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

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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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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
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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