Posttraumatic Stress Disorder Nightmares Research Articles

Effects of blast exposure on anxiety and symptoms of post-traumatic stress disorder (PTSD) among displaced Ukrainian populations.

Generalized anxiety and symptoms of post-traumatic stress disorder (PTSD) are common among individuals forcibly displaced during war and conflict. Blast exposure may be one important contributor of such symptoms. The aims of this study were to provide data on blast-related experiences of internally displaced persons (IDPs) and refugees following Russia's invasion of Ukraine, and to assess the influence of blast exposure on generalized anxiety, and PTSD flashbacks and nightmares. An online health needs survey was distributed to Ukrainian IDPs and refugees between April and July 2022 using Facebook Ads Manager. Participants reported whether they experienced blast exposure since the beginning of the invasion, and whether they took medication for a mental health condition before the war started. Finally, they completed measures of generalized anxiety (GAD-2), and PTSD flashbacks and nightmares. Analyses included 3253 IDPs and 5073 refugees (N = 8326). Results revealed that 67.6% of total participants- 79.9% of IDPs and 61.7% of refugees-reported blast exposure since Russia's invasion. Further, 69.1% (95% CI: 68.05, 70.15) of total participants met the cut-off for generalized anxiety in which further diagnostic evaluation was warranted. Compared to refugees, IDPs reported higher generalized anxiety and greater frequency of PTSD symptoms, specifically flashbacks and nightmares. Further analyses revealed that the impact of blast exposure on flashback frequency was stronger among IDPs compared to refugees (β = 0.51; t(8322) = 11.88, p < .0001, 95% CI: 0.43, 0.60) and among participants with pre-existing mental health conditions compared to those without (β = 0.18; t(8157) = 2.50, p = .013, 95% CI: 0.04, 0.33). Mental health and psychosocial support must be prioritised within humanitarian relief for both IDPs and refugees and especially among people with underlying mental health conditions.

Sleep Disturbances Associated With Posttraumatic Stress Disorder.

Sleep disturbances, namely insomnia and recurrent nightmares, are ubiquitous following trauma exposure and are considered hallmarks of posttraumatic stress disorder (PTSD). Other sleep disorders frequently co-occur with PTSD. This article describes research examining sleep problems most common in PTSD, including prevalence and clinical characteristics. Sleep disturbances are often robust to trauma-focused treatment; thus, evidence for psychological and pharmacological interventions for insomnia and nightmares in PTSD are discussed. Given the high prevalence of sleep problems in PTSD, more work is needed to empirically study putative mechanisms linking trauma exposure and sleep, as well as how to best target these symptoms in patients with PTSD.

The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder

IntroductionNightmares are a re-experiencing symptom of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). They are intrusive, involuntary and have a significant impact on wellbeing, suggesting they have substantial clinical relevance. However, little is known about the phenomenological features of post-traumatic nightmares and how they are associated with the severity of PTSD and CPTSD symptoms. MethodParticipants (N = 398) who identified that they had experienced a lifetime trauma completed various self-report questionnaires related to PTSD symptoms, CPTSD symptoms and nightmare characteristics. Participants also described their sensory experiences and rated the emotional intensity and vividness of their post-traumatic nightmares. ResultsWe found that elevated scores on various characteristics of nightmares including frequency of awakenings, nightmare severity, impact on wellbeing and the perceived realism of the nightmare were linked to more severe PTSD and CPTSD symptoms. Further, increased frequency, vividness, and emotional intensity of nightmares significantly predicted more severe PTSD symptoms but not CPTSD symptoms. ConclusionsOur study was largely exploratory and was the first to identify that specific nightmare features are related to PTSD and CPTSD symptom severity. However, although nightmare features of frequency, vividness and intensity appear to be related to CPTSD symptom severity, other variables may better predict CPTSD symptoms. Possible explanations for our findings, implications for treatment and directions for future research are discussed.

Treating nightmares in posttraumatic stress disorder with dronabinol: study protocol of a multicenter randomized controlled study (THC PTSD-trial)

BackgroundDistressing nightmares are a core symptom of posttraumatic stress disorder (PTSD) and contribute to psychiatric comorbidity, impaired physical health and decreased social functioning. No specific pharmacological treatment for PTSD-related nightmares is yet approved. Preliminary clinical data indicate that cannabinoid agonists can improve nightmares and overall PTSD symptoms in patients with PTSD. The primary objective of the study is to examine the efficacy of oral dronabinol (BX-1) versus placebo in reducing nightmares in patients with PTSD. The secondary objectives of the study are to examine the efficacy of oral BX-1 in reducing other PTSD symptoms.MethodsThe study is designed as a multi-centric, double-blind, randomized (1:1), placebo-controlled, parallel group interventional trial. Eligible patients will be randomized to BX-1 or placebo, receiving a once-daily oral dose before bedtime for 10 weeks. Primary efficacy endpoint is the Clinician-Administered PTSD Scale (CAPS-IV) B2 score for the last week, measuring frequency and intensity of nightmares. Secondary efficacy endpoints are other disorder-specific symptoms in patients with PTSD. Further, tolerability and safety of dronabinol will be assessed.DiscussionThis randomized controlled trial will provide evidence whether treating patients with PTSD and nightmares with dronabinol is safe and efficacious.Trial registrationNCT04448808, EudraCT 2019–002211-25.

Effectiveness of Targeting Insomnia and Nightmares in Post-Traumatic Stress Disorder: A Transdiagnostic Intervention

Effectiveness of Targeting Insomnia and Nightmares in Post-Traumatic Stress Disorder: A Transdiagnostic Intervention

Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.

Treatment Guidelines for PTSD: A Systematic Review.

Background: The aim of this review was to assess the quality of international treatment guidelines for post-traumatic stress disorder (PTSD), and identify differences between guideline recommendations, with a focus on the treatment of nightmares. Methods: Guidelines were identified through electronic searches of MEDLINE, CINAHL, PubMed, Embase and Science Direct, as well as web-based searches of international guideline repositories, websites of psychiatric organisations and targeted web-searches for guidelines from the three most populous English-speaking countries in each continent. Data in relation to recommendations were extracted and the AGREE II criteria were applied to assess for quality. Results: Fourteen guidelines, published between 2004–2020, were identified for inclusion in this review. Only five were less than 5 years old. Three guidelines scored highly across all AGREE II domains, while others varied between domains. Most guidelines consider both psychological and pharmacological therapies as first-line in PTSD. All but one guideline recommended cognitive behavioural therapy (CBT) as first-line psychological treatment, and selective serotonin reuptake inhibitors (SSRIs) as first-line pharmacological treatment. Most guidelines do not mention the targeted treatment of nightmares as a symptom of PTSD. Prazosin is discussed in several guidelines for the treatment of nightmares, but recommendations vary widely. Most PTSD guidelines were deemed to be of good quality; however, many could be considered out of date. Recommendations for core PTSD symptoms do not differ greatly between guidelines. However, despite the availability of targeted treatments for nightmares, most guidelines do not adequately address this. Conclusions: Guidelines need to be kept current to maintain clinical utility. Improvements are most needed in the AGREE II key domains of ‘applicability’, ‘rigour of development’ and ‘stakeholder involvement’. Due to the treatment-resistant nature of nightmares, guideline development groups should consider producing more detailed recommendations for their targeted treatment. More high-quality trials are also required to provide a solid foundation for making these clinical recommendations for the management of nightmares in PTSD.

Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure.

Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares. A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares. PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares. Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.

Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder.

About 80% of posttraumatic stress disorder (PTSD) patients suffer from nightmares or dysphoric dreams that cause major distress and impact nighttime or daytime functioning. Lucid dreaming (LD) is a learnable and effective strategy to cope with nightmares and has positive effects on other sleep variables. In LDs, the dreamer is aware of the dreaming state and able to control the dream content. The aim of this study is to evaluate the effectiveness of lucid dreaming therapy (LDT) in patients suffering from PTSD. We suggest that learning a technique that enables the affected subjects to regulate the occurrence and content of nightmares autonomously increases the chance of coping with the complex symptoms of PTSD and can reduce suffering. Sleep quality (PSQI, Pittsburgh Sleep Quality Index), daytime sleepiness (ESS, Epworth Sleepiness Scale), quality of life (MQLI, Multicultural Quality of Life Index), psychological distress (SCL-90-R, Symptom Checklist 90-Revised), distress caused by traumatic events (IE-S, Impact of Events Scale), anxiety (SAS, Self-Rating Anxiety Scale), depression (SDS, Self-Rating Depression Scale), and nightmare severity were assessed in a self-rating questionnaire before and after the intervention. LDT had no effect on the investigated sleep variables. No correlation between reduction of nightmare severity and changes in PTSD-profile (IE-S) was found. Nevertheless, levels of anxiety and depression decreased significantly in the course of therapy. LDT could provide an alternate or complementary treatment option for nightmares in PTSD, specifically for symptoms of anxiety and depression.

Use of a synthetic cannabinoid (nabilone) in the ongoing management of posttraumatic stress disorder nightmares in the Canadian Armed Forces: Results of an anonymous online survey

Introduction: The synthetic cannabinoid nabilone has shown promise in the management of posttraumatic stress disorder (PTSD) nightmares. To date, three clinical papers have been published showing positive results in nightmare suppression in civilian and military populations. This medication came on the market as an antiemetic. Nabilone has been used on an off-label basis at the Canadian Forces Operational Trauma and Stress Support Centre (OTSSC) in Ottawa for over a decade for PTSD nightmares. To date, there are no published reports of the ongoing experiences of patients who have been prescribed this medication for nightmare suppression. This research was conducted with the intent to fill this gap in the literature. Methods: An anonymous online survey was conducted in order to obtain a better understanding of the clinical effects experienced by those who continued taking nabilone. Eligible participants were active military members diagnosed with PTSD who were prescribed nabilone for the suppression of chronic nightmares. Results: Sixty military members responded to questions related to their ongoing experience using nabilone. Prior to taking nabilone, they had suffered from PTSD nightmares for an average of seven years. Suppression of nightmares was reported by 73% of respondents who continued taking nabilone. A small proportion self-discontinued nabilone to determine whether the medication was still needed. Of those who discontinued, most reported a return of nightmares an average of 1 week later; however, not all experienced a recurrence of nightmares. These findings support attempting a reduction or cessation at some point during treatment. For those who continued to experience nightmares, suppression was achieved with similar dosages to those previously prescribed; this suggests that nightmares are chronic and may need a longer duration of treatment. Discussion: This is the first survey to capture data for nabilone as a PTSD nightmare treatment beyond seven weeks. The results of this survey conform to the existing literature showing the efficacy of nabilone, a synthetic cannabinoid, as having a positive effect on nightmare suppression.

1070 An Examination of the Relationship Between Language Use in Post-Trauma Nightmares and Psychological Sequelae in a Treatment Seeking Population

Abstract Introduction Studying language use in dreams and nightmares has become an increasingly used tool to understand underlying emotional and cognitive processes. Specifically, in regards to post-trauma nightmares (PTNMs), nightmare transcriptions can offer a lens to understand a survivor’s interpretation of their trauma. The current study will utilize a method of quantitative text analysis to analyze the relationship between specific psychological constructs and symptoms of posttraumatic stress disorder (PTSD) and nightmare qualities. It is hypothesized that there will be a positive correlation between words related to perceptual processes and negative emotions in nightmares and PTSD symptom and nightmare severity. There will be a negative correlation between cognitive processes and positive emotion words, and PTSD symptom and nightmare severity. Methods Fifty-three nightmares were collected from participants that were recruited from the community in a Midwestern city as part of an ongoing investigation of the effectiveness of a brief cognitive-behavioral intervention for PTNM, Exposure, Relaxation, and Rescripting Therapy (ERRT). All participants were over the age of 18, have experienced a criterion A trauma, and have nightmares at least once weekly. Linguistic Inquiry and Word Count (LIWC) was utilized to analyze the nightmare transcriptions. The Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Trauma-related Nightmare Survey (TRNS) were used to measure symptom severity. A Pearson’s correlation analysis was used for this exploratory study. Results Words related to perceptual processes were significantly positively correlated with PTSD symptom and nightmare severity (p&amp;lt;.05) Neither negative nor positive emotion words were significantly related to PTSD and nightmare symptoms (p&amp;gt;.05). Cognitive processing words were significantly negatively correlated with PTSD and nightmare symptoms (p&amp;lt;.05). Conclusion The results of this study support the hypothesis that language use in nightmares reveals important information about underlying cognitive and emotional functioning. The results of this study may have an important impact on treatment considerations for those who have experienced trauma. Analyzing language use in PTNM may help to understand the etiology and maintenance of PTSD symptoms. Support Support for this study comes from the University of Tulsa Institute of Trauma, Adversity, and Injustice.

1063 Depression Moderates the Association Between Posttraumatic Stress Disorder and Nightmare Severity in Nurses

Abstract Introduction Nurses report a higher prevalence of posttraumatic stress disorder (PTSD) than the general population, and approximately 18% of nurses report having depression. Nightmares are a common symptom of PTSD, and both nightmares and PTSD are correlated with depression. Nightmares may represent a possible clinical target for improving outcomes in both disorders. This study assessed associations between PTSD and depressive symptoms with nightmare severity, and whether depressive symptoms moderated associations between PTSD and nightmare severity. Methods Participants were 461 nurses (91% female; 77% white, mean age = 38.39 years) recruited from two hospitals for a parent study. Participants completed the Patient Health Questionnaire (PHQ-9), Post-traumatic Stress Disorder Checklist (PCL-5), and 14 days of sleep diaries to assess daily nightmare frequency and severity (on a scale of 0 = not at all severe to 3 = very severe). Results 22.1% of participants reported at least one nightmare across the 14 days, with a mean daily nightmare frequency of 1.17 (SD = 2.15) and a mean severity of 0.11 (SD = 0.18). PCL-5 and PHQ-9 scores were significantly correlated with nightmare severity (r = 0.27; r = 0.24, respectively) and each other (r = 0.69). PHQ-9 scores moderated the association between PCL-5 scores and nightmare severity (β = -.01, SE = &amp;lt;0.01, p = 0.015). For individuals 1 SD below the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity. For individuals 1 SD above the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity, but to a lesser degree. Conclusion Both depressive and PTSD symptoms were associated with more severe nightmares. Surprisingly, the association between PTSD symptoms and nightmare severity was stronger for those with lower depressive symptoms. Results suggest depression, PTSD, and nightmares may represent a partially overlapping symptom cluster. Research should investigate how nightmare treatment may reduce PTSD and depressive symptoms. Support NIAID R01AI128359-01

Prazosin for treatment of post-traumatic stress disorder: a systematic review and meta-analysis.

Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD. A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges' g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies. Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD=-0.31; 95% confidence intervals [CI]: -0.62, -0.01), nightmares (SMD=-0.75; 95% CI: -1.24, -0.27), and sleep quality (SMD=-0.57; 95% CI: -1.02, -0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences. Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.

The Possible Mechanism of the Appearance of Nightmares in Post-Traumatic Stress Disorder and Approaches to Their Prevention

Abstract—It is hypothesized that the basis of nightmares in post-traumatic stress disorder (PTSD) is modification of synaptic transmission in neural circuits that contain one of the following structures: the visual cortex, prefrontal cortex (PfC), basolateral amygdala (BLA), hippocampus, connected with them nuclei of the thalamus and basal ganglia (BG). The emergence of dreams is promoted by the induction of long-term potentiation of excitatory inputs to the striatonigral cells and the long-term depression of the inputs to the striatopallidal cells that are connected with the visual cortex, and give rise, respectively, to a direct and indirect path way through the BG. This leads to synergistic disinhibition of certain groups of neurons in the thalamus by the output BG nuclei and the formation of activity patterns that reflect dream content in the areas of the visual cortex and hippocampus, which are connected with thalamus. The occurrence of emotionally negative episodes in dreams is a consequence of an increase in BLA activity during PTSD, whose signals are summed with the signals from the hippocampus and PfC on the neurons of the ventral striatum. This mechanism suggests that, in order to prevent nightmares, it is necessary to induce long-term depression of the excitatory inputs to the neurons of the limbic structures and to the striatonigral cells. It is undesirable to act on the receptors on the striatopallidal cells because it may simultaneously induce long-term potentiation of the excitatory inputs to the neurons of PfC, BLA, and hippocampus, which have receptors of the same types. Given the data on the types of receptors on striatal neurons, it follows from the modulation rules we earlier formulated that nightmares may be prevented by antagonists of dopamine D1 receptor and alpha1 adrenoceptor and agonists of glucocorticoid, serotonin 5-HT1B, and cannabinoid CB1 receptors. The use of mineralocorticoid and serotonin 5-HT2A receptor agonists, as well as antagonists of alpha2 adrenoreceptors and dopamine D2 receptors (which are part of some antidepressants and antipsychotics) is undesirable in order to avoid side effects. The treatment should be short-term and used only at bedtime, to avoid impairments of physical activity and sensory perception in the awake state. The consequences of the proposed mechanism are consistent with the known results of clinical studies.

Portable Devices to Induce Lucid Dreams-Are They Reliable?

One of the main current challenges in lucid dreaming (LD) research is to develop a simple and reliable way to induce it (Stumbrys et al., 2012). This is because, for most people, LD is very pleasurable but also very rare (LaBerge and Rheingold, 1990; Mota-Rolim et al., 2013). Along with its recreational nature, LD also has potential clinical applications, such as the treatment of recurrent nightmares in post-traumatic stress disorder (Aurora et al., 2010; Mota-Rolim and Araujo, 2013; Morgenthaler et al., 2018). This has attracted the attention of high-tech companies, which have been launching portable LD induction devices commercially available to the general public. This equipment captures electroencephalographic (EEG) activity for the online detection of rapid eye movement (REM) sleep, the sleep stage associated with typical dreaming (Aserinsky and Kleitman, 1953; Dement and Kleitman, 1957; for review, see Hobson et al., 2000). To induce lucidity, most devices provide visual, auditory, and/or tactile stimuli as sensory cues, which can become incubated into the dream content to alert dreamers that they are dreaming but without waking them up (LaBerge et al., 1981a; LaBerge and Levitan, 1995). Other devices provide transcranial alternating current stimulation (tACS) of the frontal cortex (Voss et al., 2014). Here we review 10 such devices: DreamLight, NovaDreamer, Aurora, Remee, REM-Dreamer, ZMax, Neuroon, iBand, LucidCatcher, and Aladdin (Figure 1). Open in a separate window Figure 1 Up: Internal views of (A) REM-Dreamer sleeping mask and (B) LucidCatcher headband (images reproduced with permission from ELI Company and Luciding Inc). Down: Table comparing the devices. Stim, Stimulus; REM detect, online REM sleep detection; tech info, technological information; sci test, scientifically tested; L, light; S, sound; V, vibration; EM, eye movement; A, accelerometer; T, temperature; P, pulse oximeter; tACS, transcranial alternating current stimulation. Neuroon, iBand, Aurora, and Aladdin electrodes are placed on Fp1/Fp2 referenced to FpZ; ZMax electrodes are placed on AF7/AF8 referenced to FpZ; and LucidCatcher electrodes are placed on Fp1/Fp2 referenced to TP9/TP10.

Emotional Content in PTSD Nightmares and Its Relation to other PTSD Features; An Exploratory Study

Nightmares are a cardinal symptom of Post-Traumatic Stress Disorder (PTSD), but little is known about the experiential aspects of PTSD dreams. The present study is a secondary exploration of data collected in a randomized, controlled trial of prazosin in PTSD patients. This study examined affective attributes of nightmares in 20 PTSD patients using visual analogue scales (VAS) rated from “0” (never) to “100” (always) for anger, fear, and sadness. PTSD diagnosis was confirmed by Clinician-Administered PTSD Scale. Sitting pulse, Disturbing Dreams and Nightmare Severity Index (DDNSI), PTSD Checklist (PCL), and other psychiatric measurements were recorded. Analytic approach included Pearson’s r, paired t-tests, and multilinear regression modeling. The mean presence of anger, fear, and sadness in dreams was noted to have been: 54.9 ± 32.0, 76.6 ± 24.3, and 71.5 ± 26.2, respectively. Significant positive correlations were found between anger scores and the relation of a dream to: prior trauma (r= 0.5113), repetitive nature (r= 0.4807), and awakening the dreamer (r= 0.5781). Significant correlations were not seen for fearful or sad affects. In multilinear regression, “PCL minus sleep” scores were predicted by DDNSI and anger scores, after covarying for age and gender (F= 4.5, df = 19, p< 0.02). DDNSI scores and resting pulse were significantly positively correlated (r= 0.5541). These results confirm that PTSD dreams are negative-affect laden, and specifically, that anger in dreams is correlated with a greater degree of traumatic themes, repetitiveness, and awakenings. Additionally, anger in dreams best indicated the presence of worse global PTSD symptoms. The correlation between resting daytime pulse and DDNSI scores underlines the unifying features of PTSD across day and night.

Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD.

Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD. PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low. Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.

An Open-Label Study of Doxazosin Extended-Release for PTSD: Findings and Recommendations for Future Research on Doxazosin.

This report presents findings from an eight-week, open-label study of doxazosin extended-release for nightmares, sleep disturbance, and overall clinical symptoms in posttraumatic stress disorder (PTSD). Recommendations for future studies of doxazosin are provided. Fifteen male and female adults were enrolled. The primary endpoints were change in Clinician-Administered PTSD Scale total, nightmare, and sleep disturbance scores from pretreatment to end of treatment. Self-report data on PTSD, sleep quality, depression, and quality of life collected at three time points and sleep diary data collected daily were analyzed secondarily. Eight participants completed eight weeks of study treatment. Among completers, significant changes in nightmares and overall PTSD symptoms were found. Secondary analyses using data from completers and noncompleters demonstrated improvements in all secondary outcomes. Of the participants who dropped out of the study, four participants discontinued because of side effects, and three participants discontinued because of other barriers to study participation. These findings indicate that doxazosin may be of value for some individuals with PTSD but problematic for others. Alternative formulations of doxazosin, such as the immediate-release formulation, should be studied. Future research should examine moderators of treatment tolerability and treatment effects to best identify those who will or will not benefit from doxazosin.

Differences in rapid eye movement (REM) sleep abnormalities between posttraumatic stress disorder (PTSD) and major depressive disorder patients: REM interruption correlated with nightmare complaints in PTSD

ObjectiveThe presence of repeated nightmares in posttraumatic stress disorder (PTSD) has been hypothesized as a dysfunction of rapid eye movement (REM) sleep, but there has been remarkably little agreement about the pathophysiology. This presents a deterrent to more effective treatments. REM sleep abnormalities including elevated REM density also have been replicated in major depressive disorder (MDD). The purpose of this study was to clarify the difference of REM sleep abnormalities between the two disorders for understanding the pathophysiology of sleep disturbances in PTSD. MethodsPolysomnographic measures were compared among 14 PTSD patients (aged 23.7 ± 5.5 years) and 14 MDD patients (aged 27.9 ± 10.1 years) under drug-naive or drug-free conditions. We defined REM interruption by summing the intrusive wake times during the REM period and adding the subsequent wake times to the last epoch of REM period. The significant polysomnographic measures were correlated with PTSD symptoms within the PTSD group. ResultsREM interruption was significantly increased in the PTSD group compared with the MDD group (12.2 vs 2.1 min, p = 0.001). REM density was also significantly increased in the PTSD group compared with the MDD group (30.5 vs 23.1%, p = 0.019). Within the PTSD group, we found significant correlations between the severity of trauma-related nightmare complaints and the percentage of REM interruption (R = 0.62, p = 0.017), but not REM density. ConclusionsREM sleep abnormalities are different between PTSD and MDD. Increased REM interruption may be a biological marker correlated with nightmare complaints in PTSD patients. Treatments including pharmacotherapy that reduces REM interruption might ameliorate nightmares in PTSD.

Psychotherapeutic approaches for post-traumatic stress disorder nightmares

Post Traumatic Stress Disorder (PTSD) can affect individuals in both their waking and sleeping life and psychotherapists can utilize interventions towards either wakefulness or sleep. This article reviews the history of PTSD, its socio-cultural contexts, as well as incidence and treatment. We then discuss a multilevel cognitive model of PTSD nightmares and research-supported treatments. Such treatments range from waking exposure, pre-sleep rescripting, to lucid dreaming exposure. The authors conclude with a discussion of Time Perspective Therapy.