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Sleep and posttraumatic stress disorder: a review
Abstract
Research seeking to establish the relationship between sleep and posttraumatic stress disorder (PTSD) is in its infancy. An empirically supported theory of the relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to critically review this literature, and to draw together the disparate theoretical perspectives that have been proposed to account for the empirical findings. After a brief overview of normal human sleep, the literature specifying the relation between sleep disturbance and PTSD is summarized. This includes studies of the prevalence of sleep disturbance and nightmares, content of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal threshold during sleep, body movement during sleep, and breathing-related sleep disorders. In addition, studies of the treatment of sleep disturbance in individuals with PTSD are reviewed. We conclude that the role of sleep in PTSD is complex, but that it is an important area for further elucidating the nature and treatment of PTSD. Areas for future research are specified. In particular, a priority is to improve the methodology of the research conducted.
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“For example, poor sleep has also been associated with post-traumatic stress [25], eating disorders [26], and psychosis spectrum experiences such as delusions and hallucinations [23,27].”
From Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials (2021) · cites this paper as [25]
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“…Objective sleep disturbances as measured with polysomnography have been less pronounced than subjective sleep complaints in PTSD (for reviews see Harvey et al., 2003; Pillar et al., 2000], but this may have been due to confounding factors in the studied PTSD samples such as age, gender,…”
MethodSpoormaker, V. I., Sturm, A., Andrade, K. C., Schröter, M. S., Goya‐Maldonado, R., Holsboer, F., Wetter, T. C., Sämann, P. G., & Czisch, M. (2010) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.04.017 · Cited by 143
“(1989) proposed that REM sleep disturbances are the hallmark of PTSD, but objective sleep disruptions have appeared less pronounced in PTSD (Harvey et al., 2003) than subjective sleep complaints such as insomnia and nightmares (Neylan et al.”
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“However, such disturbances can both exacerbate and prolong PTSD, especially since sleep serves a restorative function and facilitates emotional processing.(11)”
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“Long-lasting sleep disturbances are hallmark symptoms of PTSD that could interfere with a correct memory processing (Roszell et al., 1991; Leskin et al., 2002; Harvey et al., 2003) also causing functional and structural changes (Nardo et al.”
BackgroundA Psychometric Study of the Fear of Sleep Inventory-Short Form (FoSI-SF)
Pruiksma, K. E., Taylor, D. J., Ruggero, C. J., Boals, A., Davis, J. L., Cranston, C. C., DeViva, J. C., & Zayfert, C. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3710 · Cited by 58
The Impact of Insufficient Sleep on Combat Mission Performance
LoPresti, M. L., Anderson, J. A., Saboe, K. N., McGurk, D., Balkin, T. J., & Sipos, M. L. (2016) · Military Behavioral Health · doi:10.1080/21635781.2016.1181585 · Cited by 58
Psarros, C., Theleritis, C. G., Economou, M. P., Tzavara, C. K., Kioulos, K. T., Mantonakis, L., Soldatos, C. R., & Bergiannaki, J.-D. (2017) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2016.1276192 · Cited by 54
“Sleep disturbances were found to be core features of PTSD (Harvey et al., 2003; Szelenberger & Soldatos 2005; Germain et al. 2008; van Liempt 2012; Germain 2013; Huntley et al. 2014; Meyerhoff et al. 2014) while both REM and N-REM sleep are disrupted.”
BackgroundLewis, C., Lewis, K. S., Kitchiner, N., Isaac, S., Jones, I. R., & Bisson, J. I. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1767349 · Cited by 58
Treatment of chronic PTSD by cognitive therapy and exposure: 5-year follow-up
Tarrier, N., & Sommerfield, C. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80037-6 · Cited by 55
Horton, C. L. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00159 · Cited by 56
“Indeed, it seems likely that the only instances in which memories are replayed in their precise manner as they were originally experiences, is when they are so emotionally intense and negatively valenced that they were traumatic to the individual (50).”
BackgroundKing, H., Spence, D., Hickey, A. H., Sargent, P., Elesh, R., & Connelly, C. D. (2015) · Military Medicine · doi:10.7205/milmed-d-14-00451 · Cited by 54
“7) 0(0) 2 (10) Branch of Service Army (n, %) 1 (8.”
Pickett, S. M., Barbaro, N., & Mello, D. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000064 · Cited by 63
“Given that sleep disturbance is a common experience following trauma exposure and may be a risk factor for the subsequent development of PTSD (Babson & Feldner, 2010; Germain, 2013; Harvey et al., 2003; Marcks et al., 2010), it is important to understand how emotional reactivity and emotion regulation are associated w…”
BackgroundSpilsbury, J. C. (2009) · Behavioral Sleep Medicine · doi:10.1080/15402000903190207 · Cited by 56
“Many of these reviews focus specifically on the sleep characteristics of individuals with posttraumatic stress disorder (PTSD) or acute stress disorder (ASD; Harvey et al., 2003; Pillar et al., 2000; Singareddy & Balon, 2002).”
BackgroundWerner, K. B., Griffin, M. G., & Galovski, T. E. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.039 · Cited by 60
Raboni, M. R., Tufik, S., & Suchecki, D. (2006) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1364.054 · Cited by 57
Agorastos, A., & Olff, M. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1833644 · Cited by 56
Posttraumatic stress and sleep: Differential relations across types of symptoms and sleep problems
Babson, K. A., Feldner, M. T., Badour, C. L., Trainor, C. D., Blumenthal, H., Sachs‐Ericsson, N., & Schmidt, N. B. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.03.007 · Cited by 55
“These null findings also are consistent with the limited focus on avoidance symptoms in contemporary theoretical work aiming to explain linkages between PTSD and sleep problems (Harvey et al., 2003).”
Spoormaker, V. I., Gvozdanovic, G., Sämann, P. G., & Czisch, M. (2014) · Experimental Brain Research · doi:10.1007/s00221-014-3831-2 · Cited by 53
Pharmacological and non-pharmacological treatments for nightmare disorder
Nadorff, M. R., Lambdin, K. K., & Germain, A. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.888989 · Cited by 55
“Nightmares have a strong association with PTSD (Harvey et al., 2003; Kilpatrick et al., 1994; Mellman et al., 1995; Ohayon & Shapiro, 2000; Ross et al., 1989).”
BackgroundDissociation, memory commission errors, and heightened autonomic reactivity
Giesbrecht, T., Geraerts, E., & Merckelbach, H. L. G. J. (2007) · Psychiatry Research · doi:10.1016/j.psychres.2006.04.016 · Cited by 52
“For example, Harvey et al. (2003) consider sleep disruptions a typical reaction to traumatic events.”
BackgroundSleep’s role in the processing of unwanted memories: Sleep and processing of unwanted memories
FISCHER, S., DIEKELMANN, S., & BORN, J. (2011) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00881.x · Cited by 50
“…the unexpected disinhibition of suppressed memories observed after REM-rich sleep may have clinical implications, because diseases such as major depression and post-traumatic stress disorder (PTSD) are often related to increased REM sleep and REM density (Benca et al., 1992; Harvey et al., 2003).”
BackgroundEffects of REM deprivation and an NMDA agonist on the extinction of conditioned fear
Silvestri, A. J., & Root, D. H. (2007) · Physiology & Behavior · doi:10.1016/j.physbeh.2007.08.020 · Cited by 53
Zhou, X., Wu, X., An, Y., & Fu, F. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104470 · Cited by 54
“Furthermore, prior studies do not allow for conclusions regarding the causal relationships between specific PTSD symptom clusters and sleep problems because of cross-sectional design [12].”
BackgroundRabat, A., Bouyer, J. J., Aran, J. ‐., Courtière, A., Mayo, W., & Moal, M. L. (2004) · Brain Research · doi:10.1016/j.brainres.2004.02.046 · Cited by 47
Woods, S. J., Kozachik, S. L., & Hall, R. J. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20495 · Cited by 46
Obligate symbiosis: Sleep and affect
Walker, M. P., & Harvey, A. G. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2010.02.003 · Cited by 45
Metadata
- Authors
- Harvey, A. G., Jones, C., & Schmidt, D. A.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Harvey, Allison G
- ORCID
- Harvey, Allison G
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2003-05
- Volume
- 23
- Issue
- 3
- Pages
- 377-407
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2163325497
- Cited by
- 337
- References
- 142
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 11 · 2023: 18 · 2022: 11 · 2021: 19 · 2020: 13 · 2019: 9 · 2018: 7 · 2017: 29 · 2016: 12 · 2015: 16 · 2014: 21 · 2013: 18 · 2012: 15
- FWCI
- 12.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- post-traumatic stress disorder, sleep disorders, acute stress disorder, nightmares, REM sleep abnormalities, sleep-related movement disorders
- MeSH terms
- Humans, Middle Aged, Sleep Wake Disorders, Sleep, REM, Stress Disorders, Post-Traumatic, Veterans, Cognitive Behavioral Therapy
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