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Night terrors ptsd treatment


Management of nightmares in patients with posttraumatic stress disorder: current perspectives

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Treating PTSD Night Terrors - Psy Visions

If you scream and flail in your sleep for a few seconds to a few minutes, it’s highly likely that you suffer from night terrors. One thing’s for sure, it’s an undesired occurrence that not only negatively affects you but also the people around you.

While anyone can suffer from night terrors, there are some people who are more prone to developing them. If you have been diagnosed with PTSD, or post-traumatic stress disorder, you are vulnerable to experiencing night terrors.

PTSD and Night Terrors

Approximately 96% of people with PTSD experience terrifying nightmares that are so vivid that they seem real. Unlike bad dreams, night terrors have physical manifestations such as thrashing, flailing, screaming, and even sleepwalking. Night terrors should be addressed early on because they can put you in serious danger. Sleeping beside someone who suffers from PTSD-induced night terrors can also cause emotional distress.

Night terrors come in episodes, and in a sleep terror episode, you may:

  • Start with a scream
  • Sweat profusely and breathe heavily
  • Wake up frightened and wide-eyed
  • Have a racing pulse
  • Experiencing facial flushing and dilated pupils
  • Kick, flail, and thrash
  • Run around the house
  • Have difficulty waking
  • Cry or be inconsolable
  • Turn aggressive when restrained
  • Have no memory of the night terror episode

Any of the above behaviors are not normal and should not be shrugged off as if it were just a nightmare. Night terrors is considered a serious condition.

Treating PTSD-Induced Night Terrors

It’s important that you see a psychiatrist who specializes in treating PTSD-induced sleep disorders such as night terrors. At this point in your life, you need all the support you can get to work through your PTSD. Be open about it to your family, friends, and of course, your psychiatrist.

Treatment for PTSD-induced night terrors usually begins with making lifestyle changes such as:

  • Getting adequate sleep
  • Avoiding drugs and alcohol
  • Healthy eating
  • Keeping stress levels in check, such as with breathing exercises
  • Exercising every day
  • Doing yoga
  • Making your sleep environment safe

When lifestyle changes fail to resolve your night terrors, your psychiatrist may prescribe you with medication such as benzodiazepines and serotonin reuptake inhibitors (SSRIs). But before a resorting to medication, a psychiatrist would first help you work through any anxiety – in this case, PTSD – before prescribing medication. Psychiatrists may also employ hypnosis, cognitive behavioral therapy, or relaxation therapy to help patients with PTSD-induced night terrors.

You may also be advised to undergo a sleep study to rule out other potential causes of your night terrors. You may have an underlying medical condition that requires treatment, too, such as obstructive sleep apnea.

Psychiatric Help in Connecticut

Dr. Mark Stracks of Psy-Visions delivers the highest quality care for his patients suffering from PTSD-induced night terrors. He diagnoses and treats a wide range of conditions and disorders, including sleep disorders. His style is to spend time listening to you and talking with you, which is very crucial to determining what you need to do together to help you start feeling better.

Dr. Stracks wants you to live a happy life, the kind you deserve. He will work with you to find an effective solution, even if you don’t like to take medication.

Feel free to reach out to Psy-Visions at (203) 405-1745 or you may request an appointment now.

PTSD-related sleep disorders

Post-traumatic stress disorder (PTSD) is a trauma- and stress-related disorder characterized by reliving, avoidance, excessive arousal, and negative changes in cognition or mood. Events that threaten the integrity of one's own body or others, such as rape, physical abuse, natural disasters, and combat are commonly associated with the development of post-traumatic stress disorder. The lifetime prevalence of PTSD among adults in the United States ranges from 6% to 10%, with women more than twice as likely to have PTSD in some regions. nine0008

Significantly higher rates were registered among combat veterans (15–30%). The incidence of PTSD is higher in veterans if they have been in combat zones, have been on assignment for more than one year, have been in combat, or have been injured. In particular, among veterans deployed to Iraq and Afghanistan, 31-86% report multiple injuries sustained during combat operations, and 11-20% confirm severe symptoms of post-traumatic stress disorder. nine0003

Sleep disorders associated with post-traumatic stress disorder

Sleep complaints are common after traumatic experiences. Subjective and objective sleep disturbances are associated with an increased risk of meeting the diagnostic criteria for post-traumatic stress disorder, and insomnia and nightmares are major diagnostic features of post-traumatic stress disorder and are also frequently reported by patients with PTSD. These sleep disturbances are known to exacerbate daytime symptoms and worsen clinical outcomes. This highlights the importance of monitoring the development of sleep disorders in patients with a history of trauma and their role as mediators of clinical outcomes in post-traumatic stress disorder. Sleep disorders in this population are often resistant to first-line treatment for PTSD. Sleep-specific interventions are commonly used to relieve insomnia and nightmares. Effective treatment has been associated with improvements in daytime symptoms of post-traumatic stress disorder, depression, quality of life, and subjective physical health. nine0003

Nightmares

Nightmares are characterized by disturbing, memorable dreams that cause distress or disrupt daytime sleep (ICSD-3). Night terrors are not uncommon in the general population, with up to 85% of adults reporting at least one nightmare per year. Patients with post-traumatic stress disorder and psychiatric disorders experience nightmares much more frequently.

In addition, nightmares are associated with an increased risk of suicidal thoughts. Despite this, patients often underestimate nightmares and therefore fail to recognize them by clinicians. The high prevalence of post-traumatic stress disorder and psychiatric disorders in military personnel leads to even higher levels of nightmares. Of military personnel sent for sleep assessments, 31% had nightmares at least once a week, significantly higher than the general population (0.9-6.8%).

Treatment options for nightmares include a combination of behavioral therapies and medication. Imaginary rehearsal therapy (IRT) is a technique in which patients are taught to "rewrite" their nightmares and thus unlearn their behavior. This therapy has proven successful in combat veterans as well as civilians who have been traumatized. A variant of IRT called exposure. Rescripting and Relaxation Therapy (ERRT) incorporates aspects of traditional Cognitive Behavioral Therapy (CBT) with IRT. The combination of CBT for insomnia and IRT shows promising short-term effects in veterans with PTSD. Finally, pharmacological therapy with prazosin or positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) may also be successful for nightmares. nine0003

Trauma-related sleep disorder

In a subgroup of patients with post-traumatic stress disorder, trauma-related nightmares are accompanied by parasomnias. Trauma-related sleep disorder is a recently proposed unique parasomnia that describes the clinical features of trauma-related nightmares in association with disruptive nocturnal behaviors (DNBs).

Destructive nocturnal behaviors consist of abnormal vocalizations (screams, moans) and movements (beating, turning, sleepwalking) as well as aggressive behaviors (hitting or kicking a bed partner). DNP often mimics nightmarish content. Autonomic signs of hyperarousal (rapid heart rate, rapid breathing, night sweats) are often associated with this behavior. nine0003

Polysomnogram (PSG) scores typically show sleep recall behavior and increased muscle activity during the rapid eye movement phase (REM without atony). These patients almost always have nightmares. Trauma-related sleep disturbance can also occur along with insomnia and sleep apnea. Therefore, in patients with symptoms of a trauma-related sleep disorder, polysomnography is recommended to look for sleep breathing disorders in addition to assessing whether the patient has abnormal behaviors and/or movements during REM sleep. nine0003

There are currently no evidence-based guidelines for the treatment of this newly proposed sleep disorder. Getting enough sleep, avoiding triggers, and creating a safe sleep environment are critical. In some cases, drug therapy may be required to suppress these phenomena. Some patients respond well to combined treatment with prazosin for nightmares and disruptive nighttime behavior, behavioral therapy for insomnia, and CPAP therapy for sleep apnea. nine0003

Insomnia

Insomnia is the most common sleep complaint among both civilians and military personnel (MSMR 2013). It is also the most common symptom among returning service members and combat veterans with post-traumatic stress disorder. Up to 74% of combat veterans with PTSD meet the clinical criteria for insomnia.

In addition, sexually traumatized veterans are more likely to experience insomnia symptoms (61%) than non-injured veterans (53%). Insomnia is associated with higher severity of post-traumatic stress disorder and does not tend to resolve spontaneously over time. nine0003

Treatment options for insomnia in patients with PTSD are similar to those for the general population. However, insomnia in PTSD patients may be complicated by their PTSD symptoms as well as comorbid sleep disturbances and unhealthy sleep practices. Cognitive behavioral therapy (CBT) improves sleep quality as well as daytime symptoms of post-traumatic stress disorder in this population. In addition, combination therapy of CBT and imaginative rehearsal therapy (IRT) may be beneficial in patients with coexisting nightmares. There are currently no evidence-based guidelines for the pharmacological treatment of insomnia in the PTSD population due to a lack of high-quality research. nine0003

Although the American Academy of Sleep Medicine (AASM) generally does not recommend a polysomnogram for patients with chronic insomnia, PTSD patients have a high incidence of comorbid sleep disorders such as obstructive sleep apnea syndrome (OSAS) and periodic limb movement disorders. Polysomnography should be considered for post-traumatic stress disorder in patients with insomnia, especially if standard insomnia treatment fails. nine0003

Sleep disturbance

While insomnia and nightmares have been the most commonly reported sleep symptoms in the PTSD literature, more attention has recently been paid to the prevalence and significance of sleep disturbance in patients with PTSD. disorder. Respiratory failure, most commonly in the form of sleep apnea, affects 9-38% of the adult population, with higher rates among men, the elderly, and obese people. In addition, among the military, the frequency of sleep apnea syndrome up to 60-85% was reported. nine0003

In addition, recent literature indicates that people with PTSD have a disproportionately higher rate of sleep disturbances than the general population, with an incidence of comorbid PTSD and sleep apnea (15-90%) , depending on the diagnostic methodology used. Krakow et al., et al. proposed a new hypothesis that includes a bidirectional explanation for why patients with post-traumatic stress disorder have a high incidence of sleep apnea. This hypothesis is that the fragmentation of sleep (nightmares, insomnia) seen in post-traumatic stress disorder affects the airways, causing collapse of the upper airways and episodes of disturbed breathing during sleep. These events further fragment sleep, leading to worsening insomnia and nightmares that worsen common symptoms of post-traumatic stress disorder. nine0003

This may have clinical implications for the subset of PTSD patients who also suffer from sleep disorders, and more research is needed to clarify the best methods of diagnosis and treatment. Studies evaluating the treatment of patients with comorbid PTSD and sleep disorders show that positive airway pressure therapy can improve sleep by reducing sleep fragmentation and nightmares. nine0007

Unfortunately, PTSD patients tend to have suboptimal adherence to positive airway pressure. Because of the potential adverse outcomes of comorbid psychiatric illness and sleep disturbances, including suicide, treatment should begin as early as possible.

Conclusions

Sleep disturbances are common in patients with post-traumatic stress disorder and are often resistant to standard first-line therapies. This can lead to worsening of PTSD symptoms and worse clinical outcomes. Insomnia and nightmares are the most common sleep problems in patients with post-traumatic stress disorder, and treatment consists of a combination of behavioral methods and pharmacological therapy. Trauma-related sleep disorder is a recently described parasomnia that can occur in some patients with post-traumatic stress disorder. The prevalence of sleep apnea is higher in patients with PTSD than in the general population. Thus, polysomnography should be considered in PTSD patients with sleep disturbances, especially those who are resistant to initial treatment. CPAP therapy can improve daytime functioning as well as symptoms of post-traumatic stress disorder, but adherence to therapy is usually low. nine0006 Evaluation and treatment of sleep disorders should be an integral part of the treatment of post-traumatic stress disorder to limit their adverse effects on daytime symptoms and overall functioning.

Post-traumatic stress disorder (PTSD): symptoms, causes and treatment of PTSD

Severe stress, fears, constant nervous tension can be caused by various reasons. For many Ukrainians, these factors were the war and the complete destruction of plans for the future. Post-traumatic stress disorder can also be caused by other activators - terrible events in life experienced by a catastrophe, natural disaster, violence. Any situation that is traumatic for a person can lead to the development of PTSD. nine0003

In the majority of diagnosed cases, the disorder is caused by:

  • wars, catastrophes, acts of terrorism;
  • accidents with serious consequences;
  • sexual emotional, physical abuse;
  • natural disasters;
  • serious illnesses;
  • stressful situations at work or at the place of study;
  • complex losses, for example, the death of a loved one.

PTSD can develop in all generations. Activating factors for the development of the disorder can be strong feelings, abuse, professional risks (work in the police, armed forces, fire departments, etc.). The presence of psychiatric and anxiety disorders, alcohol and drug abuse can also increase the risk of developing PTSD. Problems may be related to heredity (for example, PTSD is more likely to develop in people whose relatives suffer from similar diseases). The lack of support of loved ones in the most difficult moments of life can become the “last straw” for the onset of symptoms of post-traumatic disorder. nine0003

Diagnosis of PTSD

Diagnosis can only be made by a doctor after a series of examinations. The reason for contacting a specialist may be experienced psychological or physical trauma or any of the symptoms, which we will discuss below. To diagnose the disorder, a doctor performs a physical examination, a psychological assessment, and tests the patient for PTSD. Special questionnaires are used as test material.

Symptoms of post-traumatic stress disorder

It is far from always that the disease manifests itself immediately after the onset of a stressful situation. In many cases, the problem becomes apparent years later. Symptoms of the disease can be divided into 4 categories:

  • obsessive memories - often occurring memories of traumatic factors, experienced stress, as well as - terrible dreams, nightmares, a strong stress reaction to such memories;
  • avoidance - refusal to remember the traumatic event and any mention of it, including - refusal to visit places associated with the trauma, communicate with people associated with the situation; nine0114
  • negative changes in the mental sphere - a feeling of loneliness, isolation from the world, negative thoughts about oneself, a feeling of hopelessness, loss of interest in hobbies and favorite activities, emotional burnout;
  • physical and emotional changes - the appearance of fright, tremors of the limbs, alcohol or drug abuse, sleep disturbances and problems concentrating on any object or activity, violent outbursts of anger, irritability, aggression, strong feelings of shame and guilt. nine0114

In childhood, post-traumatic stress disorder can manifest itself in recreating traumatic situations in a playful way. Among the symptoms of childhood PTSD, sleep disturbances and nightmares can also be distinguished.

Treatment for post-traumatic stress disorder

Treatment for PTSD is provided to improve the patient's physical and emotional well-being. The psychotherapist will prescribe therapy that helps to level the influence of traumatic factors on the life and condition of the patient. As a rule, treatment is carried out in a complex manner and includes the use of psychotherapy and drug therapy. Drug treatment involves taking medications that relieve symptoms:

  • antidepressants;
  • anti-anxiety drugs;
  • prazosin, which reduces nightmares.

Psychotherapy may combine cognitive, exposure and desensitization techniques.

In order to prevent PTSD in adults and children after the onset of a traumatic situation, we recommend contacting a specialist.

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