Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence

• Published in: Neuropharmacology Vol. 62; no. 2; pp. 576 - 585
• Main Authors: Nappi, Carla M., Drummond, Sean P.A., Hall, Joshua M.H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2012
• Subjects: Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Behavior Therapy - methods; Daytime; Dreams - drug effects; Dreams - psychology; Humans; Hypnotics and Sedatives - therapeutic use; Insomnia; Nightmares; Nighttime; Post-traumatic stress disorder; Posttraumatic stress disorder; Reviews; Sleep; Sleep disorders; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - psychology; Sleep Initiation and Maintenance Disorders - therapy; Stress; Stress Disorders, Post-Traumatic - drug therapy; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Treatment Outcome; Posttraumatic stress disorder; Sleep; Insomnia; Nightmares
• ISSN: 0028-3908; 1873-7064
• DOI: 10.1016/j.neuropharm.2011.02.029

Emerging evidence supports the notion of disrupted sleep as a core component of Posttraumatic Stress Disorder (PTSD). Effective treatments for nighttime PTSD symptoms are critical because sleep disruption may be mechanistically linked to development and maintenance of PTSD and is associated with significant distress, functional impairment, and poor health. This review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. Published studies that examined evidence for therapeutic effects upon sleep were included. Some behavioral and pharmacological interventions show promise, especially for nightmares, but there is a need for controlled trials that include valid sleep measures and are designed to identify treatment mechanisms. Our ability to treat PTSD-related sleep disturbances may be improved by moving away from considering sleep symptoms in isolation and instead conducting integrative studies that examine sequential or combined behavioral and/or pharmacological treatments targeting both the daytime and nighttime aspects of PTSD.
This article is part of a Special Issue entitled ‘Post-Traumatic Stress Disorder’.
► Sleep difficulties, especially insomnia and nightmares, are ubiquitous in PTSD. ► Behavioral interventions for PTSD may reduce nightmares but likely not insomnia. ► Behavioral treatment of nightmares is promising and requires much stronger evidence. ► CBT for Insomnia warrants randomized clinical trials and potential modifications specific to PTSD. ► No drug other than prazosin is supported for treating sleep symptoms in PTSD.