SLEEP EVENTS AMONG VETERANS WITH COMBAT-RELATED POSTTRAUMATIC-STRESS-DISORDER

Objective: Sleep disturbances are important features of posttraumatic stress disorder (PTSD); however, the published data characterizing PTS D sleep phenomena are limited. The authors report on the phenomenology and physiological correlates of symptomatic sleep events in PTSD. Met hod: The study data included survey results that addressed sleep sympt oms during the past month in combat veterans with and without PTSD (N= 58), sleep diary records of awakenings from combat veterans with PTSD hospitalized on an inpatient rehabilitation unit (N=52), and overnight polysomnography recordings obtained from 21 medication-free combat ve terans with PTSD and eight healthy comparison subjects not exposed to combat. Results: Recurrent awakenings, threatening dreams, thrashing m ovements during sleep, and awakenings with startle or panic features r epresented the most prevalently reported sleep-related symptoms. Labor atory findings of longer time awake, micro-awakenings, and a trend for patients to exhibit body and limb movements during sleep are consiste nt with the subjectively reported symptom profile. Prospectively asses sed symptomatic awakenings featured startle or panic symptoms or anxie ty related to threatening dreams. Laboratory findings revealed a trend for the symptomatic awakenings (with and without dream recall) to be disproportionately preceded by REM sleep, and the two recorded awakeni ngs with objective physiological arousal were Preceded by REM. Conclus ions: PTSD features intrusions into sleep of more highly aroused behav iors and states, which appear partially conditioned to REM sleep.