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PTSD, Arousal, and Disrupted (REM) Sleep

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Abstract

Studies on clinical symptoms have documented correlations between post-traumatic stress disorder (PTSD) and sleep disturbances, with high prevalence for subjective sleep disturbances and small-to-moderate effects regarding objective sleep parameters. Studies on cortisol responses in PTSD have been equivocal, but there is evidence that central noradrenergic levels are increased in PTSD and these may subserve fragmentation of (REM) sleep and prolong wake after sleep onset. Such REM disruptions in PTSD may impair memory consolidation and/or emotional homeostasis as REM sleep deprivation has shown to impair fear extinction consolidation. More quantitative EEG and whole-brain neuroimaging work is needed at this stage to examine the relevant neural circuitry. Understanding the effects of heightened arousal on both task performance and sleep transitions may be essential to elucidating the neurophysiological commonalities of various PTSD symptom clusters.

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References

  1. Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146:697–707.

    Article  CAS  PubMed  Google Scholar 

  2. Germain A. Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatry. 2013;170:372–82.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev. 2003;23:377–407.

    Article  PubMed  Google Scholar 

  4. Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep: what a nightmare! Sleep Med Rev. 2000;4:183–200.

    Article  PubMed  Google Scholar 

  5. Neylan TC, Marmar CR, Metzler TJ, Weiss DS, Zatzick DF, Delucchi KL, et al. Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1998;155:929–33.

    Article  CAS  PubMed  Google Scholar 

  6. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12:169–84.

    Article  PubMed  Google Scholar 

  7. Kobayashi I, Boarts JM, Delahanty D. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007;44:660–9.

    Article  PubMed  Google Scholar 

  8. Mellman TA, Bustamante V, Fins AI, Pigeon WR, Nolan B. REM sleep and the early development of posttraumatic stress disorder. Am J Psychiatry. 2002;159:1696–701.

    Article  PubMed  Google Scholar 

  9. Nappi CM, Drummond SP, Hall JM. Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence. Neuropharmacology. 2012;62:576–85.

    Google Scholar 

  10. Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner TD, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA. 2001;286:537–45.

    Article  CAS  PubMed  Google Scholar 

  11. Aston-Jones G, Cohen JD. An integrative theory of locus coeruleus-norepinephrine function: adaptive gain and optimal performance. Annu Rev Neurosci. 2005;28(1):403–50.

    Article  CAS  PubMed  Google Scholar 

  12. Aston-Jones G, Rajkowski J, Cohen J. Role of locus coeruleus in attention and behavioral flexibility. Biol Psychiatry. 1999;46(9):1309–20.

    Article  CAS  PubMed  Google Scholar 

  13. Geracioti TDJ, Baker DG, Ekhator NN, West SA, Hill KK, Bruce AB, et al. CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry. 2001;158:1227–30.

    Article  PubMed  Google Scholar 

  14. Wingenfeld K, Whooley MA, Neylan TC, Otte C, Cohen BE. Effect of current and lifetime posttraumatic stress disorder on 24-h urinary catecholamines and cortisol: results from the mind your heart study. Psychoneuroendocrinology. 2015;52:83–91.

    Article  CAS  PubMed  Google Scholar 

  15. Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, et al. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull. 2015;141(1):105–40.

    Article  PubMed  Google Scholar 

  16. Johnson JD, Allana TN, Medlin MD, Harris EW, Karl A. Meta-analytic review of P3 components in posttraumatic stress disorder and their clinical utility. Clin EEG Neurosci. 2013;44(2):112–34.

    Article  CAS  PubMed  Google Scholar 

  17. Shucard JL, McCabe DC, Szymanski H. An event-related potential study of attention deficits in posttraumatic stress disorder during auditory and visual go/NoGo continuous performance tasks. Biol Psychol. 2008;79(2):223–33.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Berridge CW, Schmeichel BE, Espana RA. Noradrenergic modulation of wakefulness/arousal. Sleep Med Rev. 2012;16:187–97.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hobson JA, Pace-Schott EF. The cognitive neuroscience of sleep: neuronal systems, consciousness and learning. Nat Rev Neurosci. 2002;3:679–93.

    Article  CAS  PubMed  Google Scholar 

  20. Berridge CW, Page ME, Valentino RJ, Foote SL. Effects of locus coeruleus inactivation on electroencephalographic activity in neocortex and hippocampus. Neuroscience. 1993;55:381–93.

    Article  CAS  PubMed  Google Scholar 

  21. Mellman TA, Kumar A, Kulick-Bell R, Kumar M, Nolan B. Nocturnal/daytime urine noradrenergic measures and sleep in combat-related PTSD. Biol Psychiatry. 1995;38:174–9.

    Article  CAS  PubMed  Google Scholar 

  22. Taylor FB, Martin P, Thompson C, Williams J, Mellman TA, Gross C, et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry. 2008;63:629–32.

    Article  CAS  PubMed  Google Scholar 

  23. Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al. Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. J Psychosom Res. 2012;72:89–96.

    Article  PubMed  Google Scholar 

  24. Cape EG, Jones BE. Differential modulation of high-frequency gamma-electroencephalogram activity and sleep-wake state by noradrenaline and serotonin microinjections into the region of cholinergic basalis neurons. J Neurosci. 1998;18:2653–66.

    CAS  PubMed  Google Scholar 

  25. Gottesmann C. The involvement of noradrenaline in rapid eye movement sleep mentation. Front Neurol. 2011;2:81.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Léna I, Parrot S, Deschaux O, Muffat-Joly S, Sauvinet V, Renaud B, et al. Variations in extracellular levels of dopamine, noradrenaline, glutamate, and aspartate across the sleep – wake cycle in the medial prefrontal cortex and nucleus accumbens of freely moving rats. J Neurosci Res. 2005;81:891–9.

    Article  PubMed  Google Scholar 

  27. Broese M, Riemann D, Hein L, Nissen C. α-adrenergic receptor function, arousal and sleep: mechanisms and therapeutic implications. Pharmacopsychiatry. 2012;45:209–16.

    Article  CAS  PubMed  Google Scholar 

  28. Steiger A, Kimura M. Wake and sleep EEG provide biomarkers in depression. J Psychiatr Res. 2010;44:242–52.

    Article  PubMed  Google Scholar 

  29. Cohen H, Zohar J, Gidron Y, Matar MA, Belkind D, Loewenthal U, et al. Blunted HPA axis response to stress influences susceptibility to posttraumatic stress response in rats. Biol Psychiatry. 2006;59:1208–18.

    Article  CAS  PubMed  Google Scholar 

  30. Delahanty DL, Raimonde AJ, Spoonster E. Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims. Biol Psychiatry. 2000;48:940–7.

    Article  CAS  PubMed  Google Scholar 

  31. Zohar J, Juven-Wetzler A, Sonnino R, Cwikel-Hamzany S, Balaban E, Cohen H. New insights into secondary prevention in post-traumatic stress disorder. Dialogues Clin Neurosci. 2011;13:301–9.

    PubMed  PubMed Central  Google Scholar 

  32. van Liempt S, Arends J, Cluitmans PJ, Westenberg HG, Kahn RS, Vermetten E. Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: a study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology. 2013;38:155–65.

    Article  PubMed  Google Scholar 

  33. Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci. 2010;11:114–26.

    Article  CAS  PubMed  Google Scholar 

  34. Walker MP, van der Helm E. Overnight therapy? The role of sleep in emotional brain processing. Psychol Bull. 2009;135:731–48.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pape HC, Pare D. Plastic synaptic networks of the amygdala for the acquisition, expression, and extinction of conditioned fear. Physiol Rev. 2010;90:419–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Rauch SL, Shin LM, Phelps EA. Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research – past, present, and future. Biol Psychiatry. 2006;60:376–82.

    Article  PubMed  Google Scholar 

  37. Blechert J, Michael T, Vriends N, Margraf J, Wilhelm FH. Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses. Behav Res Therapy. 2007;45:2019–33.

    Article  Google Scholar 

  38. Milad MR, Pitman RK, Ellis CB, Gold AL, Shin LM, Lasko NB, et al. Neurobiological basis of failure to recall extinction memory in posttraumatic stress disorder. Biol Psychiatry. 2009;66:1075–82.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wessa M, Flor H. Failure of extinction of fear responses in posttraumatic stress disorder: evidence from second-order conditioning. Am J Psychiatry. 2007;164:1684–92.

    Article  PubMed  Google Scholar 

  40. Milad MR, Quirk GJ. Fear extinction as a model for translational neuroscience: ten years of progress. Annu Rev Psychol. 2012;63:129–51.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sehlmeyer C, Schöning S, Zwitserlood P, Pfleiderer B, Kircher T, Arolt V, et al. Human fear conditioning and extinction in neuroimaging: a systematic review. PLoS One. 2009;4:e5865.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Liberzon I, Sripada CS. The functional neuroanatomy of PTSD: a critical review. Prog Brain Res. 2008;167:151–69.

    Article  PubMed  Google Scholar 

  43. Pitman RK, Rasmusson AM, Koenen KC, Shin LM, Orr SP, Gilbertson MW, et al. Biological studies of post-traumatic stress disorder. Nat Rev Neurosci. 2012;13:769–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Cohen JE, Shalev H, Admon R, Hefetz S, Gasho CJ, Shachar LJ, et al. Emotional brain rhythms and their impairment in post-traumatic patients. Hum Brain Mapp. 2013;34:1344–56.

    Article  PubMed  Google Scholar 

  45. Bódizs R, Kántor S, Szabó G, Szûcs A, Erõss L, Halász P. Rhythmic hippocampal slow oscillation characterizes REM sleep in humans. Hippocampus. 2001;11:747–53.

    Article  PubMed  Google Scholar 

  46. Fu J, Li P, Ouyang X, Gu C, Song Z, Gao J, et al. Rapid eye movement sleep deprivation selectively impairs recall of fear extinction in hippocampus-independent tasks in rats. Neuroscience. 2007;144:1186–92.

    Article  CAS  PubMed  Google Scholar 

  47. Spoormaker VI, Schröter MS, Andrade KC, Dresler M, Kiem S, Goya-Maldonado R, et al. Effects of rapid eye movement sleep deprivation on fear extinction recall and prediction error signaling. Hum Brain Mapp. 2012;33:2362–76.

    Article  PubMed  Google Scholar 

  48. Popa D, Duvarci S, Popescu AT, Léna C, Paré D. Coherent amygdalocortical theta promotes fear memory consolidation during paradoxical sleep. Proc Natl Acad Sci U S A. 2010;107:6516–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Datta S, O’Malley MW. Fear extinction memory consolidation requires potentiation of pontine-wave activity during REM sleep. J Neurosci. 2013;33:4561–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Grosmark AD, Mizuseki K, Pastalkova E, Diba K, Buzsáki G. REM sleep reorganizes hippocampal excitability. Neuron. 2012;75:1001–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Merica H, Blois R, Gaillard JM. Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neurosci. 1998;10:1826–34.

    Google Scholar 

  52. Peter-Derex L, Magnin M, Bastuji H. Heterogeneity of arousals in human sleep: a stereo-electroencephalographic study. NeuroImage. 2015;123:229–44.

    Article  PubMed  Google Scholar 

  53. Ebdlahad S, Nofzinger EA, James JA, Buysse DJ, Price JC, Germain A. Comparing neural correlates of REM sleep in posttraumatic stress disorder and depression: a neuroimaging study. Psychiatry Res Neuroimaging. 2013;214(3):422–8.

    Article  PubMed  Google Scholar 

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Correspondence to Victor I. Spoormaker .

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Spoormaker, V.I. (2018). PTSD, Arousal, and Disrupted (REM) Sleep. In: Vermetten, E., Germain, A., Neylan, T. (eds) Sleep and Combat-Related Post Traumatic Stress Disorder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7148-0_19

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  • DOI: https://doi.org/10.1007/978-1-4939-7148-0_19

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