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Case Study: Albert Smith

Albert is a 32-year-old US veteran who spent three years fighting in Iraq in the early 2000s. While on duty, he witnessed civilians gunned down in crossfire and several fellow servicemen die in a car bombing. Each caused Albert trauma. After serving, he returned home to his wife and children in New York but was not the same. The trauma he suffered caused Albert to suffer from anxiety. Albert’s anxiety made falling asleep difficult, and even worse were the nightmares that would wake Albert up at night. Albert met with a psychiatrist and was diagnosed with a condition referred to as post-traumatic stress disorder (PTSD).

PTSD Defined

Like Albert, many veterans suffer from war-induced trauma brought on while serving. Even though the trauma initiated from similar experiences, each person reacts to trauma differently. Some veterans demonstrate symptoms of stress for several days to a month after trauma in a condition known as acute stress disorder (ASD)1. Others develop a long-term condition called Post Traumatic Stress Disorder (PTSD)2.

While people normally feel distressed for days, weeks, or months following trauma, a person with PTSD may experience multiple symptoms for many months or years. Some have flashbacks and nightmares; others endure depression, anxiety, and self-driven isolation. At some point in their lifetime, approximately 15% of veterans will receive a PTSD diagnosis3. Exposure to trauma and PTSD have both been correlated to the development of sleep problems4. People suffering PTSD can experience a variety of sleep disruptors5:

  • Waking up repeatedly at night
  • Nightmares or alarming dreams
  • Violent movements during sleep

PTSD in Real Time

There is still much more to the clinical understanding of PTSD and its complex relationship with sleep. A study on PTSD revealed that self-reported increases in sleep issues in people with PTSD can occur anywhere from 2 to 45 years after the traumatic event6.

PTSD symptoms can sometimes take a long time to surface after the triggering event. This makes treating PTSD symptoms especially difficult. Incredibly, PTSD symptoms in Holocaust survivors were recorded occurring 45 years after their liberation7, that’s over half a lifetime! The longer they spent in concentration camps, the more frequent their nightmares and sleep disturbances were. Veterans are likely to have experienced similar levels of trauma. Exposure to severe trauma can lead to PTSD symptoms, such as sleep disorders, for many years after the traumatic triggering event.

Treatments of PTSD-related sleep disorders

Cognitive behavioral therapy (CBT) is the primary non-pharmacological treatment for PTSD-related sleep disorders. A particular therapy type, Image Rehearsal Therapy (IRT), helps patients with their nightmares by guiding them through a process of acceptance and control over their dreams8. IRT enables patients to “rewrite” the bad stories that repeat in their heads at night. The challenge with CBT is that patients have demonstrated difficulty sticking to treatment over a multi-month period9.

Eye Movement Desensitization and Reprocessing (EMDR) is another non-pharmacological treatment option. It involves recreating a dream-like state while awake. The process includes recalling distressing memories and tracking one’s eyes across a visual field for 20-second intervals10. This can help reduce the distress associated with these traumatic memories.

Some patients opt for pharmacological treatment of PTSD-related sleep issues. Many medications are used to treat sleep-disrupting symptoms and conditions, all with mixed outcomes and side effects. While antidepressants are often utilized, prazosin has the greatest amount of clinical evidence supporting its usage for treatment11.

Overall there is much to be hopeful about in the treatment of PTSD and subsequent sleep disruptions, particularly for veterans as the most afflicted group. As opposed to just a few decades ago, patients now are empowered with a range of sleep disorder treatment options, both pharmacological and non-pharmacological. As the dynamics between sleep disorders, trauma, and PTSD continue to be better studied, sleeping soundly becomes ever easier.

References:

[1] https://www.psychologytoday.com/us/conditions/acute-stress-disorder

[2] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[3] https://www.ptsd.va.gov/understand/common/common_veterans.asp

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795058/

[5] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.472.1992&rep=rep1&type=pdf

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795058/

[7] https://www.ncbi.nlm.nih.gov/pubmed/1984708

[8] http://jcsm.aasm.org/Articles/06_04_389_1.pdf

[9] https://mhc.cpnp.org/doi/full/10.9740/mhc.n190104

[10] Id.

[11] Id.

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