PTSD

Post – traumatic stress disorder Abdul Alraiyes MD.

©2009 Alraiyes

PTSD

PTSD

Posttraumatic stress disorder (PTSD), an anxiety disorder that results from exposure to a traumatic event.

Three symptomatic clusters:
  

(1) intrusive/re-experiencing symptoms (2) avoidance symptoms (3) hyperarousal symptoms

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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

Disturbed sleep is prevalent, has a high impact and is a risk factor for PTSD:
  

Nightmares 50-70% “less during PSG” Insomnia 40-50% PLMs 33%

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•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
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PTSD
Discrepancy between the objective and subjective sleep complaints

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PTSD

Disturbed sleep is a residual symptom after PTSD treatment

Psychological treatment
  

Cognitive - behavioral therapy (CBT) eye movement desensitization and reprocessing (EMDR) imagery rehearsal treatment (IRT).

Of the 38 included RCTs, only six included reported the effects of PTSD treatment on sleep disturbance.
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PTSD

©2009 Alraiyes

PTSD

Disturbed sleep is a residual symptom after PTSD treatment

Pharmacotherapy
   

Cyproheptadine SSRI Benzodiazepines Atypical antipsychotic “Olanzapine” best results with SSRI

Only 14 placebo-controlled trials have measured the effects of pharmacological agents on sleep in PTSD patients
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PTSD

Treatment for disturbed sleep in PTSD alleviates PTSD levels
 

imagery rehearsal treatment (IRT). “nightmares reduction” IRT with CBT and Sleep hygiene stimulus control. “insomnia reduction” also anxiety, depression and PTSD symptoms reduced Praszosin “nightmares reduction”

CPAP treatment for SBD “nightmares reduction”

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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:
  

May well be a risk factor for the development of PTSD; Seems to develop into separate disorder(s) during the course of PTSD Frequently exacerbates PTSD symptom severity.

©2009 Alraiyes

PTSD

Clinical implications:

(1) screening for sleep disorders at intake (2) adequate referral or sleep treatment by an appropriate clinician.

©2009 Alraiyes

PTSD

Nightmares:
 

(IRT) imagery rehearsal treatment after the CBT and imagery transformation Praszosin

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PTSD

Insomnia:
  

Sleep hygiene Stimulus control Sleep restriction

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PTSD

Research Implications:


   

Screening for sleep disturbs Follow up sleep measurement Sleep focused treatment Implication of PSG more ambulatory forms. IRT Praszosin

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PTSD

Questions??

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PTSD

Thank You..

©2009 Alraiyes