Sleep disturbances as the hallmark of PTSD: where are we now?

Germain, Anne

doi:10.1176/appi.ajp.2012.12040432

Cited by 634Sleep and related disordersPosttraumatic Stress Disorder ResearchSleep and Wakefulness Research

Sleep disturbances as the hallmark of PTSD: where are we now?

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Germain, Anne·2013·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2012.12040432PMC PMC4197954

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Abstract

The hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark of posttraumatic stress disorder (PTSD), proposed by Ross and colleagues in 1989, has stimulated a wealth of clinical, preclinical, and animal studies on the role of sleep in the pathophysiology of PTSD. The present review revisits this influential hypothesis in light of clinical and experimental findings that have since accumulated. Polysomnographic studies conducted in adults with PTSD have yielded mixed findings regarding REM sleep disturbances, and they generally suggest modest and nonspecific sleep disruptions. Prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms. Experimental animal and human studies that have probed the relationship between REM sleep and fear responses, as well as studies focused more broadly on sleep-dependent affective and memory processes, also provide strong support for the hypothesis that sleep plays an important role in PTSD-relevant processes. Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes. Clinicians need to consider that the chronic sleep disruption associated with nightmares may affect the efficacy of first-line PTSD treatments, but targeted sleep treatments may accelerate recovery from PTSD. The field is ripe for prospective and longitudinal studies in high-risk groups to clarify how changes in sleep physiology and neurobiology contribute to increased risk of poor psychiatric outcomes.

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Sleep disturbances and recurrent nightmares are recognized as the hallmark of PTSD.
“PTSD is characterized by hyperreactivity to emotional stimuli and an inability to extinguish traumatic memories (American Psychiatric Association, 2013) and sleep disturbances and recurrent nightmares are recognized as the hallmark of PTSD (Levin et al., 2010; Germain, 2013).”
From The Functional Role of Dreaming in Emotional Processes (2019) · cites this paper as Germain, 2013
The paper describes nightmares as a unique, core symptom of PTSD and discusses an influential hypothesis that sleep disturbances, especially REM disturbances and nightmares, are its hallmark. But the Abstract presents this as a hypothesis under review, not an established characterization, and reports mixed findings for REM sleep disturbances. The citing sentence overstates that certainty. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Sleep disruption may enhance maladaptive stress regulation.
“Stress, thus, influences sleep physiology and dream patterns and may cause both immediate and long-lasting sleep disruption (364–366), which may, in turn, enhance maladaptive stress regulation (367).”
From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [367]
PTSD patients report dreams with vivid images and negative emotions associated with the traumatic events.
“Specifically, PTSD patients report dreams with vivid images and negative emotions associated with the traumatic events (Germain, 2013).”
From The Functional Role of Dreaming in Emotional Processes (2019) · cites this paper as Germain, 2013
These sleep abnormalities are consistent with an underlying hyperarousal in PTSD that lightens sleep, prevents deeper, more restorative sleep stages, and alters the distinct physiology of REM sleep.
“These abnormalities are consistent with an underlying hyperarousal in PTSD that lightens sleep, prevents deeper, more restorative sleep stages, and alters the distinct physiology of REM sleep [20, 29, 36, 134, 143].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [36]
Both objective and subjective sleep disturbances represent core features of PTSD.
“Therefore, both objective and subjective sleep disturbances represent core features of PTSD [36, 134, 136].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [36]

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Effects of stress throughout the lifespan on the brain, behaviour and cognition
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009) · Nature Reviews Neuroscience · doi:10.1038/nrn2639 · Cited by 6,256 · see citing works
Principles and Practice of Sleep Medicine
Kryger, M. H., Roth, T. G., & Dement, W. C. (2011) · Elsevier eBooks · doi:10.1016/c2009-0-59875-3 · Cited by 5,118 · see citing works
Regularly Occurring Periods of Eye Motility, and Concomitant Phenomena, During Sleep
Aserinsky, E., & Kleitman, N. (1953) · Science · doi:10.1126/science.118.3062.273 · Cited by 2,488 · see citing works
Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.262.11.1479 · Cited by 2,440 · see citing works
Sleep-dependent memory consolidation
Stickgold, R. (2005) · Nature · doi:10.1038/nature04286 · Cited by 1,857 · see citing works
Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults
Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00188-3 · Cited by 1,831 · see citing works
The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition
Lupien, S. J., Maheu, F., Tu, M., Fiocco, A., & Schramek, T. E. (2007) · Brain and Cognition · doi:10.1016/j.bandc.2007.02.007 · Cited by 1,474 · see citing works
Sleep and Psychiatric Disorders: A Meta-analysis
Benca, R. M. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080059010 · Cited by 1,468 · see citing works
The human emotional brain without sleep—a prefrontal amygdala disconnect
Yoo, S.-S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007) · Current Biology · doi:10.1016/j.cub.2007.08.007 · Cited by 1,303 · see citing works
Sleep, learning, and dreams: off-line memory reprocessing
Stickgold, R., Hobson, J. A., Fosse, R., & Fosse, M. (2001) · Science · doi:10.1126/science.1063530 · Cited by 762 · see citing works
Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study
Raskind, M. A., Peskind, E. R., Kanter, E. D., Petrie, E. C., Radant, A. D., Thompson, C. E., Dobie, D. J., Hoff, D., Rein, R. J., Straits-Tröster, K. A., et al. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.2.371 · Cited by 607 · see citing works
REM sleep, prefrontal theta, and the consolidation of human emotional memory
Nishida, M., Pearsall, J., Buckner, R. L., & Walker, M. P. (2009) · Cerebral Cortex · doi:10.1093/cercor/bhn155 · Cited by 603 · see citing works
Sleep disturbance as the hallmark of posttraumatic stress disorder
(1989) · American Journal of Psychiatry · doi:10.1176/ajp.146.6.697 · Cited by 566 · see citing works
Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder: A Randomized Controlled Trial
Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., Tandberg, D., Lauriello, J., McBride, L., Cutchen, L., et al. (2001) · JAMA · doi:10.1001/jama.286.5.537 · Cited by 557 · see citing works
Self-citation
A Parallel Group Placebo Controlled Study of Prazosin for Trauma Nightmares and Sleep Disturbance in Combat Veterans with Post-Traumatic Stress Disorder
Raskind, M. A., Peskind, E. R., Hoff, D. J., Hart, K. L., Holmes, H. A., Warren, D., Shofer, J. B., O’Connell, J., Taylor, F., Gross, C., et al. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.06.032 · Cited by 554 · see citing works
THE AETIOLOGY OF HYSTERIA
Whitlock, F. A. (1967) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1967.tb11023.x · Cited by 482 · see citing works
EMDR: A putative neurobiological mechanism of action
Stickgold, R. (2001) · Journal of Clinical Psychology · doi:10.1002/jclp.1129 · Cited by 450 · see citing works
Polysomnographically measured sleep abnormalities in PTSD: A meta‐analytic review
Kobayashi, I., Boarts, J. M., & Delahanty, D. L. (2007) · Psychophysiology · doi:10.1111/j.1469-8986.2007.537.x · Cited by 435 · see citing works
Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents
Koren, D., Arnon, I., Lavie, P., & Klein, E. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.5.855 · Cited by 384 · see citing works
Beta EEG activity and insomnia
Perlis, M. L., Merica, H., Smith, M. T., & Giles, D. E. (2001) · Sleep Medicine Reviews · doi:10.1053/smrv.2001.0151 · Cited by 345 · see citing works
Spectral characteristics of sleep EEG in chronic insomnia
Merica, H., Blois, R., & Jm, G. (1998) · European Journal of Neuroscience · doi:10.1046/j.1460-9568.1998.00189.x · Cited by 345 · see citing works
Best practice guide for the treatment of nightmare disorder in adults
Standards of Practice Committee, Aurora, R. N., Zak, R. S., Auerbach, S. H., Casey, K. R., Chowdhuri, S., Karippot, A., Maganti, R. K., Ramar, K., Kristo, D. A., et al. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27883 · Cited by 341 · see citing works
Sleep Disturbances in Patients with Post-Traumatic Stress Disorder
Maher, M. J., Rego, S. A., & Asnis, G. M. (2006) · CNS Drugs · doi:10.2165/00023210-200620070-00003 · Cited by 337 · see citing works
Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study
Taylor, F. B., Martin, P., Thompson, C., Williams, J., Mellman, T. A., Gross, C., Peskind, E. R., & Raskind, M. A. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.07.001 · Cited by 336 · see citing works
A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder.
Bryant, R. A., Harvey, A. G., Guthrie, R. M., & Moulds, M. L. (2000) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.109.2.341 · Cited by 328 · see citing works
Sleep events among veterans with combat-related posttraumatic stress disorder
Mellman, T. A., Kulick‐Bell, R., Ashlock, L. E., & Nolan, B. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.1.110 · Cited by 315 · see citing works
Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans
(1984) · American Journal of Psychiatry · doi:10.1176/ajp.141.2.187 · Cited by 305 · see citing works
The Use of a Synthetic Cannabinoid in the Management of Treatment‐Resistant Nightmares in Posttraumatic Stress Disorder (PTSD)
Fraser, G. A. (2009) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2008.00071.x · Cited by 283 · see citing works
A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions
Gujar, N., McDonald, S. A., Nishida, M., & Walker, M. P. (2011) · Cerebral Cortex · doi:10.1093/cercor/bhq064 · Cited by 276 · see citing works
Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans
Wright, K. M., Britt, T. W., Bliese, P. D., Adler, A. B., Picchioni, D., & Moore, D. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20845 · Cited by 264 · see citing works
Sleep deprivation in the rat by the disk-over-water method
Rechtschaffen, A., & Bergmann, B. M. (1995) · Behavioural Brain Research · doi:10.1016/0166-4328(95)00020-t · Cited by 253 · see citing works
A brief Sleep Scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD
Germain, A., Hall, M. H., Krakow, B. J., Shear, M. K., & Buysse, D. J. (2004) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2004.02.001 · Cited by 247 · see citing works
Self-citation
Concepts and models of sleep regulation: an overview
Borbély, A. A., & Achermann, P. (1992) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1992.tb00013.x · Cited by 244 · see citing works
Sleep Disturbance Immediately Prior to Trauma Predicts Subsequent Psychiatric Disorder
Bryant, R. A., Creamer, M., O'Donnell, M., Silove, D., & McFarlane, A. C. (2010) · Sleep · doi:10.1093/sleep/33.1.69 · Cited by 243 · see citing works
Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans
Germain, A., Richardson, R., Moul, D. E., Mammen, O. K., Haas, G. L., Forman, S. D., Rode, N., Begley, A. E., & Nofzinger, E. A. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.11.010 · Cited by 231 · see citing works
Self-citation
Does cognitive–behavioral therapy for PTSD improve perceived health and sleep impairment?
Galovski, T. E., Monson, C., Bruce, S. E., & Resick, P. A. (2009) · Journal of Traumatic Stress · doi:10.1002/jts.20418 · Cited by 223 · see citing works
Rapid eye movement sleep disturbance in posttraumatic stress disorder
Ross, R. J. M., Ball, W. A., Dinges, D. F., Kribbs, N. B., Morrison, A. R., Silver, S. M., & Mulvaney, F. D. (1994) · Biological Psychiatry · doi:10.1016/0006-3223(94)91152-5 · Cited by 221 · see citing works
Relationships between REM sleep findings and PTSD symptoms during the early aftermath of trauma
Mellman, T. A., Pigeon, W. R., Nowell, P. D., & Nolan, B. (2007) · Journal of Traumatic Stress · doi:10.1002/jts.20246 · Cited by 221 · see citing works
Adverse childhood experiences and sleep disturbances in adults
Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., & Perry, G. S. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2011.03.013 · Cited by 217 · see citing works
Sleep pathophysiology in posttraumatic stress disorder and idiopathic nightmare sufferers
Germain, A., & Nielsen, T. A. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00071-4 · Cited by 214 · see citing works
Self-citation
A Multi-Component Cognitive-Behavioral Intervention for Sleep Disturbance in Veterans with PTSD: A Pilot Study
Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.28042 · Cited by 207 · see citing works
Sleep Promotes Generalization of Extinction of Conditioned Fear
(2009) · Sleep · doi:10.5665/sleep/32.1.19 · Cited by 196 · see citing works
Increases in Number of REMS and REM Density in Humans following an Intensive Learning Period
Smith, C. T., & Lapp, L. (1991) · SLEEP · doi:10.1093/sleep/14.4.325 · Cited by 181 · see citing works
Adverse childhood experiences associated with sleep in primary insomnia
BADER, K., SCHÄFER, V., SCHENKEL, M., NISSEN, L., & SCHWANDER, J. (2007) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2007.00608.x · Cited by 164 · see citing works
The nightmare : the psychology and biology of terrifying dreams
Hartmann, E. L. (1984) · Basic Books · Cited by 161 · see citing works
Heart rate variability during sleep and the early development of posttraumatic stress disorder
Mellman, T. A., Knorr, B. R., Pigeon, W. R., Leiter, J. C., & Akay, M. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2003.12.018 · Cited by 155 · see citing works
A Polysomnographic Comparison of Veterans With Combat-Related PTSD, Depressed Men, and Non-Ill Controls
Mellman, T. A., Nolan, B., Hebding, J., Kulick‐Bell, R., & Dominguez, R. A. (1997) · SLEEP · doi:10.1093/sleep/20.1.46 · Cited by 153 · see citing works
Childhood Abuse as a Risk Factor for Sleep Problems in Adulthood: Evidence from a U.S. National Study
Greenfield, E. A., Lee, C., Friedman, E. L., & Springer, K. W. (2011) · Annals of Behavioral Medicine · doi:10.1007/s12160-011-9285-x · Cited by 151 · see citing works
New Findings on the Neurological Organization of Dreaming: Implications for Psychoanalysis
Solms, M. (1995) · The Psychoanalytic Quarterly · doi:10.1080/21674086.1995.11927443 · Cited by 150 · see citing works
Laboratory sleep correlates of nightmare complaint in PTSD inpatients11The percentage of nights with nightmare reports across these four studies could rise to 41% if indeterminate numbers of nightmares and nights observed were set to their respective upper and lower bounds.
Woodward, S. H., Arsenault, N. J., Murray, C. F., & Bliwise, D. L. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00917-3 · Cited by 143 · see citing works
Polysomnographic sleep is not clinically impaired in vietnam combat veterans with chronic posttraumatic stress disorder
Hurwitz, T. D., Mahowald, M. W., Kuskowski, M. A., & Engdahl, B. E. (1998) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00089-4 · Cited by 137 · see citing works
The neural correlates and temporal sequence of the relationship between shock exposure, disturbed sleep and impaired consolidation of fear extinction
Spoormaker, 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 136 · see citing works
Dreams that work: The relation of dream incorporation to adaptation to stressful events.
CARTWRIGHT, R. D. (1991) · Dreaming · doi:10.1037/h0094312 · Cited by 132 · see citing works
Sleep Disruptions Among Returning Combat Veterans From Iraq and Afghanistan
Capaldi, V. F., Guerrero, M. L., & Killgore, W. D. S. (2011) · Military Medicine · doi:10.7205/milmed-d-10-00440 · Cited by 125 · see citing works
REM sleep deprivation affects extinction of cued but not contextual fear conditioning
Silvestri, A. J. (2005) · Physiology & Behavior · doi:10.1016/j.physbeh.2004.11.011 · Cited by 124 · see citing works
Simulation of Human Sleep: Ultradian Dynamics of Electroencephalographic Slow-Wave Activity
Achermann, P., & Borbély, A. A. (1990) · Journal of Biological Rhythms · doi:10.1177/074873049000500206 · Cited by 121 · see citing works
Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial
Cook, J. M., Harb, G. C., Gehrman, P., Cary, M. S., Gamble, G. M., Forbes, D., & Ross, R. J. M. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20569 · Cited by 120 · see citing works
Rapid Eye Movement Sleep Characteristics During and After Mood-Disturbing Events
CARTWRIGHT, R. D. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790020095009 · Cited by 119 · see citing works
Sleep and dreams in Vietnam PTSD and depression
Dow, B. M., Kelsoe, J. R., & Gillin, J. C. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00103-4 · Cited by 118 · see citing works
A rodent model of sleep disturbances in posttraumatic stress disorder: The role of context after fear conditioning
Pawlyk, A. C., Jha, S. K., Brennan, F. X., Morrison, A. R., & Ross, R. J. M. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.11.008 · Cited by 115 · see citing works
Differential Item Functioning Between Ethnic Groups in the Epidemiological Assessment of Depression
Breslau, J. A., Javaras, K. N., Blacker, D., Murphy, J. M., & Normand, S. T. (2008) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31816a490e · Cited by 115 · see citing works
Increased Activation of Anterior Paralimbic and Executive Cortex FromWaking to Rapid Eye Movement Sleep in Depression
Nofzinger, E. A., Buysse, D. J., Germain, A., Carter, C., Luna, B., Price, J. C., Meltzer, C. C., Miewald, J. M., Reynolds, C. F., & Kupfer, D. J. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.7.695 · Cited by 113 · see citing works
Self-citation
Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder
Engdahl, B. E., Eberly, R. E., Hurwitz, T. D., Mahowald, M. W., & Blake, J. D. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00201-2 · Cited by 113 · see citing works
PTSD-related hyperarousal assessed during sleep
Woodward, S. H., Murburg, M. M., & Bliwise, D. L. (2000) · Physiology & Behavior · doi:10.1016/s0031-9384(00)00271-7 · Cited by 108 · see citing works
Impact of Imagery Rehearsal Treatment on Distressing Dreams, Psychological Distress, and Sleep Parameters in Nightmare Patients
Germain, A., & Nielsen, T. (2003) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0103_2 · Cited by 104 · see citing works
Self-citation
Sleep complaints are not corroborated by objective sleep measures in post‐traumatic stress disorder: a 1‐year prospective study in survivors of motor vehicle crashes
Klein, E., Koren, D., Arnon, I., & Lavie, P. (2003) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2003.00334.x · Cited by 101 · see citing works
Paradoxical sleep deprivation impairs acquisition, consolidation, and retrieval of a discriminative avoidance task in rats
Alvarenga, T. A., Patti, C. L., Andersen, M. L., Silva, R. H., Calzavara, M. B., Lopez, G. B., Frussa‐Filho, R., & Tufik, S. (2008) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2008.07.013 · Cited by 96 · see citing works
The Effects of Stress Films on Dream Affect and on Respiration and Eye‐Movement Activity During Rapid‐Eye‐Movement Sleep
Goodenough, D. R., Witkin, H. A., Koulack, D., & Cohen, H. D. (1975) · Psychophysiology · doi:10.1111/j.1469-8986.1975.tb01298.x · Cited by 96 · see citing works
Changes in Cardiac Variability after REM Sleep Deprivation in Recurrent Nightmares
Nielsen, T., Paquette, T., Solomonova, E., Lara-Carrasco, J., Colombo, R., & Lanfranchi, P. A. (2010) · SLEEP · doi:10.1093/sleep/33.1.113 · Cited by 89 · see citing works
REM sleep: a sensitive index of fear conditioning in rats
Jha, S. K., Brennan, F. X., Pawlyk, A. C., Ross, R. J. M., & Morrison, A. R. (2005) · European Journal of Neuroscience · doi:10.1111/j.1460-9568.2005.03920.x · Cited by 83 · see citing works
EFFECTS OF A STRESSFUL PRESLEEP EXPERIENCE ON ELECTROENCEPHALOGRAPHRECORDED SLEEP
Bkeland, F., Koulack, D., & Lasky, R. (1968) · Psychophysiology · doi:10.1111/j.1469-8986.1968.tb02784.x · Cited by 83 · see citing works
Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors
Krakow, B. J., Germain, A., Tandberg, D., Koss, M. P., Schrader, R., Hollifield, M. A., Cheng, D., & Edmond, T. E. (2000) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(00)90131-7 · Cited by 82 · see citing works
Self-citation
Influence of fear conditioning on elicited ponto-geniculo-occipital waves and rapid eye movement sleep.
Sanford, L., Silvestri, A. J., Ross, R. J., & Morrison, A. R. (2001) · PubMed · Cited by 81 · see citing works
Effects of pre- or post-training paradoxical sleep deprivation on two animal models of learning and memory in mice
Silva, R. H. (2004) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2004.04.005 · Cited by 81 · see citing works
Enhancement of memory by auditory stimulation during postlearning REM sleep in humans
Guerrién, A., Dujardin, K., Mandal, O., Sockeel, P., & Leconte, P. (1989) · Physiology & Behavior · doi:10.1016/0031-9384(89)90219-9 · Cited by 66 · see citing works
Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder
Brown, T. M., & Boudewyns, P. A. (1996) · Journal of Traumatic Stress · doi:10.1007/bf02116838 · Cited by 65 · see citing works
Alterations in regional cerebral glucose metabolism across waking and non-rapid eye movement sleep in depression.
Nofzinger, E., Buysse, D. J., Germain, A., Price, J., Meltzer, C., Miewald, J., & Kupfer, D. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.4.387 · Cited by 62 · see citing works
Self-citation
Movement During Sleep: Associations with Posttraumatic Stress Disorder, Nightmares, and Comorbid Panic Disorder
Woodward, S. H., Leskin, G. A., & Sheikh, J. I. (2002) · SLEEP · doi:10.1093/sleep/25.6.669 · Cited by 61 · see citing works
Contextual Fear Extinction Ameliorates Sleep Disturbances Found Following Fear Conditioning in Rats
Wellman, L. L., Yang, L., Tang, X., & Sanford, L. D. (2008) · SLEEP · doi:10.5665/sleep/31.7.1035 · Cited by 60 · see citing works
Nefazodone in Patients With Treatment-Refractory Posttraumatic Stress Disorder
Zisook, S., Chentsova-Dutton, Y. E., Smith-Vaniz, A., Kline, N. A., Ellenor, G. L., Kodsi, A. B., & Gillin, J. C. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0310 · Cited by 60 · see citing works
REM sleep characteristics of nightmare sufferers before and after REM sleep deprivation
Nielsen, T., Paquette, T., Solomonova, E., Lara-Carrasco, J., Popova, A. A., & Levrier, K. (2009) · Sleep Medicine · doi:10.1016/j.sleep.2008.12.018 · Cited by 54 · see citing works
Case Series Utilizing Exposure, Relaxation, and Rescripting Therapy: Impact on Nightmares, Sleep Quality, and Psychological Distress
Davis, J. L., & Wright, D. C. (2005) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0303_3 · Cited by 54 · see citing works
The nightmare: The psychology and biology of terrifying dreams
Zorn, C. (1990) · New Ideas in Psychology · doi:10.1016/0732-118x(90)90038-4 · Cited by 54 · see citing works
Sleep, Dreaming, and Adaptation to a Stressful Intellectual Activity
Koulack, D., Prevost, F., & Koninck, J. D. (1985) · SLEEP · doi:10.1093/sleep/8.3.244 · Cited by 52 · see citing works
Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims
Kobayashi, I., Sledjeski, E. M., Spoonster, E., Fallon, W. F., & Delahanty, D. L. (2008) · Journal of Traumatic Stress · doi:10.1002/jts.20368 · Cited by 51 · see citing works
Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans
Insana, S., Kolko, D. J., & Germain, A. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.01.001 · Cited by 50 · see citing works
Self-citation
A Research-Based Reconsideration of the Psychoanalytic Theory of Dreaming
Greenbérg, R., Katz, H. M., Schwartz, W. R., & PEARLMAN, C. A. (1992) · Journal of the American Psychoanalytic Association · doi:10.1177/000306519204000211 · Cited by 44 · see citing works
Nocturnal panic and trauma
Freed, S., Craske, M. G., & Greher, M. R. (1999) · Depression and Anxiety · doi:10.1002/(sici)1520-6394(1999)9:3 · Cited by 31 · see citing works
Comparing neural correlates of REM sleep in posttraumatic stress disorder and depression: A neuroimaging study
Ebdlahad, S., Nofzinger, E. A., James, J. A., Buysse, D. J., Price, J. C., & Germain, A. (2013) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2013.09.007 · Cited by 30 · see citing works
Self-citation
Different types of avoidance behavior in rats produce dissociable post-training changes in sleep
Fogel, S. M., Smith, C. T., Higginson, C., & Beninger, R. J. (2010) · Physiology & Behavior · doi:10.1016/j.physbeh.2010.10.024 · Cited by 15 · see citing works
Sleep disruption in PTSD: A pilot study with home-based polysomnography
Germain, A., Hall, M. H., Shear, M. K., Nofzinger, E. A., & Buysse, D. J. (2006) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2006.00230.x · Cited by 11 · see citing works
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Research works printed but not linked: 2

[2]Hanlon J Kellerman H The nightmare and intrapsychic conflict The Nightmare: Psychological and Biological Foundations New York Columbia University Press 1987 16 32
[3]Kavaler S Kellerman H Nightmares and object relation theory The Nightmare: Psychological and Biological Foundations New York Columbia University Press 1987 33 57

Sorted by citations

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Krause, A. J., Simon, E. B., Mander, B. A., Greer, S. M., Saletin, J. M., Goldstein-Piekarski, A. N., & Walker, M. P. (2017) · Nature Reviews Neuroscience · doi:10.1038/nrn.2017.55 · Cited by 1,200 · see citing works
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Goldstein, A. N., & Walker, M. P. (2014) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032813-153716 · Cited by 1,052 · see citing works
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Background
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Freeman, D., Sheaves, B., Waite, F., Harvey, A. G., & Harrison, P. J. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30136-x · Cited by 843 · see citing works
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Shalev, A. Y., Liberzon, I., & Marmar, C. R. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1612499 · Cited by 799 · see citing works
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Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. S. (2014) · Behavioral and Brain Sciences · doi:10.1017/s0140525x14000041 · Cited by 572 · see citing works
Next-generation psychiatric assessment: Using smartphone sensors to monitor behavior and mental health.
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Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation
Agorastos, A., Pervanidou, P., Chrousos, G. P., & Baker, D. G. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00118 · Cited by 385 · see citing works
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Self-citation
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Self-citation
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Simor, P., van der Wijk, G., Nobili, L., & Peigneux, P. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101305 · Cited by 207 · see citing works
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Ho, F. Y., Chan, C. S., & Tang, K. N. S. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.09.005 · Cited by 188 · see citing works
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Self-citation
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Self-citation
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Self-citation
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Agorastos, A., Nicolaides, N. C., Bozikas, V. P., Chrousos, G. P., & Pervanidou, P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.01003 · Cited by 89 · see citing works
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Short, N. A., Allan, N. P., & Schmidt, N. B. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.07.014 · Cited by 86 · see citing works
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Zuj, D., & Norrholm, S. (2019) · Progress in Neuro-psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.08.014 · Cited by 78 · see citing works
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Tempesta, D., de Gennaro, L., Natale, V., & Ferrara, M. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.01.024 · Cited by 81 · see citing works
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Clouston, S., Kotov, R., Pietrzak, R. H., Luft, B. J., Gonzalez, A., Richards, M., Ruggero, C. J., Spiro, A., & Bromet, E. J. (2016) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1016/j.dadm.2016.08.001 · Cited by 84 · see citing works
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Werner, G. G., Riemann, D. W., & Ehring, T. W. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101383 · Cited by 82 · see citing works
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Lancel, M., Stroebe, M., & Eisma, M. C. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101331 · Cited by 80 · see citing works
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Karanikas, E., Daskalakis, N. P., & Agorastos, A. (2021) · Brain Sciences · doi:10.3390/brainsci11060723 · Cited by 78 · see citing works
Childhood maltreatment and sleep in children and adolescents: A systematic review and meta-analysis
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Mindfulness buffers the impact of COVID-19 outbreak information on sleep duration.
Zheng, M. X., Yao, J., & Narayanan, J. (2020) · doi:10.31234/osf.io/wuh94 · Cited by 77 · see citing works
Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders
Vandrey, R. G., Babson, K. A., Herrmann, E. S., & Bonn‐Miller, M. O. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.901300 · Cited by 76 · see citing works
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Ney, L. J., Matthews, A. J., Bruno, R., & Felmingham, K. L. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2019.03.017 · Cited by 76 · see citing works
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Tamanna, S., Parker, J. D., Lyons, J., & Ullah, M. I. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3786 · Cited by 75 · see citing works
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Liu, Y., Lin, W., Liu, C., Luo, Y., Wu, J., Bayley, P. J., & Qin, S. (2016) · Nature Communications · doi:10.1038/ncomms13375 · Cited by 74 · see citing works
Sleep smart—optimizing sleep for declarative learning and memory
Feld, G. B., & Diekelmann, S. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00622 · Cited by 74 · see citing works
Pre-deployment insomnia is associated with post-deployment post-traumatic stress disorder and suicidal ideation in US Army soldiers
Wang, H. E., Campbell‐Sills, L., Kessler, R. C., Sun, X., Heeringa, S. G., Nock, M. K., Ursano, R. J., Jain, S., & Stein, M. B. (2018) · SLEEP · doi:10.1093/sleep/zsy229 · Cited by 74 · see citing works
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Gallegos, A. M., Trabold, N., Cerulli, C., & Pigeon, W. (2019) · Trauma, Violence, & Abuse · doi:10.1177/1524838019852633 · Cited by 65 · see citing works
Validation of the French version of the Pittsburgh Sleep Quality Index Addendum for posttraumatic stress disorder
Aoudia, M. A., Lévy, P., Bui, É., Insana, S., de Fouchier, C., Germain, A., & Jehel, L. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.19298 · Cited by 73 · see citing works
Self-citation
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Vanderheyden, W. M., George, S. A., Urpa, L., Kehoe, M., Liberzon, I., & Poe, G. R. (2015) · Experimental Brain Research · doi:10.1007/s00221-015-4302-0 · Cited by 72 · see citing works
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Williams, S. G., Collen, J. F., Orr, N., Holley, A. B., & Lettieri, C. J. (2014) · Sleep And Breathing · doi:10.1007/s11325-014-0984-y · Cited by 72 · see citing works
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Psarros, C., Theleritis, C. G., Kokras, N., Lyrakos, D., Koborozos, A., Kakabakou, O., Tzanoulinos, G., Katsiki, P., & Bergiannaki, J.-D. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1368703 · Cited by 72 · see citing works
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Timpano, K. R., Carbonella, J. Y., Bernert, R. A., & Schmidt, N. B. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.06.021 · Cited by 69 · see citing works
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Cipolli, C., Ferrara, M., De Gennaro, L., & Plazzi, G. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.07.005 · Cited by 67 · see citing works
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El-Solh, A. (2018) · Nature and Science of Sleep · doi:10.2147/nss.s166089 · Cited by 69 · see citing works
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Sleep disturbances in veterans with chronic war-induced PTSD
Khazaie, H., Ghadami, M. R., & Masoudi, M. (2016) · Journal of Injury and Violence Research · doi:10.5249/jivr.v8i2.808 · Cited by 68 · see citing works
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Kanady, J. C., Talbot, L. S., Maguen, S., Straus, L. D., Richards, A. L., Yack, L. M., Metzler, T. J., & Neylan, T. C. (2018) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7224 · Cited by 66 · see citing works
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Agorastos, A., & Olff, M. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1956746 · Cited by 70 · see citing works
Nightmares in United States military personnel with sleep disturbances
Creamer, J. L., Brock, M. S., Matsangas, P., Motamedi, V., & Mysliwiec, V. (2018) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6990 · Cited by 63 · see citing works
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Walters, E. M., Jenkins, M. M., Nappi, C. M., Clark, J. W., Lies, J., Norman, S. B., & Drummond, S. P. A. (2019) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000478 · Cited by 63 · see citing works
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Pigeon, W. R., Funderburk, J. S., Cross, W. F., Bishop, T. M., & Crean, H. F. (2019) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz108 · Cited by 63 · see citing works
Insomnia and post-traumatic stress disorder: A meta-analysis on interrelated association (n = 57,618) and prevalence (n = 573,665)
Ahmadi, R., Rahimi, S., Olfati, M., Javaheripour, N., Emamian, F., Ghadami, M. R., Khazaie, H., Knight, D. C., Tahmasian, M., & Sepehry, A. A. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104850 · Cited by 67 · see citing works
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Cabrera, Y., Koymans, K. J., Poe, G. R., Kessels, H. W. H. G., Someren, E. J. W. V., & Wassing, R. (2024) · Nature reviews. Neuroscience · doi:10.1038/s41583-024-00799-w · Cited by 66 · see citing works
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Gorgoni, M., Scarpelli, S., Alfonsi, V., Annarumma, L., Cordone, S., Stravolo, S., & Gennaro, L. D. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.02.006 · Cited by 61 · see citing works
Rate and correlates of post-traumatic stress disorder (PTSD) following the Beirut blast and the economic crisis among Lebanese University students: a cross-sectional study
Zouki, C.-J. E., Chahine, A., Mhanna, M., Obeïd, S., & Hallit, S. R. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04180-y · Cited by 61 · see citing works
Sleep in PTSD: Conceptual model and novel directions in brain-based research and interventions
Germain, A., McKeon, A. B., & Campbell, R. L. (2016) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2016.12.004 · Cited by 60 · see citing works
Self-citation
Pre- to postsleep change in psychophysiological reactivity to emotional films: Late-night REM sleep is associated with attenuated emotional processing.
Werner, G. G., Schabus, M., Blechert, J., Kolodyazhniy, V., & Wilhelm, F. (2015) · Psychophysiology · doi:10.1111/psyp.12404 · Cited by 63 · see citing works
An epidemiologic study of childhood sexual abuse and adult sleep disturbances.
Lind, M. J., Aggen, S. H., Kendler, K. S., York, T. P., & Amstadter, A. B. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000080 · Cited by 61 · see citing works
Influence of Sleeping Patterns in Health and Academic Performance Among University Students
Toscano-Hermoso, M. D., Arbinaga, F., Ozcorta, E. J. F., Gómez-Salgado, J. C., & Ruíz-Frutos, C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082760 · Cited by 58 · see citing works
Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults
Wright, L., Steptoe, A., & Fancourt, D. E. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248919 · Cited by 57 · see citing works
Maintaining factors of posttraumatic stress symptoms following childbirth: A population-based, two-year follow-up study
Garthus‐Niegel, S., Ayers, S., von Soest, T., Torgersen, L., & Eberhard‐Gran, M. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.003 · Cited by 58 · see citing works
Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares.
Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000238 · Cited by 59 · see citing works
From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction
Simon, L., & Admon, R. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01638-9 · Cited by 59 · see citing works
The impact of poor sleep on cognition and activities of daily living after traumatic brain injury: A review
Duclos, C., Beauregard, M., Bottari, C. L., Ouellet, M., & Gosselin, N. (2014) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.12164 · Cited by 58 · see citing works
Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use
Contractor, A. A., Frankfurt, S. B., Weiss, N. H., & Elhai, J. D. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.02.051 · Cited by 56 · see citing works
“…the significant correlations between PTSD and smartphonemisusemay be due to common underlying shared risk factors such as impulsivity, neuroticism, low self-esteem (Billieux, 2012; Elhai, Dvorak, et al., 2017), and sleep-related difficulties (Germain, 2013; Rosen, Carrier, et al., 2016).”
Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies
Sheaves, B., Rek, S. V., & Freeman, D. H. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102241 · Cited by 56 · see citing works
Trajectories of Insomnia in Adults After Traumatic Brain Injury
Wickwire, E. M., Albrecht, J. S., Capaldi, V. F., Jain, S., Gardner, R. C., Werner, J. K., Mukherjee, P., McKeon, A. B., Smith, M. T., Giacino, J. T., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.45310 · Cited by 55 · see citing works
Sleep-Disordered Breathing in Patients with Post-traumatic Stress Disorder
Jaoude, P., Vermont, L. N., Porhomayon, J., & El-Solh, A. (2014) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201407-299fr · Cited by 55 · see citing works
Insomnia and PTSD one month after wildfires: evidence for an independent role of the “fear of imminent death”
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 · see citing works
The retinoid-related orphan receptor alpha (RORA) gene and fear-related psychopathology
Miller, M. W., Wolf, E. J., Logue, M. W., & Baldwin, C. T. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.07.022 · Cited by 55 · see citing works
The impact of disaster work on community volunteers: The role of peri-traumatic distress, level of personal affectedness, sleep quality and resource loss, on post-traumatic stress disorder symptoms and subjective health
Thormar, S. B., Gersons, B. P. R., Juen, B. H., Djakababa, M. N., Karlsson, Þ., & Olff, M. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.10.006 · Cited by 56 · see citing works
The relationship between subjective sleep disturbance, sleep quality, and emotion regulation difficulties in a sample of college students reporting trauma exposure.
Pickett, S. M., Barbaro, N., & Mello, D. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000064 · Cited by 54 · see citing works
Trauma exposure and sleep: using a rodent model to understand sleep function in PTSD
Vanderheyden, W. M., Poe, G. R., & Liberzon, I. (2014) · Experimental Brain Research · doi:10.1007/s00221-014-3890-4 · Cited by 54 · see citing works
IMPAIRED FEAR EXTINCTION ASSOCIATED WITH PTSD INCREASES WITH HOURS-SINCE-WAKING
Zuj, D. V., Palmer, M. A., Hsu, C.-M. K., Nicholson, E., Cushing, P. J., Gray, K. E., & Felmingham, K. L. (2016) · Depression and Anxiety · doi:10.1002/da.22463 · Cited by 53 · see citing works
Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder
Werner, K. B., Griffin, M. G., & Galovski, T. E. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.039 · Cited by 52 · see citing works
Modelling posttraumatic stress disorders in animals
Török, B., Sipos, E., Pivac, N., & Zelena, D. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.11.013 · Cited by 52 · see citing works
Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption
Agorastos, A., & Olff, M. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1833644 · Cited by 53 · see citing works

Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment
Koffel, E., Khawaja, I. S., & Germain, A. (2016) · Psychiatric Annals · doi:10.3928/00485713-20160125-01 · Cited by 129 · see citing works
Self-citation
Sleep and posttraumatic stress disorder: a review
Harvey, A. G., Jones, C., & Schmidt, D. A. (2003) · Clinical Psychology Review · doi:10.1016/s0272-7358(03)00032-1 · Cited by 337 · see citing works
Sleep in Posttraumatic Stress Disorder
Singareddy, R. K., & Balon, R. (2002) · Annals of Clinical Psychiatry · doi:10.3109/10401230209147455 · Cited by 58 · see citing works
Sleep Disturbances in PTSD
Wellman, L. L., Ross, R. J. M., & Sanford, L. D. (2016) · InTech eBooks · doi:10.5772/64189 · Cited by 2 · see citing works
Psychobiology of Sleep Disturbances in Posttraumatic Stress Disorder
Mellman, T. A. (1997) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1997.tb48275.x · Cited by 70 · see citing works

Authors: Germain, A.
Affiliations: University of Pittsburgh (US)
Corresponding author: Germain, Anne
ORCID: Germain, Anne
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2013-04
Volume: 170
Issue: 4
Pages: 372-382
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2012.12040432
PMC: PMC4197954
OpenAlex: W2102756647
Semantic Scholar: e9d1a019386f28018bcb41195e229c22cc06a117
Cited by: 634
References: 91
Citations by year: 2026: 71 · 2025: 42 · 2024: 34 · 2023: 56 · 2022: 50 · 2021: 60 · 2020: 48 · 2019: 51 · 2018: 40 · 2017: 50 · 2016: 40 · 2015: 39 · 2014: 34 · 2013: 16 · 2012: 1
FWCI: 38.55
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R21MH083035)
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, PTSD pathophysiology, nightmares, fear response, sleep-dependent memory consolidation, sleep interventions, polysomnography findings
MeSH terms: Animals, Dreams, Emotions, Humans, Sleep Initiation and Maintenance Disorders, Memory, Stress Disorders, Post-Traumatic, Polysomnography, REM Sleep Behavior Disorder, Resilience, Psychological, Brain Waves

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