Am J Psychiatry 1995; 152:1659-1663
Copyright © 1995 by American Psychiatric Association
Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew
TA Mellman, D David, R Kulick-Bell, J Hebding and B Nolan
Department of Psychiatry, University of Miami School of Medicine, FL, USA.
OBJECTIVE: Sleep disturbance is an important dimension of posttraumatic
stress disorder (PTSD), but most of the limited available data were
obtained years after the original traumatic event. This study provides
information on sleep disturbance and its relationship to posttraumatic
morbidity from evaluations done within a year after the trauma. METHOD:
Sleep and psychiatric symptoms of 54 victims (12 men and 42 women) of
Hurricane Andrew who had no psychiatric illness in the 6 months before the
hurricane were evaluated. A subset of hurricane victims with active
psychiatric morbidity (N = 10) and nine comparison subjects who were
unaffected by the hurricane were examined in a sleep laboratory. RESULTS: A
broad range of sleep-related complaints were rated as being greater after
the hurricane, and psychiatric morbidity (which was most commonly PTSD,
followed by depression) had a significant effect on most of the subjective
sleep measures. In addition, subjects with active morbidity endorsed
greater frequencies of "bad dreams" and general sleep disturbances before
the hurricane. Polysomnographic results for the hurricane victims revealed
a greater number of arousals and entries into stage 1 sleep. REM density
correlated positively with both the PTSD symptom of reexperiencing trauma
and global distress. CONCLUSIONS: Subjects affected by Hurricane Andrew
reported sleep disturbances, particularly those subjects with psychiatric
morbidity. Tendencies to experience bad dreams and interrupted sleep before
a trauma appear to mark vulnerability to posttraumatic morbidity. Results
of sleep laboratory evaluations suggested brief shifts toward higher
arousal levels during sleep for PTSD subjects and a relationship of REM
phasic activity and symptom severity.
