impacted by sleep disorders?

A July 2021 study in the Journal of Clinical Sleep Medicine reported that undiagnosed and undertreated sleep disorders are common among veterans at risk for cardiovascular disease. In a sample of 420 veterans, more than half (52.1%) screened positive for sleep apnea.

In addition to a high prevalence of sleep apnea, many veterans experience insomnia as well.

A report published in the journal SLEEP found that in a study of more than 5,500 post-9/11 veterans, 57.2% had insomnia. This is much higher than the general population. Studies have found that about 30% of the general adult population experience insomnia.

The study also found that insomnia rates increased among veterans with certain conditions. More than 93% of veterans with PTSD also had insomnia. Also, 77.7% of veterans with a traumatic brain injury and 69.6% of veterans with chronic pain also had insomnia.

Older veterans may experience long-term sleep problems, too. One study found that many older veterans have reported sleep problems that began during or immediately following military service and have persisted for decades.

Sleep problems may be common among veterans, but they can be treated effectively.

If you are experiencing sleep problems, seek help from your primary care doctor at Veterans Affairs or use the AASM sleep center directory to find an accredited sleep center near you.

Medical review by Virginia Skiba, MD

Authored by:

Kate Robards

The post Veterans are at risk for sleep apnea, insomnia, and nightmares appeared first on Sleep Education.

The study involved 405 veterans with insomnia disorder. They received up to six sessions of cognitive behavioral therapy for insomnia. CBT-I helps you change attitudes and habits that keep you from sleeping well. It also helps you learn new strategies to sleep better.

Results show that treating insomnia also reduced the risk of thinking about suicide. Suicidal thoughts decreased by 33 percent after treatment with CBT-I.

“Chronic insomnia is especially common among veterans,” said Dr. Timothy Morgenthaler. He is president of the American Academy of Sleep Medicine.  “This study emphasizes that effectively treating insomnia can be life-changing and potentially life-saving.”

Insomnia is the most common sleep complaint. It involves having trouble falling asleep or staying asleep. It also occurs when you wake up earlier than desired. About 10 percent of people have chronic insomnia disorder.

The CDC reports that suicide is the 10th leading cause of death in the U.S. It accounts for more than 38,000 deaths each year. Get help for feelings of despair by contacting the National Suicide Prevention Lifeline. Call 1-800-273-TALK (8255).

Learn more about the study in the journal Sleep: Effects of Cognitive Behavioral Therapy for Insomnia on Suicidal Ideation in Veterans.

The post Treating insomnia in veterans reduces suicidal thoughts appeared first on Sleep Education.

“We found that sleep quality was more strongly associated with physical activity one year later than was having a diagnosis of PTSD,” said lead author Lisa Talbot, postdoctoral fellow at the San Francisco VA Medical Center and the University of California, San Francisco. “The longitudinal aspect of this study suggests that sleep may influence physical activity.”

In other words, people are more likely to exercise is they get a good night’ sleep.

The study involved data from the Mind Your Heart Study, a prospective cohort study of 736 outpatients recruited from two Department of Veterans Affairs (VA) medical centers.

PTSD was assessed using the Clinician-Administered PTSD Scale (CAPS).

Participants rated their sleep quality overall during the last month, at baseline and again one year later. They reported the level of physical activity during the last month. Of the 736 military veteran participants, 258 had current or subsyndromal PTSD.

According to Talbot, the results suggest that behavioral interventions to increase physical activity should include an assessment for sleep disturbance.

According to the National Center for PTSD of the U.S. Department of Veterans Affairs, PTSD symptoms such as nightmares or flashbacks usually start soon after a traumatic event, but they may not appear until months or years later.

Symptoms that last longer than four weeks, cause great distress, or interfere with daily life may be a sign of PTSD.

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“Current combat veterans are a particularly vulnerable population due to psychiatric diseases such as PTSD, depression and anxiety, substance use, traumatic brain injuries and multiple injuries often associated with disability and chronic pain,” said lead author Jacob Collen, MD, Maj., MC, U.S. Army, Pulmonary, Critical Care and Sleep Medicine fellow at Walter Reed National Military Medical Center in Bethesda, Md. “Sleep disordered breathing is highly prevalent and has been demonstrated to worsen outcomes in patients with psychiatric disease, and prior, smaller studies have demonstrated that CPAP therapy may improve outcomes in patients with PTSD and obstructive sleep apnea.”

The study, which will appear in the December 15, 2012 edition of the Journal of Clinical Sleep Medicine, involved 90 patients with newly diagnosed OSA who initiated CPAP therapy (45 with combat-related PTSD and 45 controls). Results show that regular use of CPAP was significantly less common among patients with PTSD and was observed in 25.2 percent, compared with 58.3 percent among patients without PTSD. Greater adherence with CPAP was observed among patients with PTSD who were chronically using sedatives.

The authors were surprised to find that concurrent use of unspecified sedative agents was associated with improved CPAP compliance in patients with PTSD. Given the near universal use of multiple psychoactive medications in this population, it was not possible to discern which agents were responsible. However, in previous studies, they have demonstrated that use of nonbenzodiazepine sedative hypnotics, a group of drugs used to treat insomnia, improves short-term CPAP compliance.

“Given the multiple health concerns these soldiers face, and the rise in suicides in returning veterans, it is critical that we look for viable strategies to improve their overall health,” said Collen.  “Patients with PTSD tend to have worse adherence with a number of medical therapies, which creates a barrier to improving clinical outcomes. This study makes it clear that we need to do a better job at optimizing CPAP compliance in this population.”

The project mentor for this study was Christopher Lettieri, MD, Lt. Col., MC, U.S. Army, Chief of Sleep Medicine at Walter Reed National Military Medical Center in Bethesda, Md.

The post Vets with PTSD and sleep apnea less likely to use CPAP appeared first on Sleep Education.

Post-traumatic stress disorder (PTSD) affects nearly 1 in 4 veterans who served in either Afghanistan or Iraq. Once they return home, as many as 91 percent of veterans report having trouble falling asleep or staying asleep.

The study involved a group of 22 veterans with sleep problems related to symptoms of PTSD. Half of the veterans received a combination of cognitive-behavioral therapy for insomnia and image rehearsal therapy for PTSD-related nightmares. The control group was assigned prescription drugs including sleeping pills, antidepressants and other mood stabilizers. Both treatments lasted about twelve weeks.

Short-term results show the group who received CBT and image rehearsal therapy saw significant improvements in sleep and PTSD symptoms. Due to the sample size and the nature of the pilot study, further research is needed to demonstrate the effectiveness of the approach.

The study was published in the February issue of Journal of Clinical Sleep Medicine, the official journal of the American Academy of Sleep Medicine.

The approach used in the study combines two commonly used treatments for related conditions. Cognitive behavioral therapy is considered the frontline treatment for long-term insomnia. And behavioral sleep specialists use image rehearsal therapy to treat nightmare disorder. Both sleep disorders have similarities to the sleep-related symptoms of PTSD.

Another recent study proposed a more radical treatment for PTSD – sleep avoidance after a traumatic event. The authors theorize the trauma won’t go into memory if you don’t sleep. Sleep after all plays an important role in the development of memories.

Learn more about sleep and memory.

The post A solution to sleep problems from post-war trauma appeared first on Sleep Education.

Sleep problems were considerably more common and severe among those with post-traumatic stress disorder (PTSD), reports Military.com. PTSD is an anxiety syndrome that occurs after a traumatic event, such as combat or military exposure. Symptoms typically improve after three months of treatment, but for some people the problem continues for the rest of their lives.

Data from the Pentagon suggests that up to 20 percent of returning Iraq war veterans suffer from PTSD. Records from the Department of Veterans Affairs show that nearly 76,000 veterans of the current wars were diagnosed with PTSD between 2002 and mid-2008.

According to the AASM, most people with PTSD report having disturbed sleep, and suffer from severe nightmares in which they relive the traumatic event. Severe cases of PTSD may be treated with cognitive behavioral therapy and medications to improve sleep.

The post Civilian life is interrupted by PTSD and sleep disorders for many soldiers returning from Iraq appeared first on Sleep Education.

Stars and Stripes, the American Forces Press Service and the New York Times report that the Defense Department recently rejected the idea.

A Purple Heart is only awarded when a soldier with one of the U.S. Armed Services is wounded or killed by enemy action. Army Regulation 600-8-22 defines a wound as “an injury to any part of the body from an outside force or agent.” The wound “must have required treatment by a medical officer.”

The regulation lists PTSD as an injury that clearly does not meet these requirements. The Purple Heart has never been awarded for mental or psychological problems.

In a May article in Stars and Stripes a military psychologist argued for a change in the policy. He said that PTSD is in part a physical disorder because it damages the brain.

The idea got the attention of U.S. Secretary of Defense Robert Gates. This prompted a review of the policy and stoked the debate.

Common signs of PTSD include feelings of intense fear and horror after a terrifying event. Sometimes this response is delayed. Symptoms may not appear until a few days or even weeks after the event.

Recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Most people with PTSD also report having disturbed sleep. It can be very hard to fall asleep or stay asleep. This is known as “adjustment insomnia.”

About half of people with PTSD get better within three months. For others it can be a lifelong problem.

What do you think? Are veterans with PTSD being overlooked? Comment below to share your thoughts.

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