A Solution to Sleep Problems from Post-War Trauma

A new pilot study shows a treatment approach that combines cognitive-behavioral therapy with image rehearsal can help shell-shocked veterans find more peaceful sleep. PTSD affects nearly 1 in 4 veterans who served in either Afghanistan or Iraq. Once they return home, as many as 91 percent of veterans report having trouble falling asleep or staying asleep.

The study involved a group of 22 veterans with sleep problems related to symptoms of post-traumatic stress disorder (PTSD). Half of the veterans received a combination of cognitive-behavioral for insomnia and image rehearsal therapy for PTSD-related nightmares. The control group was assigned prescription drugs including sleeping pills, antidepressants and other mood stabilizers. Both treatments lasted about twelve weeks.

Short term results show the group who received CBT and image rehearsal therapy saw significant improvements in sleep and PTSD symptoms. Due to the sample size and the nature of the pilot study, further research is needed to demonstrate the effectiveness of the approach.

The study was published in the February issue of Journal of Clinical Sleep Medicine, the official journal of the American Academy of Sleep Medicine.

The approach used in the study combines two commonly used treatments for related conditions. Cognitive behavioral therapy is considered the front line treatment for long-term insomnia. And behavioral sleep specialists use image rehearsal therapy to treat nightmare disorder. Both sleep disorders bare similarities to the sleep-related symptoms of PTSD.

Another recent study proposed a more radical treatment for PTSD - sleep avoidance after a traumatic event. The authors theorize the trauma won’t go into memory if you don’t sleep. Sleep after all plays an important role in the development of memories.

Learn more about sleep and memory.

Sleep Deprivation May Help in Emotional Trauma Treatment

Normally the Sleep Education Blog reports on the numerous physical and mental health problems caused by sleep deprivation. In this one case, sleep deprivation may actually have a benefit. If you don’t sleep after a traumatic event, you may avoid developing PTSD or other anxiety disorders, a recent study reports.

Plenty of studies have shown that sleep is central to the development of memories. This approach to PTSD works the opposite, researchers theorize: Avoid sleeping and avoid the memory-forming mechanism.

So far, sleep restriction has only been used to treat trauma in artificial, academic environments. The approach has not been put to practice with patients at risk for PTSD, such as accident victims or deployed troops.

The double-blind study involved video clips of safe driving with shocking footage of sudden car accidents mixed in. Half of the participants who watched the videos stayed up all night afterwards. The others received a normal night’s sleep.

The group assigned to sleep deprivation had few fear-associated memories of the accident footage, compared to subjects who received a full night’s sleep.

The authors of the study insist sleep deprivation could be a possible therapy for post-traumatic stress or anxiety. Further research is needed before the therapy can be put into practice for real-life traumatic events.

Two U.S. military supported studies find bright lights can improve alertness, reduce post-traumatic stress

A series of brief flashes of bright light is all it takes to improve alertness at night, as reported in a research abstract (#0257) presented Monday at SLEEP 2010.

Test subjects were wakened two hours after their typical bedtimes, brought into a dark room and were exposed to a two-millisecond light pulse once a minute for an hour.

Researchers at Stanford University noted a significant improvement in self-rated alertness and reaction time, as measured by the auditory Psychomotor Vigilance Test.

The subjects also spent an hour in darkness at a different time and date showed no improvements.

“We found it shocking that light exposure as brief as a few milliseconds could engender changes in alertness and brain wave activity,” said lead researcher Jamie M. Zeitzer, PhD. “These results change the manner in which we think about the brain’s capacity to respond to light.”

These findings could lead to a breakthrough for shift workers and military personnel, who are often required to go days without sleeping during wartime deployment.

Another study (# 0706) on display offers new hope for troops returning from battle with Post Traumatic Stress Disorder.

Researchers found bright light therapy greatly reduced the sleep disturbances specific to PTSD. The treatment also produced a moderate improvement in other PTSD symptoms and depression.

16 soldiers participated in the study after returning home to the U.S. from Afghanistan or Iraq with combat-related PTSD.

Half of the troops received 30 minutes a day of 10,000 lux bright light therapy for one month. The other half received a sham treatment as a placebo.

At the onset and immediately following treatment the soldiers were given the clinician-administered PTSD scale. The troops also completed weekly depression and sleep quality assessments.

Bright light therapy typically involves exposure to up to 10,000 lux of light for scheduled periods of 20 minutes or more. The technique can decrease sleepiness and improve alertness by suppressing the production of melatonin, a hormone that tells your body when its time to sleep.

Images courtesy the U.S. Army

New PTSD Sleep Clinic Opens in New Mexico

A new PTSD Sleep Clinic is opening today in Albuquerque, N.M. The clinic will target the sleep problems that plague people who have post-traumatic stress disorder.

The clinic is directed by AASM member Dr. Barry Krakow. He is the founder of the Maimonides International Nightmare Treatment Center.

Krakow notes that antidepressant medications may not be the best option for people who have PTSD. And many people with PTSD also have obstructive sleep apnea. This can make their PTSD symptoms even worse.



The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Krakow says that treating sleep problems can greatly reduce PTSD symptoms. Daytime fatigue and sleepiness decrease, and energy levels increase. This provides a boost for the coping skills and motivation needed to tackle the problems related to PTSD.

His clinic uses a variety of techniques to treat PTSD. These include cognitive behavioral therapy, imagery rehearsal therapy and sleep-related emotion-focused therapy.

Last year the Sleep Education Blog reported that imagery rehearsal therapy is helping some people change their nightmares. Yoga also is being used to help soldiers who have PTSD. And a recent study showed that old fear memories can be “updated” to prevent the return of fear.

Read more about PTSD and nightmares.

How Does Yoga Help You Sleep?

Yesterday the Globe and Mail examined how yoga helps you sleep.

Harvard assistant professor Sat Bir Khalsa, PhD, told the Globe and Mail that yoga helps reduce the stress that can hinder sleep.

“With time and practice, the stress system begins to quiet down,” he said.

What changes occur in the body during yoga? The NCCAM reports that it is unclear. But there is growing evidence that yoga enhances stress-coping mechanisms.

One study by Khalsa used yoga to help people with chronic insomnia. They had one in-person training session. Then they practiced yoga on their own for eight weeks. They also had brief follow-ups by phone and in person.

Results show that sleep improved in 20 people who completed the study. They fell asleep faster and slept longer.

A review he published found that most yoga research has been conducted and published in India. But researchers in the U.S. and England are starting to conduct more studies.

A yoga instructor also explained to the Globe and Mail that bedtime yoga is easy and convenient. She practices yoga techniques while in bed in her pajamas.

“It’s not a magic button,” she said. “But I know that I’m not just lying down there and tossing and turning – I’m restoring my body.”

The article also described the iRest program. It involves a form of yoga called “yoga nidra.” It reduces stress and promotes deep relaxation.

In 2006 the U.S. Department of Defense began testing the iRest protocol. It has been used to help soldiers who have PTSD.

Learn more about sleep and yoga. Read more about insomnia.

There are a variety of cognitive and behavioral methods that are effective for treating insomnia. Learn more about cognitive behavioral therapy on SleepEducation.com.

Image courtesy of the National Institute on Aging

Sleep, Traumatic Injuries & Mental Health

A new study evaluated how sleep problems prior to a traumatic injury may affect mental health. The results were published in the Jan. 1 issue of the journal Sleep.

The study was performed in Australia. It involved 1,033 people who had a traumatic injury. They spent an average of 12.5 days in the hospital.

About 65 percent were hurt in a motor-vehicle accident. Fifteen percent were injured in a traumatic fall. Seven percent had an industrial accident. And six percent were victims of assault.

An initial assessment took place during their hospital admission. This included an evaluation of sleep disturbance in the two weeks prior to the injury. They were re-assessed three months later.

Results show that mental health problems were common at the three-month follow-up. Thirty percent of people who had no prior disorder developed a new psychiatric disorder after the injury.

The most common disorders were major depression and agoraphobia. Other common disorders were PTSD and generalized anxiety disorder.

Data analysis found that sleep impairment prior to the injury was a risk factor for the development of a mental health disorder. People with disturbed sleep prior to trauma were two times more likely to develop a psychiatric disorder.

The risk was even greater for people with no history of mental health problems. They were three times more likely to develop a psychiatric disorder if they had sleep problems prior to the trauma.

The authors suggested that sleep problems may limit your ability to manage stress after a traumatic event. Poor sleep may reduce your emotional, mental and physical resources. This may hinder your recovery.

They also noted that sleep problems may have contributed directly to the traumatic injuries. Disturbed sleep can result in fatigue, poor concentration and slow reaction times.

In November the Sleep Education Blog reported that the higher rate of insomnia in women may be linked to mental health problems such as depression. Read more about sleep and depression.

Get help for a sleep problem at an AASM-accredited sleep center near you.

Image by Joe

Updating Memories to Prevent the Return of Fear

A new study shows that old fear memories can be “updated” to prevent the return of fear. The discovery is promising for the treatment of post-traumatic stress disorder.

"Our results suggest a non-pharmacological, naturalistic approach to more effectively manage emotional memories," study co-author Elizabeth Phelps, PhD, said in a press release.

The researchers used mild wrist shocks to condition participants to fear colored squares. A day later, the memory was reactivated.

Participants were re-exposed to the feared squares. This was followed by extinction training. They were repeatedly exposed to the colored squares without shocks.

The fear response was banished only if extinction training followed soon after the fear reactivation. This “reconsolidation window” appears to last for about six hours after the fear is reactivated.

During this time an old memory can be “rewritten.” It can be updated with non-fearful information.

"Timing may have a more important role in the control of fear than previously appreciated," said Phelps. "Our memory reflects our last retrieval of it rather than an exact account of the original event."

The study also found that the technique had a long-lasting effect. Fear responses were no longer expressed when tested one year later.

The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Earlier this year the Sleep Education Blog reported that playing the computer game Tetris can reduce unwanted “flashbacks.” Last month the blog noted that imagery rehearsal therapy is helping some people change their nightmares.

Learn more about sleep and memory.

Image by Stu Mayhew

Civilian Life is Interrupted by PTSD and Sleep Disorders for Many Soldiers Returning from Iraq

A new study finds high rates of disturbed sleep among current and former military personnel who served in Afghanistan during Operation Enduring Freedom or Iraq during Operation Iraqi Freedom.

Sleep problems were considerably more common and severe among those with post-traumatic stress disorder (PTSD), reports Military.com. PTSD is an anxiety syndrome that occurs after a traumatic event, such as combat or military exposure. Symptoms typically improve after three months of treatment, but for some people the problem continues for the rest of their lives.

Data from the Pentagon suggests that up to 20 percent of returning Iraq war veterans suffer from PTSD. Records from the Department of Veterans Affairs show that nearly 76,000 veterans of the current wars were diagnosed with PTSD between 2002 and mid-2008.

According to the AASM, most people with PTSD report having disturbed sleep, and suffer from severe nightmares in which they relive the traumatic event. Severe cases of PTSD may be treated with cognitive behavioral therapy and medications to improve sleep.

Learn more about PTSD on SleepEducation.com.

Image courtesy of the U.S. Army.

Treating Nightmares with Imagery Rehearsal Therapy

It’s bad enough to have your sleep disrupted by a nightmare. It’s even worse when recurring episodes of disturbing dreams turn into a nightmare disorder.

This is a common problem for soldiers and other people who have post-traumatic stress disorder. Their dreams often replay a disturbing event in a way that seems shockingly real.

But the Pittsburgh Post-Gazette reports that treatment can help break the cycle of recurring nightmares. This can help your sleep, and your daytime life, return to normal.

One of the most effective treatments for nightmares is “imagery rehearsal therapy.” According to the article, it is effective in more than 90 percent of people who try it.

“You train your brain to have a new set of images,” sleep researcher Anne Germain told the Post-Gazette.

Germain also said that the high blood pressure medication prazosin is another treatment option. The drug is effective at eliminating nightmares.

Get help for nightmare disorder at an AASM-accredited sleep center near you.

Learn more about dreams and nightmares on SleepEducation.com.

Image by Vanessa C

Sleep and Memory: Remembering & Forgetting

A new article in Newsweek provides an overview of how “sleeping on it” improves memory.

Forming memories. Consolidating memories. Making connections between memories. Sleep appears to play an important role in all these processes.

Another Newsweek article examines whether or not we can learn to forget. New research shows that memory “reconsolidation” may be possible.

Being able to change long-term memories could have practical benefits. In particular it could aid people who suffer from post-traumatic stress disorder.

Nightmares tend to be the most disturbing feature of PTSD. Most people with PTSD also report having disturbed sleep.

Finally, Newsweek offers an online memory Q&A. Find answers to some of the most common questions about memory.

Sleeping Scared: Nightmares & Children

As a parent it is natural to be concerned when your child has a nightmare. But should these disturbing dreams cause you to worry about your child?

In most cases nightmares are a normal and common part of a child’s development. They occur in equal rates among boys and girls.

Children tend to begin having nightmares between the ages of three and six. The frequency of these disturbing dreams usually peaks between the ages of six and 10. Most children then begin to have nightmares less often.

Some children may continue to have nightmares as teens and adults. For them it may be a lifelong problem.

A nightmare disorder may develop if a child has frequent nightmares that wake him or her from sleep. This disorder can cause anxiety, sleep loss and daytime problems. It is one of the childhood parasomnias.

In some children nightmares may be a sign of post-traumatic stress disorder. This problem occurs when the child experiences a traumatic or stressful event. In his or her dreams the child may re-enact the event.

Parents can provide comfort and reassurance to a child who has nightmares. Cognitive behavioral therapy may help in the case of an ongoing problem.

Parents also can follow these tips to help a child who has nightmares:

• Let your child sleep with a special blanket or stuffed animal for security.


• Use a dim nightlight in your child’s room to help him or her feel safe.


• Respond quickly to comfort your child when he or she wakes up from a nightmare.


• Discuss nightmares openly with your child during the day.


• Assure your child that it is normal for children and even adults to have nightmares.


• Talk to your child’s doctor if recurring nightmares greatly disturb your child.

Are you unsure if your child is having nightmares or another type of parasomnia? Compare the common features of childhood parasomnias.

Get more tips for parents of a child who has a parasomnia.

Preventing Nightmares and PTSD Flashbacks with Tetris

A new study in the online journal PLoS ONE shows that playing the computer game Tetris can reduce unwanted “flashbacks.”

This is promising for people who suffer from post-traumatic stress disorder (PTSD). Could it also help other people who suffer from nightmares?

The study involved 40 people who watched a traumatic, 12-minute film. It contained scenes of real injury and death.

After a 30-minute break, half of the group played Tetris for 10 minutes. The other half sat quietly.

Flashbacks were monitored for one week using a daily diary. Subjects then returned to the lab for an assessment.

Results show that Tetris players had significantly fewer flashbacks. They also had fewer clinical symptoms of trauma.

At the one-week follow up, both groups scored the same on a recognition memory test for the film. This indicates that voluntary recall was similar between the groups. It was the rate of involuntary memories – flashbacks – that was different.

Tetris requires you to arrange a falling puzzle of colorful block-like shapes. The authors told Reuters that the visual aspect of the game may compete with the traumatic, visual memories. It may interfere with how your mind forms and stores the memories.

One of the study’s authors noted that you have about six hours to affect memories before they are stored in the brain. Any type of intervention needs to be done in this window of time.

The AASM reports that nightmares tend to be the most disturbing aspect of PTSD. Often the dreams involve a flashback to the event that seems shockingly real.

Potential implications of the study also extend beyond PTSD. It suggests that a visual distraction like Tetris could reduce nightmares for anyone after a stressful event.

It could be especially helpful for children who are prone to having nightmares after seeing a scary movie or other distressing images.

No Purple Hearts for PTSD

Does a U.S. soldier who has post-traumatic stress disorder (PTSD) deserve a Purple Heart? The question has sparked a heated debate in the military community.

Stars and Stripes, the American Forces Press Service and the New York Times report that the Defense Department recently rejected the idea.

A Purple Heart is only awarded when a soldier with one of the U.S. Armed Services is wounded or killed by enemy action. Army Regulation 600-8-22 defines a wound as “an injury to any part of the body from an outside force or agent.” The wound “must have required treatment by a medical officer.”

The regulation lists PTSD as an injury that clearly does not meet these requirements. The Purple Heart has never been awarded for mental or psychological problems.

In a May article in Stars and Stripes a military psychologist argued for a change in the policy. He said that PTSD is in part a physical disorder because it damages the brain.

The idea got the attention of U.S. Secretary of Defense Robert Gates. This prompted a review of the policy and stoked the debate.

Common signs of PTSD include feelings of intense fear and horror after a terrifying event. Sometimes this response is delayed. Symptoms may not appear until a few days or even weeks after the event.

Recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Most people with PTSD also report having disturbed sleep. It can be very hard to fall asleep or stay asleep. This is known as “adjustment insomnia.”

About half of people with PTSD get better within three months. For others it can be a lifelong problem.

What do you think? Are veterans with PTSD being overlooked?