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.

Brain trauma may disrupt melatonin production, disturb sleep

Sleep is never the same after a devastating brain injury and researchers now have a clearer idea why. People with brain injuries produce less melatonin at night and spend more time in slow wave sleep, according to a new study.

Australian researchers used a sleep lab to monitor subjects who were recovering from severe brain trauma. The findings were published in the May issue of the journal Neurology.

A small sample of 23 patients volunteered to undergo a sleep study. Each suffered a brain injury an average of 14 months before the study. Their data was measured alongside a control group of 23 healthy people.

The patients produced significantly less melatonin in the evenings compared to healthy individuals. Melatonin is a hormone that regulates tiredness by letting the brain know when it’s the evening and its time to sleep.

Sleep architecture changed after brain trauma and sleep quality rated lower. 24 percent of the experimental groups’ sleep was in the late non-REM stages known as slow wave sleep. Most people spend only about 15-20 percent of the sleep time in this deep sleep.

Those with brain injuries spent more than double the time awake after initially falling asleep. On average, they spent more than an hour awake in bed compared to 27 minutes for the healthy group.

The frequency of mental disorders including anxiety and depression was also higher, possibly due to poor sleep.

The authors of the study theorized head injuries may disrupt the brain structures that produce melatonin, causing a slew of sleep-related symptoms. They said future studies should explore the effectiveness of using melatonin supplements to compensate for the loss in production of the hormone.

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

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.