THE COMPLEX RELATIONSHIP BETWEEN INSOMNIA AND POST-TRAUMATIC STRESS DISORDER (PTSD): A SYSTEMATIC REVIEW
Main Article Content
Keywords
Post-Traumatic Stress Disorder(PTSD), Insomnia, quality of life
Abstract
Background: Post-Traumatic Stress Disorder (PTSD) and insomnia frequently co-occur, complicating both diagnosis and treatment. Insomnia, a common complaint in individuals with PTSD, exacerbates daytime dysfunction, impairs recovery, and reduces the overall quality of life.
Objectives: This systematic review aims to:
- Assess the prevalence of insomnia in individuals with PTSD across different populations.
- Identify key factors associated with the co-occurrence of insomnia and PTSD.
Methods: A comprehensive literature search was conducted using databases including PubMed, PsycINFO, and Web of Science. Studies were selected based on their exploration of the relationship between PTSD and insomnia. Inclusion criteria encompassed peer-reviewed studies in adults that examined both conditions, using either cross-sectional or longitudinal designs
Results: The prevalence of insomnia in PTSD patients was consistently high, ranging from 50% to 90%, with variations across trauma types and comorbidities. Factors such as symptom severity, trauma exposure, and the presence of anxiety or depression were found to significantly influence insomnia. Key mechanisms proposed to explain the relationship include heightened hyperarousal, circadian rhythm abnormalities, and trauma-related fear conditioning.
Conclusion: Insomnia plays a critical role in perpetuating PTSD symptoms, and its treatment may improve both sleep and PTSD outcomes. Further research should explore targeted interventions, such as cognitive-behavioral therapy for insomnia (CBT-I), in the management of comorbid insomnia and PTSD.
References
2. Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191 /box/part1_ch3.box16/
3. Insomnia and posttraumatic stress symptoms: Evidence of shared etiology Rebecca C. Coxa, Steven Taylorb, Eric Strachanc, Bunmi O. Olatunjia.
4. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms
5. Family Name, G. N. (n.d.). Title of the book. http://mizedujournal.com/images/resources/ v10/n1-2/lalrinchhani.pdf
6. .Babson, K. A., & Feldner, M. T. (2010). Temporal relations between sleep problems and both traumatic event exposure and PTSD: A critical review of the emp”rical literature. Journal of Anxiety Disorders, 24(1), 1-15. https://doi.org/10.1016/j.janxdis.2009.08.002
7. Bryant, R. A. (2019). Post-traumatic stress disorder: A state-of-the-art review of evidence and challenges. World Psychiatry, 18(3), 259-269. https://doi.org/10.1002/wps.20656
8. Capaldi, V. F., Guerrero, M. L., & Killgore, W. D. (2011). Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Military Medicine, 176(8), 879-888. https://doi.org/10.7205/MILMED-D-10-00208
9. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 170(4), 372-382. https://doi.org/10.1176/appi.ajp.2012.12040432
10. Harvey, A. G., & Tang, N. K. (2012). (Mis)perception of sleep in insomnia: A puzzle and a resolution. Psychological Bulletin, 138(1), 77-101. https://doi.org/10.1037/a0025730
11. Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014). PTSD treatment for soldiers after combat deployment: Low utilization of mental health care and reasons for dropout. Psychiatric Services, 65(8), 997-1004. https://doi.org/10.1176/appi.ps.201300307
12. Kobayashi, I., Sledjeski, E. M., & Spoonster, E. (2008). PTSD symptoms, comorbid mental health conditions, and perceived coping ability among World Trade Center rescue and recovery workers. Psychological Medicine, 38(8), 1031-1040. https://doi.org/10.1017 /S0033291707002666
13. Krakow, B., Melendrez, D. C., Pederson, B., Johnston, L., Hollifield, M., Germain, A., & Koss, M. (2001). Complex insomnia: Insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD.Biological Psychiatry, 49(11), 948-953. https://doi.org/10.1016/S0006-3223(00)01127-7
14. . Lamarche, L. J., & De Koninck, J. (2007). Sleep disturbance in adults with posttraumatic stress disorder: A review. Journal of Clinical Psychiatry, 68(8), 1257-1270. https://doi.org/10.4088/JCP.v68n0818
15. . McLay, R. N., Klam, W. P., & Volkert, S. L. (2010). Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in U.S.service members returning from military deployments. Military Medicine, 175(10), 759-762. https://doi.org/10.7205/MILMED-D-10-00050
16. . Mellman, T. A., & Hipolito, M. M. S. (2006). Sleep disturbances in the aftermath of trauma and posttraumatic stress disorder. CNS Spectrums, 11(8), 611-615. https://doi.org/10.1017/S1092852900014822
17. . Pigeon, W. R., & Gallegos, A. M. (2015). Posttraumatic stress disorder and sleep. Sleep Medicine Clinics, 10(1), 41-48. https://doi.org/10.1016/j.jsmc.2014.11.001
18. . Raskind, M. A., Peterson, K., Williams, T., Hoff, D. J., Hart, K., Holmes, H., & McFall, M. E. (2013). A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. American Journal of Psychiatry, 170(9), 1003-1010. https://doi.org/10.1176/appi.ajp.2013.12081133
19. . Ross, R. J., Ball, W. A., Sullivan, K. A., & Caroff, S. N. (1989). Sleep disturbance as the hallmark of posttraumatic stress disorder. American Journal of Psychiatry, 146(6), 697-707.https://doi.org/10.1176/ajp.146.6.697
20. . Spoormaker, V. I., & Montgomery, P. (2008). Disturbed sleep in post-traumatic stress disorder: Secondary symptom or core feature? Sleep Medicine Reviews, 12(3), 169-184. https://doi.org/10.1016/j.smrv.2007.08.008
21. . Stein, M. B., Walker, J. R., Hazen, A. L., & Forde, D. R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154(8), 1114-1119.https://doi.org/10.1176/ajp.154.8.1114
22. . Swanson, L. M., Favorite, T. K., Horin, E. D., & Arnedt, J. T. (2009). A combined cognitive-behavioral treatment for nightmares and insomnia in posttraumatic stress disorder: A pilot study. Journal of Traumatic Stress, 22(6), 639-642. https://doi.org/10.1002/jts.20468
23. Van Liempt, S., Vermetten, E., & Geuze, E. (2006). The impact of impaired sleep on the development of PTSD symptoms and the development of anxiety and depression. Neurobiology of Learning and Memory, 87(4), 598-609. https://doi.org/10.1016/j.nlm.2006.01.009
24. Zayfert, C., DeViva, J. C., & Spencer, M. A. (2005). Residual insomnia following cognitive behavioral therapy for PTSD. Journal of Traumatic Stress, 18(3), 245-248. https://doi.org/10.1002/jts.20024
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Muhammad Asjad Abbas
Shifa College of Medicine/Shifa International Hospital, Islamabad Pakistan.
Dr Vaisakh Shajikumar
KIMSHEALTH Medical Center (Dubai Health Authority).
Dr Shanza Bashir
MCPS Anaesthesia, Shifa International Hospital, Islamabad Pakistan.
Dr Ann Al Maha Faisal
Demonstrator, Department of Pharmacology, Shifa Tameer e Millat University, Islamabad, Pakistan.
Dr Faiz Ahmad
Islam Medical and Dental College, Sialkot Pakistan.
Dr Uswa Tahir
FMH College of Medicine and Dentistry, Lahore Pakistan.
Dr. Fathima Farzana
General Practitioner, GSM Medical Center LLC
Dr Alaa Al Hurini
Gulf Medical University
Dr Ashtar Kariem
Trainee Physician, SGH, Dubai, UAE.
Dr Lina Rabah El-Sayed
MBBS, College of Medicine, Gulf Medical University, Ajman, UAE.