For example, rapid eye movement (REM) fragmentation within 1 month after a traumatic event was shown to predict PTSD symptom severity 6 weeks later. For instance, insomnia was shown to precede trauma and predict the development of PTSD.
There is evidence that sleep disturbances predict PTSD acquisition, severity, and treatment. While OSA, nightmares, and insomnia are fully separate disorders, they may all influence PTSD and sleep stages through shared effects including sleep fragmentation.
Although sleep disturbances are symptoms of PTSD, they are best considered co-occurring and independent disorders. The most common sleep disorders include insomnia, obstructive sleep apnea (OSA), and nightmares, with prevalence rates in PTSD that are considerably higher than in unaffected individuals. We discuss gaps in the extant literature and make suggestions on utilizing evidence-based sleep treatments to decrease the incidence of PTSD and increase treatment effectiveness.Ĭomorbidity of PTSD and sleep disorders is staggeringly high, with 70–91% of individuals with PTSD reporting disturbed sleep. Our paper reviews the most recent literature on the relationship between fear/extinction/safety processes, sleep, and PTSD. However, there is a dearth of information examining the relationships between sleep, emotional memory and learning process, and PTSD together. Additionally, sleep disturbances are linked to emotional memory and learning processes. For example, there is evidence that sleep disturbances predict PTSD acquisition (e.g., ), severity (e.g., ), and treatment response (e.g., ). Sleep disturbances have been linked to both PTSD and emotional learning and memory processes. Examining modifiable factors that relate to both PTSD and emotional learning and memory mechanisms, such as disrupted sleep, may offer additional insight into processes relevant in the initiation and maintenance of PTSD as well as guide treatment interventions. Additionally, safety learning and extinction are hypothesized mechanisms for evidence-based PTSD treatment (e.g., ). Exaggerated acquisition of conditioned fear as well as impairments in safety learning and extinction processes are hypothesized to be critical factors in the development and maintenance of PTSD (e.g., ). The emotional memory and learning model of PTSD posits dysfunctional or maladaptive Pavlovian fear conditioning, fear extinction learning, fear extinction recall, and safety learning (the ability to differentiate safe from unsafe cues ) as central mechanisms to PTSD. Advancing our understanding of mechanisms that influence PTSD acquisition, maintenance, and treatment can help guide interventions to decrease PTSD onset and severity and create more effective treatment interventions. While there are several effective evidence-based interventions for PTSD, there are still a significant proportion of non-responders or partial responders to treatment. PTSD affects approximately 5.2 million adults in the USA and is associated with numerous negative physical and mental health consequences. Posttraumatic stress disorder (PTSD) is characterized by exposure to trauma, distressing re-experiencing of traumatic memory, avoidance of cues associated with the traumatic event, alterations in negative cognitions and mood, and hyperarousal symptoms.
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