Sleep and PTSD

The Chapter reviews two long standing concerns of sleep research in PTSD. The first is characterizing dysregulations of arousal that manifest in relation to sleep including disturbances of sleep initiation, maintenance, and depth. The other is characterizing nightmare disturbances in PTSD and establishing the role of the neurophysiological substrate of dreams, rapid eye movement sleep (REMS), in the disorder. While there has been uncertainty and controversy regarding these issues, a comprehensive look at findings and their context (e.g. duration of PTSD, setting of recordings) allows some reconciliation of findings. Recent developments include assessment of autonomic balance during sleep and application of functional brain imaging. Emerging research on the role of sleep, particularly REMS, on emotional learning has been linked to PTSD. Treatments specifically targeting nightmares and other sleep disruptions, such as the alpha adrenergic antagonist prazosin and imagery rehearsal therapy, continue to be developed and evaluated.