COMMENTARY

Sleep Disturbances and Posttraumatic Stress Disorder

Nicholas H. Orr, MD; Christopher J. Lettieri, MD 

Disclosures

March 16, 2011

In This Article

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a chronic psychiatric condition that is associated with exposure to a traumatic event.[1]

The gross features of the illness are characterized by fear, a sense of hopelessness, and social impairments. Three additional symptom clusters must be present to confirm the diagnosis: (1) recurrent mental imagery re-experiencing the traumatic event, (2) a pattern of avoidance behaviors, and (3) hypervigilance.[1]

It is estimated that between 2% and 12% of the population will experience PTSD throughout the course of their lives.[2,3] It is significantly more common in individuals with combat experience, and the prevalence of PTSD may approach 25% in service members returning from war.[4,5]

In addition to experiencing a physical and/or emotionally traumatic event, risk factors for the development of PTSD include female gender, comorbid psychiatric illness, and substance abuse.[2,3,6,7] Sexual assault is the most common precipitating cause reported by women with PTSD, whereas combat deployments are the most commonly identified etiology in men.[2,3,4,5,6,7,8]

Recently, sleep disturbances or other factors that can diminish resiliency have been linked with an increased risk for PTSD. Similarly, case reports and studies of individuals surviving motor vehicle collisions, hurricanes, and traumatic injuries suggest that posttraumatic sleep disturbances (eg, insomnia, nightmares) can predict both the development of PTSD and the severity of symptoms.[9]

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