Insomnia symptoms, reported by ~70% of patients ( 8), are often related to increased autonomic arousal and fear of sleep: fear of loss of control and/or of having nightmares ( 9, 10). These can be exact replications or more symbolic representations of traumatic experiences, and primarily occur during rapid eye movement sleep (REMS) ( 7). The majority of patients with PTSD, about 50–70%, suffer from recurrent distressing nightmares (see Table 1 for an overview of the most frequently occurring sleep disorders in PTSD, their characteristics, ways of assessment and treatment). Our aim is to enhance awareness of clinical practitioners of the importance of targeting sleep in PTSD treatment. Finally, our perspectives for future research directed at more effective sleep-targeted interventions and integrated treatment strategies are described. In this paper we provide an overview of prevalent sleep disorders in PTSD, the reciprocal association of sleep disturbances and PTSD and its underlying mechanisms, as well as information on accurate assessment and treatment of disturbed sleep tailored to the PTSD patient population. It has long been thought that interventions focusing on trauma itself would eventually reduce disturbed sleep, but accumulating evidence shows that sleep disorders play a central role in both the development and maintenance of PTSD and therefore require particular clinical attention. In addition, various other sleep disorders are common in PTSD. Nightmares (intrusions) and difficulties sleeping (hyperarousal) are specifically included in the diagnostic (DSM-5) criteria of the disorder ( 2). Sleep disturbances frequently occur in posttraumatic stress disorder (PTSD) and are reported by 70–90% of patients ( 1). Finally, we will present some perspectives on future multidisciplinary clinical and experimental research to develop new, more effective sleep therapies to improve both sleep and PTSD. Furthermore, diagnostic procedures, standard interventions-particularly first choice non-pharmacological therapies-and practical problems that often arise in the assessment and treatment of sleep disturbances in PTSD are described. This article provides a concise overview of the literature on prevalent comorbid sleep disorders, their reciprocal relation with PTSD and possible underlying neurophysiological mechanisms. Yet, relations between disturbed sleep and PTSD are far more complex: PTSD is linked to a broad range of sleep disorders and disturbed sleep markedly affects PTSD-outcome. Insomnia and nightmares are viewed as core symptoms of PTSD. Sleep disturbances frequently co-occur with posttraumatic stress disorder (PTSD). 5ARQ Centrum'45, Oegstgeest, Netherlands.4GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands.3Department of Psychiatry, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands.2Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.1Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, Netherlands.
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