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Am J Psychiatry 1995; 152:110-115
Copyright © 1995 by American Psychiatric Association
Sleep events among veterans with combat-related posttraumatic stress disorder
TA Mellman, R Kulick-Bell, LE Ashlock and B Nolan
Miami VA Medical Center, Psychiatry Service, FL 33125.
OBJECTIVE: Sleep disturbances are important features of posttraumatic
stress disorder (PTSD); however, the published data characterizing PTSD
sleep phenomena are limited. The authors report on the phenomenology and
physiological correlates of symptomatic sleep events in PTSD. METHOD: The
study data included survey results that addressed sleep symptoms during the
past month in combat veterans with and without PTSD (N = 58), sleep diary
records of awakenings from combat veterans with PTSD hospitalized on an
inpatient rehabilitation unit (N = 52), and overnight polysomnography
recordings obtained from 21 medication-free combat veterans with PTSD and
eight healthy comparison subjects not exposed to combat. RESULTS: Recurrent
awakenings, threatening dreams, thrashing movements during sleep, and
awakenings with startle or panic features represented the most prevalently
reported sleep-related symptoms. Laboratory findings of longer time awake,
micro-awakenings, and a trend for patients to exhibit body and limb
movements during sleep are consistent with the subjectively reported
symptom profile. Prospectively assessed symptomatic awakenings featured
startle or panic symptoms or anxiety related to threatening dreams.
Laboratory findings revealed a trend for the symptomatic awakenings (with
and without dream recall) to be disproportionately preceded by REM sleep,
and the two recorded awakenings with objective physiological arousal were
preceded by REM. CONCLUSIONS: PTSD features intrusions into sleep of more
highly aroused behaviors and states, which appear partially conditioned to
REM sleep.
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