Cited by 93Sleep and related disordersPosttraumatic Stress Disorder ResearchSleep and Wakefulness Research

Sleep disturbances and PTSD: a perpetual circle?

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van Liempt, Saskia·2012·European Journal of Psychotraumatology

Abstract

BACKGROUND: Sleep facilitates the consolidation of fear extinction memory. Nightmares and insomnia are hallmark symptoms of posttraumatic stress disorder (PTSD), possibly interfering with fear extinction and compromising recovery. A perpetual circle may develop when sleep disturbances increase the risk for PTSD and vice versa. To date, therapeutic options for alleviating sleep disturbances in PTSD are limited. METHODS: WE CONDUCTED THREE STUDIES TO EXAMINE THE RELATIONSHIP BETWEEN SLEEP AND POSTTRAUMATIC SYMPTOMS: (1) a prospective longitudinal cohort study examining the impact of pre-deployment insomnia symptoms and nightmares on the development of PTSD; (2) a cross-sectional study examining subjective sleep measures, polysomnography, endocrinological parameters, and memory in veterans with PTSD, veterans without PTSD, and healthy controls (HCs); (3) a randomized controlled trial (RCT) (n=14) comparing the effect of prazosin and placebo on sleep disturbances in veterans with PTSD. In addition to these studies, we systematically reviewed the literature on treatment options for sleep disturbances in PTSD. RESULTS: Pre-deployment nightmares predicted PTSD symptoms at 6 months post-deployment; however, insomnia symptoms did not. Furthermore, in patients with PTSD, a correlation between the apnea index and PTSD severity was observed, while obstructive sleep apnea syndrome was not more prevalent. We observed a significant increase in awakenings during sleep in patients with PTSD, which were positively correlated with adrenocorticotropic hormone (ACTH) levels, negatively correlated with growth hormone (GH) secretion, and the subjective perception of sleep depth. Also, heart rate was significantly increased in PTSD patients. Interestingly, plasma levels of GH during the night were decreased in PTSD. Furthermore, GH secretion and awakenings were independent predictors for delayed recall, which was lower in PTSD. In our RCT, prazosin was not associated with improvement of any subjective and objective sleep parameters. Only a few RCTs have been published. They show promising results for atypical antipsychotics and prazosin, the latter especially on nightmare reduction. CONCLUSIONS: Disturbed sleep due to nightmares increases the risk for PTSD. PTSD in turn leads to increased sleep fragmentation, decreased GH secretion, and frequent nightmares, which may again compromise fear extinction, synaptic plasticity, and recovery. This suggests that disturbed sleep is a precipitating and perpetuating factor in PTSD symptomatology, creating a perpetual circle. This dissertation suggests that activity of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system (SNS) is involved in disturbed sleep in patients with PTSD.

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  • Repetitive nightmares in PTSD patients do not lead to forgetting of the traumatic event, but are associated with increased severity of the disorder and considered a risk factor in the development of PTSD.

    “Finally, repetitive nightmares, which are highly prevalent in patients suffering from posttraumatic stress disorders (PTSD), do not lead to forgetting of the traumatic event, but are rather associated with increased severity of the disorder and considered a risk factor in the development of PTSD (75,1240,1331).”

    From About Sleep's Role in Memory (2013) · cites this paper as [1240]

    The Summary of major findings reports that pre-deployment nightmares were associated with increased risk of PTSD symptoms after military deployment. The Abstract’s Conclusions say frequent nightmares may compromise fear extinction, but fear extinction is described as weakening an association with a trigger, not forgetting the traumatic event. The paper links greater PTSD severity to sleep apnea, not specifically to repetitive nightmares. (LLM, conf=0.86)

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Authors
van Liempt, S.
Affiliations
Military Mental Health, University Medical Centre
Venue
European Journal of Psychotraumatology
Published
2012-10-03
Volume
3
Issue
1
ISSN
2000-8066 (ISSN-L)
OpenAlex
W2029780232
Cited by
93
References
69
Citations by year
2026: 7 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 6 · 2017: 9 · 2016: 4 · 2015: 9 · 2014: 10 · 2013: 5 · 2012: 1
FWCI
10.73
Type
journal article
Language
en
Open access
Locations
  • European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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, nightmares, insomnia, fear extinction memory, veterans, prazosin, growth hormone secretion, ACTH, sleep fragmentation, obstructive sleep apnea, hypothalamic-pituitary-adrenal axis, sympathetic nervous system, heart rate, atypical antipsychotics, PTSD treatment

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