Abstract
Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.
Highlights
The present review focused on the interrelationship between sleep disturbances and Post-Traumatic Stress Disorder (PTSD) in the military population
trauma-associated sleep disorder (TSD) is described, after combat or other extreme traumatic experience, by (1) altered dream mentation; (2) disruptive nocturnal behaviors; (3) autonomic hyperarousal during sleep; and (4) REM sleep without atonia or dream enactment behavior during REM sleep as seen on PSG recordings [62,71]. This definition of TSD is very interesting because, within the broad category of PTSD, it identifies a subgroup of patients for whom sleep may be of particular importance both in the physiology of the disorder and its clinical manifestations
In military personnel diagnosed with insomnia or comorbid insomnia with obstructive sleep apnea (OSA) receiving four to eight biweekly sessions of cognitive behavioral therapy for insomnia (CBT) and CPAP for their OSA, improvements in sleep quality were associated with significant declines in depression and posttraumatic arousal symptoms, and a significant increase in plasma concentrations of IGF-1, the growth hormone dependent factor implicated in memory processes [7,116]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The present review focused on the interrelationship between sleep disturbances and PTSD in the military population This population represents a relatively homogeneous population in age which is exposed to well-defined physical and psychological constraints and to life-threatening occupational events, and whose medical state of health is rigorously monitored over the long-term. All of this facilitates clinical and fundamental research on sleep parameters that predict and/or aggravate chronic PTSD. PTSD in military forces could open up unique perspectives for biomedical research and care
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