There are higher rates of insomnia, nightmares and sleep apnoea in individuals exposed to trauma, and animal models demonstrate that acute and chronic stress lead to disturbed sleep. Over 80% of patients with post-traumatic stress disorder report nightmares characterised by intrusive/re-experiencing symptoms and hyperarousal. The presence of nightmares following a traumatic experience predicts delayed onset of PTSD and even when PTSD resolves, PTSD associated nightmares can persist throughout life.
Treatment of sleep apnoea is complicated by other sleep disturbances associated with PTSD and high level evidence exists that supports the use of prazosin in PTSD nightmares. For other agents, the evidence is of lesser quality. Behavioural treatments such as imagery rehearsal have some support from randomised controlled trials but not all have been positive. Other behavioural treatments have lower degrees of evidence. Current best practice in the area requires an interdisciplinary approach Associate Professor Delwyn Bartlett focuses on the clinical perspective while Dr Ron Grunstein will provide an overview of the theoretical aspects in another lecture titled: Sleep disturbances and trauma
