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Sleep Disturbances in Patients with Post-Traumatic Stress Disorder

Epidemiology, Impact and Approaches to Management

  • Therapy In Practice
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Abstract

Subjective reports of sleep disturbance indicate that 70–91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling or staying asleep. Nightmares are reported by 19–71% of patients, depending on the severity of their PTSD and their exposure to physical aggression. Objective measures of sleep disturbance are inconsistent, with some studies that used these measures indicating poor sleep and others finding no differences compared with non-PTSD controls. Future research in this area may benefit from examining measures of instability in the microstructure of sleep. Additionally, recent findings suggest that sleep disordered breathing (SDB) and sleep movement disorders are more common in patients with PTSD than in the general population and that these disorders may contribute to the brief awakenings, insomnia and daytime fatigue in patients with PTSD. Overall, sleep problems have an impact on the development and symptom severity of PTSD and on the quality of life and functioning of patients.

In terms of treatments, SSRIs are commonly used to treat PTSD, and evidence suggests that they have a small but significant positive effect on sleep disruption. Studies of serotonin-potentiating non-SSRIs suggest that nefazodone and trazodone lead to significant reductions in insomnia and nightmares, whereas cyproheptadine may exacerbate sleep problems in patients with PTSD. Prazosin, a centrally acting α1-adrenoceptor antagonist, has led to large reductions in nightmares and insomnia in small studies of patients with PTSD. Augmentation of SSRIs with olanzapine, an atypical antipsychotic, may be effective for treatment-resistant nightmares and insomnia, although adverse effects can be significant. Additional medications, including zolpidem, buspirone, gabapentin and mirtazapine, have been found to improve sleep in patients with PTSD. Large randomised, placebo-controlled trials are needed to confirm the above findings. In contrast, evidence suggests that benzodiazepines, TCAs and MAOIs are not useful for the treatment of PTSD-related sleep disorders, and their adverse effect profiles make further studies unlikely.

Cognitive behavioural interventions for sleep disruption in patients with PTSD include strategies targeting insomnia and imagery rehearsal therapy (IRT) for nightmares. One large randomised controlled trial of group IRT demonstrated significant reductions in nightmares and insomnia. Similarly, uncontrolled studies combining IRT and insomnia strategies have demonstrated good outcomes.

Uncontrolled studies of continuous positive airway pressure for SDB in patients with PTSD show that this treatment led to significant decreases in nightmares, insomnia and PTSD symptoms. Controlled studies are needed to confirm these promising findings.

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Notes

  1. Cohen’s d = (Mt – Mc)/SD, in which Mt and Mc represent the treatment and control group means and SD represents their pooled standard deviation. A medium effect is d = 0.50, while large effects start at d = 0.80.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. text revision. Washington, DC: American Psychiatric Association, 2000

    Google Scholar 

  2. Leskin GA, Woodward SH, Young HE, et al. Effects of comorbid diagnoses on sleep disturbance in PTSD. J Psychiatr Res 2002; 36(6): 449–52

    PubMed  Google Scholar 

  3. Krakow B, Melendrez D, Warner TD, et al. To breathe, perchance to sleep: sleep-disordered breathing and chronic insomnia among trauma survivors. Sleep Breath 2002; 6(4): 189–202

    PubMed  Google Scholar 

  4. Mellman TA, David D, Kulick-Bell R, et al. Sleep disturbance and its relationship to psychiatric morbidity after hurricane Andrew. Am J Psychiatry 1995; 152(11): 1659–63

    PubMed  CAS  Google Scholar 

  5. Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev 2003; 23(3): 377-407

    PubMed  Google Scholar 

  6. Horne JA. Human sleep, sleep loss and behavior: implications for the prefrontal cortex and psychiatric disorder. Br J Psychiatry 1993; 162: 413–9

    PubMed  CAS  Google Scholar 

  7. Gaily JA, Edelman GM. Neural reapportionment: an hypothesis to account for the function of sleep. C R Biol 2004; 327: 721–7

    Google Scholar 

  8. Mellman TA, David D, Bustamante V, et al. Dreams in the acute aftermath of trauma and their relationship to PTSD. J Trauma Stress 2001; 14(1): 241–7

    Google Scholar 

  9. Hartmann E. Nightmare after trauma as a paradigm for all dreams: a new approach to the nature and function of dreaming. Psychiatry 1998; 61: 223–38

    PubMed  CAS  Google Scholar 

  10. Foa EB, Riggs DS, Gershuny BS. Arousal, numbing, and intrusion: symptom structure of PTSD following assault. Am J Psychiatry 1995; 152(1): 116–20

    PubMed  CAS  Google Scholar 

  11. Kilpatrick DG, Resick HS, Freedy JR, et al. Posttraumatic stress disorder field trail: evaluation of the PTSD construct: criteria A through E. In: Widiger TA, Friedman MJ, Pincus HA, et al., editors. DSM-IV sourcebook. Washington, DC: American Psychiatric Press, 1998: 803–46

    Google Scholar 

  12. Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry 2000; 41(6): 469–78

    PubMed  CAS  Google Scholar 

  13. Germain A, Buysse DJ, Shear MK, et al. Clinical correlates of poor sleep quality in posttraumatic stress disorder. J Trauma Stress 2004; 17(6): 477–84

    PubMed  Google Scholar 

  14. Krakow B, Germain A, Warner TD, et al. The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. J Trauma Stress 2001; 14(4): 647–65

    PubMed  CAS  Google Scholar 

  15. Roszell DK, McFall ME, Malas KL. Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD. Hosp Community Psychiatry 1991; 42(3): 293–6

    PubMed  CAS  Google Scholar 

  16. Neylan TC, Marmar CR, Metzler TJ, et al. Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatry 1998; 155(7): 929–33

    PubMed  CAS  Google Scholar 

  17. Koren D, Arnon I, Lavie P, et al. Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents. Am J Psychiatry 2002; 159(5): 855–7

    PubMed  Google Scholar 

  18. Harvey AG, Bryant RA. The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol 1998; 66(3): 507–12

    PubMed  CAS  Google Scholar 

  19. Lavie P, Katz N, Pillar G, et al. Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients. Biol Psychiatry 1998; 44(10): 1060–5

    PubMed  CAS  Google Scholar 

  20. Lavie P, Hefez A, Halperin G, et al. Long-term effects of traumatic war-related events on sleep. Am J Psychiatry 1979; 136: 175–8

    PubMed  CAS  Google Scholar 

  21. Habukawa M, Uchimura N, Kotorii N, et al. Evaluation of sleep disturbance in post-traumatic stress disorder. Sleep Biol Rhythms 2003; 1(3): 241–3

    Google Scholar 

  22. Mellman TA, Kulick-Bell R, Ashlock LE, et al. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry 1995; 152(1): 100–5

    Google Scholar 

  23. Breslau N, Roth T, Burduvali E, et al. Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. Arch Gen Psychiatry 2004; 61(5): 508–16

    PubMed  Google Scholar 

  24. Dagan Y, Zinger Y, Lavie P. Actigraphic sleep monitoring in posttraumatic stress disorder (PTSD) patients. J Psychosom Res 1997; 42(6): 577–81

    PubMed  CAS  Google Scholar 

  25. Engdahl BE, Eberly RE, Hurwitz TD, et al. Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder. Biol Psychiatry 2000; 47(6): 520–5

    PubMed  CAS  Google Scholar 

  26. Fuller KH, Waters WF, Scott O. An investigation of slow-wave sleep processes in chronic PTSD patients. J Anxiety Disord 1994; 8(3): 227–36

    Google Scholar 

  27. Hurwitz TD, Mahowald MW, Kuskowski M, et al. Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry 1998; 44(10): 1060–5

    Google Scholar 

  28. Klein E, Koren D, Arnon I, et al. No evidence of sleep disturbance in post-traumatic stress disorder: a polysomnographic study in injured victims of traffic accidents. Isr J Psychiatry Relat Sci 2002; 39(1): 3–10

    PubMed  Google Scholar 

  29. Woodward SH, Bliwise DL, Friedman MJ, et al. Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD. J Trauma Stress 1996; 9(1): 137–43

    PubMed  CAS  Google Scholar 

  30. Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep: what a nightmare! Sleep Med Rev 2000; 4(2): 183–200

    PubMed  Google Scholar 

  31. Edinger JD, Erwin CW, Fins AI, et al. Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients. J Clin Neurophysiol 1995; 12(3): 302–9

    PubMed  CAS  Google Scholar 

  32. Edinger JD, Glenn DM, Bastian LA, et al. Sleep in the laboratory and sleep at home II: comparisons of middle-aged insomnia sufferers and normal sleepers. Sleep 2001; 24(7): 761–70

    PubMed  CAS  Google Scholar 

  33. Terzano MG, Parrino L. Origin and significance of the cyclic alternating pattern (CAP). Sleep Med Rev 2000; 4(1): 101–23

    PubMed  Google Scholar 

  34. Parrino L, Ferrillo F, Smerieri A, et al. Is insomnia a neurophysiological disorder? The role of sleep EEG microstructure. Brain Res Bull 2004; 63(5): 377–85

    PubMed  Google Scholar 

  35. Halasz P, Terzano M, Parrino L, et al. The nature of arousal in sleep. J Sleep Res 2004; 13(1): 1–23

    PubMed  Google Scholar 

  36. Drake CL, Roehrs T, Roth T. Insomnia causes, consequences, and therapeutics: an overview. Depress Anxiety 2003; 18(4): 163–76

    PubMed  Google Scholar 

  37. Drummond SP, Smith MT, Orff HJ, et al. Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia. Sleep Med Rev 2004; 8(3): 243–7

    Google Scholar 

  38. Thorpy M. International classification of sleep disorders: diagnostic and coding manual. Rochester (MN): American Sleep Disorders Association, 1990

    Google Scholar 

  39. Brown TM, Boudewyns PA. Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder. J Trauma Stress 1996; 9(1): 129–36

    PubMed  CAS  Google Scholar 

  40. Ross RJ, Ball WA, Dinges DF, et al. Rapid eye movement sleep disturbance in posttraumatic stress disorder. Biol Psychiatry 1994; 35(3): 195–202

    PubMed  CAS  Google Scholar 

  41. Germain A, Nielsen TA. Sleep pathophysiology in posttraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry 2003; 54(10): 1092–8

    PubMed  Google Scholar 

  42. Krakow B, Germain A, Tandberg D, et al. Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors. Compr Psychiatry 2000; 41(1): 49–56

    PubMed  CAS  Google Scholar 

  43. Ross RJ, Ball WA, Dinges DF, et al. Motor dysfunction during sleep in posttraumatic stress disorder. Sleep 1994; 17(8): 723–32

    PubMed  CAS  Google Scholar 

  44. Duran J, Esnaola S, Rubio R, et al. Obstructive sleep apnea: hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years. Am J Respir Crit Care Med 2001; 163: 685–9

    PubMed  CAS  Google Scholar 

  45. American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22(5): 667–89

    Google Scholar 

  46. Moore P, Bardwell WA, Ancoli-Israel S, et al. Association between polysomnographic sleep measures and health-related quality of life in obstructive sleep apnea. J Sleep Res 2001; 10(4): 303–8

    PubMed  CAS  Google Scholar 

  47. Bennett LS, Barbour C, Langford B, et al. Health status in obstructive sleep apnea: relationship with sleep fragmentation and daytime sleepiness, and effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med 1999; 159(6): 1884–90

    PubMed  CAS  Google Scholar 

  48. Krakow B, Melendrez D, Pedersen B, et al. Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD. Biol Psychiatry 2001; 49(11): 948–53

    PubMed  CAS  Google Scholar 

  49. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163(3): 608–13

    PubMed  CAS  Google Scholar 

  50. Olson LG, King MT, Hensley MJ, et al. A community study of snoring and sleep-disordered breathing: prevalence. Am J Respir Crit Care Med 1995; 152(2): 711–6

    PubMed  CAS  Google Scholar 

  51. Dagan Y, Lavie P. Sleep apnea syndrome in war related PTSD victims [abstract]. Sleep Res 1991; 20: 178

    Google Scholar 

  52. Lavie P. Sleep disturbances in the wake of traumatic events. N Engl J Med 2001; 345(25): 1825–8

    PubMed  CAS  Google Scholar 

  53. Dagan Y, Lavie P, Bleich A. Elevated awakening thresholds in sleep stage 3–4 in war-related post-traumatic stress disorder. Biol Psychiatry 1991; 30(6): 618–22

    PubMed  CAS  Google Scholar 

  54. Schoen L, Kramer M, Kinney L. Auditory thresholds in the dream disturbed [abstract]. Sleep Res 1984; 13: 102

    Google Scholar 

  55. Blanchard EB, Hickling EJ, Buckley TC, et al. Psychophysiology of posttraumatic stress disorder related to motor vehicle accidents: replication and extension. J Consult Clin Psychol 1996; 64(4): 742–51

    PubMed  CAS  Google Scholar 

  56. Casada JH, Amdur R, Larsen R, et al. Psychophysiologic responsivity in posttraumatic stress disorder: generalized hyperresponsiveness versus trauma specificity. Biol Psychiatry 1998; 44(10): 1037–44

    PubMed  CAS  Google Scholar 

  57. Orr SP, Metzger LJ, Lasko NB, et al. Physiologic responses to sudden, loud tones in monozygotic twins discordant for combat exposure: association with posttraumatic stress disorder. Arch Gen Psychiatry 2003; 60(3): 283–8

    PubMed  Google Scholar 

  58. Shalev AY, Peri T, Brandes D, et al. Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study. Am J Psychiatry 2000; 157(2): 255–61

    PubMed  CAS  Google Scholar 

  59. Krakow B, Tandberg D, Scriggins L, et al. A controlled comparison of self-rated sleep complaints in acute and chronic nightmare sufferers. J Nerv Ment Dis 1995; 183(10): 623–7

    PubMed  CAS  Google Scholar 

  60. Idzikowski C. Impact of insomnia on health-related quality of life. Pharmacoeconomics 1996; 10 Suppl. 1: 15–24

    Google Scholar 

  61. Leger D, Guilleminault C, Bader G, et al. Medical and socio-professional impact of insomnia. Sleep 2002; 25(6): 625–9

    PubMed  Google Scholar 

  62. Dement WC, Pelayo R. Public health impact and treatment of insomnia. Eur Psychiatry 1997; 12(1): 31–9S

    PubMed  Google Scholar 

  63. Krakow B, Hollifield M, Johnston L, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 2001; 286(5): 537–45

    PubMed  CAS  Google Scholar 

  64. Jenkinson C, Davies RJ, Mullins R, et al. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 1999; 353: 2100–5

    PubMed  CAS  Google Scholar 

  65. Krakow B, Haynes PL, Warner TD, et al. Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. J Trauma Stress 2004; 17(3): 257–68

    PubMed  Google Scholar 

  66. Kramer M, Kinney L. Vigilance and avoidance during sleep in US Vietnam war veterans with posttraumatic stress disorder. J Nerv Ment Dis 2003; 191(10): 685–7

    PubMed  Google Scholar 

  67. Clum GA, Nishith P, Resick PA. Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims. J Nerv Ment Dis 2001; 189(9): 618–22

    PubMed  CAS  Google Scholar 

  68. Nishith P, Resick PA, Mueser KT. Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder. J Trauma Stress 2001; 14(3): 469–79

    PubMed  CAS  Google Scholar 

  69. Woodward SH, Arsenault NJ, Murray C, et al. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol Psychiatry 2000; 48(11): 1081–7

    PubMed  CAS  Google Scholar 

  70. Zayfert C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress 2004; 17(1): 69–73

    PubMed  Google Scholar 

  71. DeViva JC, Zayfert C, Mellman TA. Factors associated with insomnia among civilians seeking treatment for PTSD: an exploratory study. Behav Sleep Med 2004; 2(3): 162–76

    PubMed  Google Scholar 

  72. Krakow B, Hollifield M, Schrader R, et al. A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: a preliminary report. J Trauma Stress 2000; 13(4): 589–609

    PubMed  CAS  Google Scholar 

  73. Krakow B, Artar A, Warner TD, et al. Sleep disorder, depression, and suicidality in female sexual assault survivors. Crisis 2000; 21(4): 163–70

    PubMed  CAS  Google Scholar 

  74. Krakow B, Melendrez D, Johnston L, et al. Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. J Nerv Ment Dis 2002; 190(7): 442–52

    PubMed  Google Scholar 

  75. Krakow B, Lowry C, Germain A, et al. A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. J Psychosom Res 2000; 49(5): 291–8

    PubMed  CAS  Google Scholar 

  76. Youakim JM, Doghramji K, Schutte SL. Posttraumatic stress disorder and obstructive sleep apnea syndrome. Psychosomatics 1998; 39(2): 168–71

    PubMed  CAS  Google Scholar 

  77. Foa EB, Davidson JRT, Frances A. The expert consensus guideline series: treatment of posttraumatic stress disorder. The Expert Consensus Panels for PTSD. J Clin Psychiatry 1999; 60 Suppl. 16: 3–76

    Google Scholar 

  78. Asnis GM, Kohn SR, Henderson M, et al. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs 2004; 64(4): 383–404

    PubMed  CAS  Google Scholar 

  79. Brady KT, Pearlstein T, Ansis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA 2000; 283: 1837–44

    PubMed  CAS  Google Scholar 

  80. Davidson JR, Rothbaum BO, van der Kolk BA, et al. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 2001; 58(5): 485–92

    PubMed  CAS  Google Scholar 

  81. Davidson JR, Landerman LR, Farfel GM, et al. Characterizing the effects of sertraline in posttraumatic stress disorder. Psychol Med 2002; 32: 661–70

    PubMed  CAS  Google Scholar 

  82. Singareddy RK, Balon R. Sleep in posttraumatic stress disorder. Ann Clin Psychiatry 2002; 14(3): 183–90

    PubMed  Google Scholar 

  83. Stein DJ, Davidson J, Seedat S, et al. Paroxetine in the treatment of post-traumatic stress disorder: pooled analysis of placebo-controlled studies. Expert Opin Pharmacother 2003; 4(10): 1829–38

    PubMed  CAS  Google Scholar 

  84. Meltzer-Brody S, Connor KM, Churchill E, et al. Symptom-specific effects of fluoxetine in post-traumatic stress disorder. Int Clin Psychopharmacol 2000; 15(4): 227–31

    PubMed  CAS  Google Scholar 

  85. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder: randomised, double-blind study. Br J Psychiatry 1999; 175: 17–22

    PubMed  CAS  Google Scholar 

  86. Neylan TC, Metzler TJ, Schoenfeld FB, et al. Fluvoxamine and sleep disturbances in posttraumatic stress disorder. J Trauma Stress 2001; 14(3): 461–7

    PubMed  CAS  Google Scholar 

  87. Rosenthal R, Rosnow RL. Essentials of behavioral research: methods and data analysis. New York: McGraw Hill, 1991

    Google Scholar 

  88. De Boer M, Op den Velde W, Falger PJ, et al. Fluvoxamine treatment for chronic PTSD: a pilot study. Psychother Psychosom 1992; 57(4): 158–63

    PubMed  Google Scholar 

  89. Fujishiro J, Imanishi T, Onozawa K, et al. Comparison of the anticholinergic effects of the serotonergic antidepressants, paroxetine, fluvoxamine and clomipramine. Eur J Pharmacol 2002; 454(2–3): 183–8

    PubMed  CAS  Google Scholar 

  90. Zisook S, Chentsova-Dutton YE, Smith-Vaniz A, et al. Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry 2000; 61(3): 203–8

    PubMed  CAS  Google Scholar 

  91. Neylan TC, Lenoci M, Maglione ML, et al. The effect of nefazodone on subjective and objective sleep quality in posttraumatic stress disorder. J Clin Psychiatry 2003; 64(4): 445–50

    PubMed  CAS  Google Scholar 

  92. Gillin J, Smith-Vaniz A, Schnierow B, et al. An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic combat-related posttraumatic stress disorder. J Clin Psychiatry 2001; 62(10): 789–96

    PubMed  CAS  Google Scholar 

  93. McRae AL, Brady KT, Mellman TA, et al. Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depress Anxiety 2004; 19(3): 190–6

    PubMed  CAS  Google Scholar 

  94. Rosack J. FDA orders liver warning on nefazodone labels. Psychiatr News 2002; 37(3): 19

    Google Scholar 

  95. Nierenberg A, Adler L, Peselow E, et al. Trazodone for antidepressant-associated insomnia. Am J Psychiatry 1994; 151(7): 1069–72

    PubMed  CAS  Google Scholar 

  96. Warner MD, Dorn MR, Peabody CA. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry 2001; 34(4): 128–31

    PubMed  CAS  Google Scholar 

  97. Warner MD, Peabody CA, Whiteford H, et al. Trazodone and priapism. J Clin Psychiatry 1987; 48(6): 244–5

    PubMed  CAS  Google Scholar 

  98. Ashford J, Miller TW. Effects of trazodone on sleep in patients diagnosed with post-traumatic stress disorder (PTSD). J Contemp Psychother 1996; 26(3): 221–33

    Google Scholar 

  99. Lerer B, Bleich A, Kotier M, et al. Posttraumatic stress disorder in Israeli combat veterans: effect of phenelzine treatment. Arch Gen Psychiatry 1987; 44(11): 976–81

    PubMed  CAS  Google Scholar 

  100. Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20(8): 533–59

    PubMed  CAS  Google Scholar 

  101. Wilson S, Argyropoulos S. Antidepressants and sleep: a qualitative review of the literature. Drugs 2005; 65(7): 927–47

    PubMed  CAS  Google Scholar 

  102. Kuenzel HE, Murck H, Held K, et al. Antidepressants and periodic leg movements of sleep. Pharmacopsychiatry 2005; 37(5): 193–5

    Google Scholar 

  103. Yang C, White DP, Winkelman JW. Antidepressants and periodic leg movements of sleep. Biol Psychiatry 2005; 58(6): 510–4

    PubMed  CAS  Google Scholar 

  104. Picchietti D, Winkelman JW. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep 2004; 28(7): 891–8

    Google Scholar 

  105. Castillo JL, Menendeza P, Segoviaa L, et al. Effectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome. Sleep Med 2004; 5: 507–8

    PubMed  Google Scholar 

  106. Brophy MH. Cyproheptadine for combat nightmares in posttraumatic stress disorder and dream anxiety disorder. Mil Med 1991; 156(2): 100–1

    PubMed  CAS  Google Scholar 

  107. Harsch HH. Cyproheptadine for recurrent nightmares. Am J Psychiatry 1986; 143(11): 1491–2

    PubMed  CAS  Google Scholar 

  108. Gupta S, Austin R, Cali LA, et al. Nightmares treated with cyproheptadine. J Am Acad Child Adolesc Psychiatry 1998; 37(6): 570–2

    PubMed  CAS  Google Scholar 

  109. Jacobs-Rebhun S, Schnurr PP, Friedman MJ, et al. Posttraumatic stress disorder and sleep difficulty. Am J Psychiatry 2000; 157(9): 1525–6

    PubMed  CAS  Google Scholar 

  110. Taylor F, Raskind MA. The alphal-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol 2002; 22(1): 82–5

    PubMed  CAS  Google Scholar 

  111. Raskind MA, Dobie DJ, Kanter ED, et al. The alphal-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases. J Clin Psychiatry 2000; 61(2): 129–33

    PubMed  CAS  Google Scholar 

  112. Raskind MA, Peskind ER, Kanter ED, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry 2003; 160(2): 371–3

    PubMed  Google Scholar 

  113. Jakovljevic M, Sagud M, Mihaljevic-Peles A. Olanzapine in the treatment-resistant, combat-related PTSD: a series of case reports. Acta Psychiatr Scand 2003; 107(5): 394–6

    PubMed  CAS  Google Scholar 

  114. States J, St Dennis C. Chronic sleep disruption and the reexperiencing cluster of posttraumatic stress disorder symptoms are improved by olanzapine: brief review of the literature and a case-based series. Prim Care Companion J Clin Psychiatry 2003; 5(2): 74–9

    PubMed  Google Scholar 

  115. Ahearn EP, Krohn A, Connor KM, et al. Pharmacologic treatment of posttraumatic stress disorder: a focus on antipsychotic use. Ann Clin Psychiatry 2003; 15(3/4): 193–201

    PubMed  Google Scholar 

  116. Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 2002; 159(10): 1777–9

    PubMed  Google Scholar 

  117. Butterfield MI, Becker ME, Connor KM, et al. Olanzapine in the treatment of post-traumatic stress disorder: a pilot study. Int Clin Psychopharmacol 2001; 16(4): 197–203

    PubMed  CAS  Google Scholar 

  118. Robert S, Hamner MB, Kose S, et al. Quetiapine improves sleep disturbances in combat veterans with PTSD: sleep data from a prospective, open-label study. J Clin Psychopharmacol 2005; 25(4): 387–8

    PubMed  Google Scholar 

  119. Mellman TA, Clark RE, Peacock WJ. Prescribing patterns for patients with posttraumatic stress disorder. Psychiatr Serv 2003; 54(12): 1618–21

    PubMed  Google Scholar 

  120. Cates ME, Bishop MH, Davis LL, et al. Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Ann Pharmacother 2004; 38(9): 1395–9

    PubMed  CAS  Google Scholar 

  121. Braun P, Greenberg D, Dasberg H, et al. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry 1990; 51(6): 236–8

    PubMed  CAS  Google Scholar 

  122. Barker MJ, Greenwood KM, Jackson M, et al. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004; 19: 437–54

    PubMed  Google Scholar 

  123. Guilleminault C. Benzodiazepines, breathing, and sleep. Am J Med 1990; 88(3A): 25–8S

    Google Scholar 

  124. Dieperink ME, Drogemuller L. Zolpidem for insomnia related to PTSD [letter]. Psychiatr Serv 1999; 50(3): 421

    PubMed  CAS  Google Scholar 

  125. Pagel JF, Parnes B. Medications for the treatment of sleep disorders: an overview. Prim Care Companion J Clin Psychiatry 2001; 3(3): 118–25

    PubMed  Google Scholar 

  126. Wells BG, Chu CC, Johnson R, et al. Buspirone in the treatment of posttraumatic stress disorder. Pharmacotherapy 1991; 11(4): 340–3

    PubMed  CAS  Google Scholar 

  127. Duffy JD, Malloy PF. Efficacy of buspirone in the treatment of posttraumatic stress disorder: an open trial. Ann Clin Psychiatry 1994; 6(1): 33–7

    PubMed  CAS  Google Scholar 

  128. Fichtner CG, Crayton JW. Buspirone in combat-related posttraumatic stress disorder. J Clin Psychopharmacol 1994; 14(1): 79–81

    PubMed  CAS  Google Scholar 

  129. Hamner MB, Brodrick PS, Labbate LA. Gabapentin in PTSD: a retrospective, clinical series of adjunctive therapy. Ann Clin Psychiatry 2001; 13(3): 141–6

    PubMed  CAS  Google Scholar 

  130. De Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry 1996; 57Suppl. vn4: 19–25

    PubMed  Google Scholar 

  131. Lewis JD. Mirtazapine for PTSD nightmares. Am J Psychiatry 2002; 159(11): 1948–9

    PubMed  Google Scholar 

  132. Foa EB, Davidson JRT, Frances A. Effective treatments for PTSD. New York: Guilford Press, 2000

    Google Scholar 

  133. Nishith P, Duntley SP, Domitrovich PP, et al. Effect of cognitive behavioral therapy on heart rate variability during REM sleep in female rape victims with PTSD. J Trauma Stress 2003; 16(3): 247–50

    PubMed  Google Scholar 

  134. Krakow B, Johnston L, Melendrez D, et al. An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am J Psychiatry 2001; 158(12): 2043–7

    PubMed  CAS  Google Scholar 

  135. Krakow BJ, Melendrez DC, Johnston LG, et al. Sleep dynamic therapy for Cerro Grande fire evacuees with posttraumatic stress symptoms: a preliminary report. J Clin Psychiatry 2002; 63(8): 673–84

    PubMed  Google Scholar 

  136. Morin CM, Hauri PJ, Espie CA, et al. Nonpharmacologic treatment of chronic insomnia: an American Academy of Sleep Medicine review. Sleep 1999; 22(8): 1134–56

    PubMed  CAS  Google Scholar 

  137. Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999; 115(4): 1127–39

    PubMed  CAS  Google Scholar 

  138. Melendrez D, Krakow B, Johnston L, et al. A prospective study on the treatment of “complex insomnia”: insomnia plus sleep-disordered breathing: in a small series of crime victims with PTSD. Sleep 2001; 24Suppl. 2: A120

    Google Scholar 

  139. Krakow B, Melendrez D, Lee SA, et al. Refractory insomnia and sleep-disordered breathing: a pilot study. Sleep Breath 2004; 8(1): 15–29

    PubMed  Google Scholar 

  140. Bao G, Guilleminault C. Upper airway resistance syndrome: one decade later. Curr Opin Pulm Med 2004; 10(6): 461–7

    PubMed  Google Scholar 

  141. Brown TM, Skop BP, Mareth TR. Pathophysiology and management of the serotonin syndrome. Ann Pharmacother 1996; 30(5): 527–33

    PubMed  CAS  Google Scholar 

  142. Deviva JC, Zayfert C, Pigeon WR, et al. Treatment of residual insomnia after CBT for PTSD: case studies. J Trauma Stress 2005; 18(2): 155–9

    PubMed  Google Scholar 

  143. Stephen GA, Eichung PS, Quan SF. Treatment of sleep disordered breathing and obstructive sleep apnea. Minerva Med 2004; 95(4): 323–36

    PubMed  CAS  Google Scholar 

  144. Lesage S, Hening WA. The restless legs syndrome and periodic limb movement disorder: a review of management. Semin Neurol 2004; 24(3): 249–59

    PubMed  Google Scholar 

  145. Connor KM, Rothbaum B, Foa EB, et al. A controlled trial of combined sertraline and prolonged exposure therapy in post-traumatic stress disorder. Eur Neuropsychopharmacol 2002; 12Suppl. 3: S335

    Google Scholar 

  146. Otto MW, Hinton D, Korbly NB, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther 2003; 41: 1271–6

    PubMed  Google Scholar 

  147. Marshall RD, Cloitre M. Maximizing treatment outcome in post-traumatic stress disorder by combining psychotherapy with pharmacotherapy. Curr Psychiatry Rep 2000; 2: 335-40

    PubMed  CAS  Google Scholar 

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Acknowledgements

Drs Maher and Rego have no potential conflicts of interest directly relevant to the content of this review. Professor Asnis has received grants from Pfizer, GlaxoSmithKline, Wyeth and Sepracor, and has lectured for Pfizer, GlaxoSmithKline, Hoffman La Roche and Sanofi-Aventis. No sources of funding were used to assist in the preparation of this review.

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  1. Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, 10467, USA

    Michael J. Maker, Simon A. Rego &  Gregory M. Asnis

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  1. Michael J. Maker
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  2. Simon A. Rego
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  3. Gregory M. Asnis
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Correspondence to Gregory M. Asnis.

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Maker, M.J., Rego, S.A. & Asnis, G.M. Sleep Disturbances in Patients with Post-Traumatic Stress Disorder. CNS Drugs 20, 567–590 (2006). https://doi.org/10.2165/00023210-200620070-00003

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