PTSD and Sleep
Friday, March 8, 2013
When patients re-experience traumatic events and flashbacks during sleep, these nightmares can be accompanied by real physical reactions to feelings of fear, such as a pounding heart and sweating. The re-experience can occur at random or might be triggered by sights, sounds, or smells that remind the person of the trauma. Therefore, patients suffering from PTSD often try to avoid objects, places, events, or even emotions that trigger memories of the traumatic event.
In addition to nightmares, people with PTSD can manifest a state of hyperarousal, in which the individual is subconsciously “on guard” to protect himself, and as a result feels anxious, has difficulty falling asleep, is irritable, suffers emotional outbursts, or is easily startled.
Treating patients with PTSD for sleep disorders has sometimes been heartbreaking. Until the past few decades, people with PTSD were not treated for it, because the condition had not even been described. Today, treatments have evolved and patients can benefit from them.
Treatment should be coordinated by an expert in treating PTSD, most often a psychiatrist. The therapies that may be effective are the “talk therapies,” often in concert with medications. Two drugs have been approved by the FDA to treat PTSD: sertraline (Zoloft®) and paroxetine (Paxil®).
In an exciting development, recent research shows that an “old” drug, prazosin, originally used to treat high blood pressure, may be effective in reducing the nightmares in PTSD patients. It is believed that norepinephrine may play a role in causing sleep disturbances and nightmares in PTSD, and prazosin reduces the levels of norepinephrine in the brain.
There Is Much We Do Not Know
Medical science does not yet understand why witnessing or experiencing a traumatic event sears the event into the brain and may cause symptoms decades later. Are there actual chemical or structural changes in the brain related to fear, pain, guilt, and shame? What is the role of disrupted sleep and nightmares in perpetuating symptoms of PTSD?
We also wonder why some individuals suffer PTSD and others who witness or experience the same traumatic events do not develop symptoms of PTSD.