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Poor sleep affects severity and treatment of PTSD

Poor sleep is not just a major health concern, but may also potentially influence the severity of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Research on sleep in TBI and PTSD has found that interventions directed towards sleep improvement can enhance treatment outcomes.

A study was conducted by researchers at Boston University School of Medicine (BUSM) and VA Boston Healthcare System.

The article is published online in the journal of Clinical Psychology Review.

Regardless of the severity of initial injuries, TBI patients can suffer from permanent sleep problems. Approximately 40 to 65 percent of individuals have insomnia after mild TBI, while patients with sleep difficulties are at a higher risk of developing PTSD. Despite significant statistics and evidence, sleep has remained under analyzed in the veteran population.

The review discovered that poor sleep often persists in veterans even after the resolution of their PTSD and minor TBI symptoms, but few treatments and rehabilitation protocols are designed specifically to focus on sleep.

“In these veterans, sleep disturbances continue to adversely impact daily functioning and quality of life. PTSD, TBI, and sleep problems significantly affect functional status and quality of life in veterans returning from combat,” explained lead author Yelena Bogdanova, Ph.D., assistant professor of psychiatry at BUSM.

Severe psychological or physical trauma can cause changes in a person’s basic biological functioning. As a result of being traumatized, a person with PTSD may be constantly hyper-vigilant, or be alert to protect himself or herself from danger, finding it hard to sleep. More often the associated medical conditions of PTSD such as chronic pain, stomach and intestinal problems, and pelvic area issues, particularly for women, affect sleep.

Since an individual battling PTSD is more susceptible to developing a substance abuse disorder, excessive use of drugs and alcohol disrupts sleeping patterns and the quality of sleep.

Moreover, distressing dreams or nightmares, anxiety attacks and screaming or thrashing during sleep are all highly characteristic of PTSD.

Sleep plays an integral role in maintaining restorative processes. Hence, evaluation of sleep problems should be essential in the clinical management of PTSD and TBI. “Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes,” added Bogdanova. “Future research efforts should target the development of sleep-focused interventions.”

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