The purpose of this study was to determine how sleep quality affects cognitive functioning in returning combat veterans after accounting for effects of combat exposure, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) history. This was a cross-sectional assessment study evaluating combat exposure, PTSD, mTBI history, sleep quality, and neuropsychological functioning. One hundred and nine eligible male Iraq/Afghanistan combat veterans completed an assessment consisting of a structured clinical interview, neuropsychological battery, and self-report measures. Using partial least squares structural equation modeling, combat experiences and mTBI history were not directly associated with sleep quality. PTSD was directly associated with sleep quality, which contributed to deficits in neuropsychological functioning independently of and in addition to combat experiences, PTSD, and mTBI history. Combat experiences and PTSD were differentially associated with motor speed. Sleep affected cognitive function independently of combat experiences, PTSD, and mTBI history. Sleep quality also contributed to cognitive deficits beyond effects of PTSD. An evaluation of sleep quality may be a useful point of clinical intervention in combat veterans with cognitive complaints. Improving sleep quality could alleviate cognitive complaints, improving veterans' ability to engage in treatment. (PsycINFO Database Record(c) 2016 APA, all rights reserved). Language: en

Sleep quality affects cognitive functioning in returning combat veterans beyond combat exposure, PTSD, and mild TBI history.

Women are approximately twice as likely as men to develop posttraumatic stress disorder (PTSD) after trauma exposure. Mechanisms underlying this difference are not well understood. Although sleep is recognized to have a critical role in PTSD and physical and psychological health more generally, research into the role of sleep in PTSD sex differences has been only recent. In this article, we review both animal and human studies relevant to sex differences in sleep and PTSD with an emphasis on the roles of sex hormones. Sleep impairment including insomnia, trauma-related nightmares, and rapid-eye-movement (REM) sleep fragmentation has been observed in individuals with chronic and developing PTSD, suggesting that sleep impairment is a characteristic of PTSD and a risk factor for its development. Preliminary findings suggested sex specific patterns of sleep alterations in developing and established PTSD. Sleep maintenance impairment in the aftermath of trauma was observed in women who subsequently developed PTSD, and greater REM sleep fragmentation soon after trauma was associated with developing PTSD in both sexes. In chronic PTSD, reduced deep sleep has been found only in men, and impaired sleep initiation and maintenance with PTSD have been found in both sexes. A limited number of studies with small samples have shown that sex hormones and their fluctuations over the menstrual cycle influenced sleep as well as fear extinction, a process hypothesized to be critical to the pathogenesis of PTSD. To further elucidate the possible relationship between the sex specific patterns of PTSD-related sleep alterations and the sexually dimorphic risk for PTSD, future studies with larger samples should comprehensively examine effects of sex hormones and the menstrual cycle on sleep responses to trauma and the risk/resilience for PTSD utilizing various methodologies including fear conditioning and extinction paradigms and animal models.

/pdf/one-s-sex-sleep-and-posttraumatic-stress-disorder-yw37dc0gnj.pdf

One's sex, sleep, and posttraumatic stress disorder

/pdf/a-laboratory-model-intervention-that-prevents-a-stress-5nsc7vi246.pdf

A laboratory model intervention that prevents a stress effect on sleep.

Twenty-five years ago, the nightmares typically experienced in the course of PTSDwere first referred to as a hallmark of the disorder. PTSD-related nightmares share some characteristics with idiopathic nightmares, but the often trauma-replicating nature of disturbing dreams experienced by individuals with PTSD continues to be a key clinical manifestation of PTSD. A number of validated measures have been developed to measure the frequency, intensity, content, and clinical significance of nightmares. The neurobiologic mechanisms underlying the development and persistence of replicative nightmares in PTSD are still being investigated. Two sets of psychological theories of dreaming, threat simulation theory and theories related to emotional adaptation, provide some context for understanding nightmares. Clinically, nightmares in PTSD are associated with significant distress and morbidity. In addition to psychological interventions that may reduce the frequency and intensity of nightmares, numerous medications have been evaluated for the treatment of nightmares with prazosin standing out as the most promising of these pharmacotherapies. List of Abbreviations CAPS Clinician-administered PTSD scale CBT Cognitive-behavioral therapy CBT-I Cognitive-behavioral therapy for insomnia DSM 5 Diagnostic and statistical manual of mental disorders 5 edition IRT Imagery rehearsal therapy NM Nightmare PTSD Post-traumatic stress disorder RCT Randomized controlled trial

Nightmares and PTSD: Characterization, Theories, and Treatment Approaches

Background 
This study compares the sleep architecture of patients with posttraumatic stress disorder (PTSD) with that of both patients with depression and subjects with no mental disorder.


Method 
45 German armed forces personnel with PTSD, 72 German armed forces personnel with depression and 24 healthy control subjects underwent 24-hour polysomnography. The effects of group membership, medication and the statistical interaction of group and medication were analysed for the following variables: sleep onset latency, REM sleep latency, slow-wave sleep and REM sleep percentages.


Results 
Sleep onset latency was significantly prolonged in both the PTSD and the depression group. Moreover, psychotropic medication was associated with significantly prolonged REM sleep latency.


Conclusion 
The impact on sleep onset latency is of special clinical relevance in that according to preliminary studies, it is of major importance for subjective sleep quality. In contrast to the other parameters, an increase in sleep onset latency results in a subjective reduction in sleep quality which can lead to hyperarousal and increased preoccupation with sleep, which in turn may lead to dysfunctional sleep patterns.

Changes in sleep architecture in German Armed Forces personnel with posttraumatic stress disorder compared with depressed and healthy control subjects

The few pharmacological treatments shown to be effective in reducing sleep disturbance in posttraumatic stress disorder (PTSD) might work through normalization of rapid eye movement (REM). However, evidence of REM sleep disturbance in PTSD has been inconsistent and the definition of REM bout has varied as well. In this study, we compared polysomnographic findings in adults with PTSD to both normal sleepers and insomniacs. We found no differences between those with and without PTSD on REM bout frequency or duration. We did, however, find gender differences within our PTSD sample as consistent with a previous review suggesting that males with PTSD are more likely to demonstrate REM sleep disturbance. Consensus on REM bout definition is needed, in addition to studies powered to detect gender differences.

REM Sleep Bout Duration and Frequency in PTSD

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REM Sleep Bout Duration and Frequency in PTSD