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.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146:697–707.
Germain A. Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatry. 2013;170:372–82.
Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev. 2003;23:377–407.
Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep: what a nightmare! Sleep Med Rev. 2000;4:183–200.
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.
Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12:169–84.
Kobayashi I, Boarts JM, Delahanty D. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007;44:660–9.
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.
Nappi CM, Drummond SP, Hall JM. Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence. Neuropharmacology. 2012;62:576–85.
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.
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.
Aston-Jones G, Rajkowski J, Cohen J. Role of locus coeruleus in attention and behavioral flexibility. Biol Psychiatry. 1999;46(9):1309–20.
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.
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.
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.
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.
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.
Berridge CW, Schmeichel BE, Espana RA. Noradrenergic modulation of wakefulness/arousal. Sleep Med Rev. 2012;16:187–97.
Hobson JA, Pace-Schott EF. The cognitive neuroscience of sleep: neuronal systems, consciousness and learning. Nat Rev Neurosci. 2002;3:679–93.
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.
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.
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.
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.
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.
Gottesmann C. The involvement of noradrenaline in rapid eye movement sleep mentation. Front Neurol. 2011;2:81.
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.
Broese M, Riemann D, Hein L, Nissen C. α-adrenergic receptor function, arousal and sleep: mechanisms and therapeutic implications. Pharmacopsychiatry. 2012;45:209–16.
Steiger A, Kimura M. Wake and sleep EEG provide biomarkers in depression. J Psychiatr Res. 2010;44:242–52.
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.
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.
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.
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.
Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci. 2010;11:114–26.
Walker MP, van der Helm E. Overnight therapy? The role of sleep in emotional brain processing. Psychol Bull. 2009;135:731–48.
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.
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.
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.
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.
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.
Milad MR, Quirk GJ. Fear extinction as a model for translational neuroscience: ten years of progress. Annu Rev Psychol. 2012;63:129–51.
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.
Liberzon I, Sripada CS. The functional neuroanatomy of PTSD: a critical review. Prog Brain Res. 2008;167:151–69.
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.
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.
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.
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.
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.
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.
Datta S, O’Malley MW. Fear extinction memory consolidation requires potentiation of pontine-wave activity during REM sleep. J Neurosci. 2013;33:4561–9.
Grosmark AD, Mizuseki K, Pastalkova E, Diba K, Buzsáki G. REM sleep reorganizes hippocampal excitability. Neuron. 2012;75:1001–7.
Merica H, Blois R, Gaillard JM. Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neurosci. 1998;10:1826–34.
Peter-Derex L, Magnin M, Bastuji H. Heterogeneity of arousals in human sleep: a stereo-electroencephalographic study. NeuroImage. 2015;123:229–44.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Science+Business Media LLC
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-1-4939-7148-0_19
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-7146-6
Online ISBN: 978-1-4939-7148-0
eBook Packages: MedicineMedicine (R0)