©2009 Alraiyes
PTSD
PTSD
Posttraumatic stress disorder (PTSD), an
anxiety disorder that results from exposure to a
traumatic event.
©2009 Alraiyes
SLEEP and PTSD
Standard cognitive - behavioral treatment for
mood and anxiety disorders exclusively focuses
on daytime symptoms, and psychiatrists and
psychologists tend to know little about sleep
disorders due to a lack of training.
©2009 Alraiyes
PTSD
©2009 Alraiyes
PTSD
PTSD
many PTSD experts know so little about sleep
Sleep disorders are neglected not because of
unwillingness, but largely because of ignorance.
©2009 Alraiyes
PTSD
PTSD
©2009 Alraiyes
•Geracioti Jr TD, Baker DG, Ekhator NN, West SA, Hill KK, Bruce AB, et al. CSF norepinephrine concentrations inposttraumatic
stress disorder.Psychiatry 2001;158:1227–30.
•Mellman TA, Kumar A, Kulick-Bell R, Kumar M, Nolan B. Nocturnal/daytime noradrenergicmeasures and sleep incombat-related
PTSD. Biol Psychiatry 1995;38:174–9
Objective Prevalence
In PSG:
More Stage 1
Less SWS
More REM to wake and REM to stage 1 short dense REM
and more PLMs during REM
REM fragmentation
©2009 Alraiyes
PTSD
©2009 Alraiyes
PTSD
Disturbed sleep is a residual symptom after PTSD
treatment
Psychological treatment
©2009 Alraiyes
PTSD
©2009 Alraiyes
PTSD
Disturbed sleep is a residual symptom after PTSD
treatment
Pharmacotherapy
Cyproheptadine
SSRI
Benzodiazepines
Atypical antipsychotic “Olanzapine” best results with SSRI
©2009 Alraiyes
PTSD
Treatment for disturbed sleep in PTSD alleviates
PTSD levels
©2009 Alraiyes
PTSD
Conclusion:
Sleep disturbances
exacerbates the PTSD
Unlikely to be secondary to PTSD
Unlikely to be the primary problem in PTSD
©2009 Alraiyes
PTSD
Disturbed sleep:
©2009 Alraiyes
PTSD
Clinical implications:
©2009 Alraiyes
PTSD
Nightmares:
©2009 Alraiyes
PTSD
Insomnia:
Sleep hygiene
Stimulus control
Sleep restriction
©2009 Alraiyes
PTSD
Research Implications:
©2009 Alraiyes
PTSD
Questions??
©2009 Alraiyes
PTSD
Thank You..
©2009 Alraiyes