title: Diagnosis and management of sleep disorders in posttraumatic stress disorder:a review of the literature.
abstract: OBJECTIVE
  International and societal conflicts and natural disasters can leave physical and mental scars in people who are directly affected by these traumatic experiences. Posttraumatic stress disorder (PTSD) is the clinical manifestation of these experiences in the form of re-experiencing the trauma, avoidance of trauma-related stimuli, and persistent symptoms of hyperarousal. There is growing evidence that sleep disruption that occurs following trauma exposure may in fact contribute to the pathophysiology of PTSD and poor clinical outcomes. The purpose of this review is to highlight the importance of recognition and management of sleep disorders in patients with PTSD.
  
  
  METHODS
  English-language, adult research studies published between 1985 and April 2014 were identified via the PubMed database. The search terms used were PTSD AND sleep disorders.
  
  
  METHODS
  The search identified 792 original and review articles. Of these, 53 articles that discussed or researched sleep disorders in PTSD were selected. Fourteen randomized controlled trials of therapy for PTSD are included in this review.
  
  
  RESULTS
  Impaired sleep is a common complaint mainly in the form of nightmares and insomnia among people with PTSD. Sleep apnea and periodic limb movement disorder are particularly prevalent in patients with PTSD and, yet, remain unrecognized. Although selective serotonin reuptake inhibitors are effective in improving PTSD global symptoms, they have a variable and modest effect on sleep disorder symptoms. Cognitive-behavioral treatment targeted to sleep and/or the use of the centrally acting selective α1 antagonist prazosin have been more successful in treating insomnia and nightmares in PTSD than other classes of medications. In view of the high occurrence of sleep apnea and periodic leg movement disorder, a thorough sleep evaluation and treatment are warranted.
  
  
  CONCLUSIONS
  Patients with PTSD have a high prevalence of sleep disorders and should be queried for insomnia, nightmares, periodic limb movement disorder, and sleep-disordered breathing.
authors.affiliation: Private Practice Psychiatry, New Haven, Connecticut (Dr S. Mohsenin) and Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut (Dr V. Mohsenin).
authors.forename: Shahla
authors.initials: S
authors.lastname: Mohsenin
authors.affiliation: Private Practice Psychiatry, New Haven, Connecticut (Dr S. Mohsenin) and Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut (Dr V. Mohsenin).
authors.forename: Vahid
authors.initials: V
authors.lastname: Mohsenin
references.citation: J Trauma Stress. 2001 Oct;14(4):791-7
references.pmid: 11776425
references.citation: J Trauma Stress. 2004 Feb;17(1):69-73
references.pmid: 15027796
references.citation: Am J Psychiatry. 1998 Jul;155(7):929-33
references.pmid: 9659859
references.citation: Expert Opin Pharmacother. 2003 Oct;4(10):1829-38
references.pmid: 14521492
references.citation: J Psychiatr Res. 2002 Nov-Dec;36(6):449-52
references.pmid: 12393315
references.citation: Am J Med. 2013 Apr;126(4):e1-3
references.pmid: 22959786
references.citation: Sleep. 2005 Apr;28(4):499-521
references.pmid: 16171294
references.citation: Brain Res Bull. 2004 Jun 30;63(5):377-83
references.pmid: 15245764
references.citation: Sleep. 2012 Aug 01;35(8):1039-62
references.pmid: 22851801
references.citation: J Trauma Stress. 2003 Jun;16(3):247-50
references.pmid: 12816336
references.citation: Am J Psychiatry. 2002 Oct;159(10):1696-701
references.pmid: 12359675
references.citation: J Anxiety Disord. 2005;19(2):233-44
references.pmid: 15533706
references.citation: J Trauma Stress. 1996 Jan;9(1):129-36
references.pmid: 8750456
references.citation: Sleep Med Rev. 2012 Feb;16(1):27-45
references.pmid: 21616693
references.citation: Annu Rev Clin Psychol. 2005;1:255-91
references.pmid: 17716089
references.citation: Arch Gen Psychiatry. 1993 Apr;50(4):266-74
references.pmid: 8466387
references.citation: Sleep. 1997 Jan;20(1):46-51
references.pmid: 9130334
references.citation: Biol Psychiatry. 1998 Nov 15;44(10):1066-73
references.pmid: 9821572
references.citation: Compr Psychiatry. 2000 Nov-Dec;41(6):469-78
references.pmid: 11086154
references.citation: Chest. 2013 Aug;144(2):549-57
references.pmid: 23681455
references.citation: Arch Gen Psychiatry. 2006 Oct;63(10):1158-65
references.pmid: 17015818
references.citation: N Engl J Med. 2004 Jul 1;351(1):13-22
references.pmid: 15229303
references.citation: Behav Brain Res. 2000 Nov;115(2):183-204
references.pmid: 11000420
references.citation: Hum Psychopharmacol. 2004 Oct;19(7):489-94
references.pmid: 15378676
references.citation: Sleep Med Rev. 2008 Jun;12(3):185-95
references.pmid: 17997114
references.citation: Int J Emerg Ment Health. 2005 Winter;7(1):49-57
references.pmid: 15869081
references.citation: Behav Res Ther. 2002 Apr;40(4):439-57
references.pmid: 12002900
references.citation: Arch Gen Psychiatry. 2009 Oct;66(10 ):1099-107
references.pmid: 19805700
references.citation: PLoS One. 2012;7(10):e46833
references.pmid: 23056477
references.citation: Ann N Y Acad Sci. 2006 Nov;1083:196-213
references.pmid: 17148741
references.citation: Arch Gen Psychiatry. 1998 Jul;55(7):626-32
references.pmid: 9672053
references.citation: Biol Psychiatry. 2008 Mar 15;63(6):629-32
references.pmid: 17868655
references.citation: J Psychiatry Neurosci. 2012 Jul;37(4):241-9
references.pmid: 22313617
references.citation: J Clin Sleep Med. 2011 Oct 15;7(5):459-65B
references.pmid: 22003340
references.citation: J Trauma Stress. 1996 Jan;9(1):137-43
references.pmid: 8750457
references.citation: J Comp Neurol. 2005 Dec 5;493(1):92-8
references.pmid: 16254994
references.citation: J Clin Psychiatry. 2011 Jul;72(7):892-7
references.pmid: 21367352
references.citation: J Psychosom Res. 2012 Feb;72(2):89-96
references.pmid: 22281448
references.citation: Am J Psychiatry. 1995 Jan;152(1):116-20
references.pmid: 7802101
references.citation: Behav Res Ther. 2007 Mar;45(3):627-32
references.pmid: 16777060
references.citation: Am J Psychiatry. 1995 Jan;152(1):110-5
references.pmid: 7802100
references.citation: Biol Psychiatry. 2007 Apr 15;61(8):928-34
references.pmid: 17069768
references.citation: Depress Anxiety. 1999;9(3):141-5
references.pmid: 10356654
references.citation: Am J Psychiatry. 2002 Oct;159(10 ):1777-9
references.pmid: 12359687
references.citation: J Trauma Stress. 2004 Jun;17(3):257-68
references.pmid: 15253098
references.citation: Brain Res. 2009 Oct 13;1293:24-39
references.pmid: 19332035
references.citation: Biol Psychiatry. 2000 Mar 15;47(6):520-5
references.pmid: 10715358
references.citation: Front Psychiatry. 2011 Nov 14;2:62
references.pmid: 22102841
references.citation: Sleep. 1984;7(4):365-72
references.pmid: 6515252
references.citation: J Sleep Res. 2000 Mar;9(1):5-11
references.pmid: 10733683
references.citation: Depress Anxiety. 2004;19(3):190-6
references.pmid: 15129422
references.citation: Sleep. 1994 Dec;17(8):723-32
references.pmid: 7701184
references.citation: Acta Psychiatr Scand. 2010 Jan;121(1):33-40
references.pmid: 19426163
references.citation: Nature. 2006 Nov 30;444(7119):559-60
references.pmid: 17086196
references.citation: Sleep Med. 2003 Jan;4(1):35-41
references.pmid: 14592358
references.citation: Am J Psychiatry. 2001 Dec;158(12):2043-7
references.pmid: 11729023
references.citation: Int J Neuropsychopharmacol. 2012 Jul;15(6):825-40
references.pmid: 21798109
references.citation: Arch Gen Psychiatry. 2001 May;58(5):485-92
references.pmid: 11343529
references.citation: Sleep. 2006 Aug;29(8):1031-5
references.pmid: 16944671
references.citation: J Consult Clin Psychol. 1998 Jun;66(3):507-12
references.pmid: 9642889
references.citation: Psychophysiology. 2007 Jul;44(4):660-9
references.pmid: 17521374
references.citation: Biol Psychiatry. 2001 Jun 1;49(11):948-53
references.pmid: 11377413
references.citation: J Biol Rhythms. 2006 Dec;21(6):482-93
references.pmid: 17107938
references.citation: J Rehabil Res Dev. 2012;49(5):vii-viii
references.pmid: 23015588
references.citation: Arch Gen Psychiatry. 1993 Apr;50(4):295-305
references.pmid: 8466391
references.citation: Am J Psychiatry. 2003 Feb;160(2):371-3
references.pmid: 12562588
references.citation: N Engl J Med. 2008 Jan 31;358(5):453-63
references.pmid: 18234750
references.citation: Behav Sleep Med. 2007;5(4):256-78
references.pmid: 17937582
references.citation: JAMA. 2000 Apr 12;283(14):1837-44
references.pmid: 10770145
references.citation: Sleep. 2010 Jan;33(1):69-74
references.pmid: 20120622
references.citation: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references.pmid: 7492257
references.citation: Am J Psychiatry. 2002 May;159(5):855-7
references.pmid: 11986142
references.citation: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002795
references.pmid: 16437445
references.citation: J Psychosom Res. 2000 Nov;49(5):291-8
references.pmid: 11164053
references.citation: Compr Psychiatry. 2000 Jan-Feb;41(1):49-56
references.pmid: 10646619
references.citation: Mil Med. 2014 Jan;179(1):12-8
references.pmid: 24402979
references.citation: Am J Psychiatry. 2004 Oct;161(10 ):1856-63
references.pmid: 15465983
references.citation: J Rehabil Res Dev. 2012;49(5):703-15
references.pmid: 23015581
references.citation: JAMA. 2001 Aug 1;286(5):537-45
references.pmid: 11476655