This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Treatment of sleep disturbances in posttraumatic stress disorder: A review Frank B. Schoenfeld, MD; Jason C. DeViva, PhD; Rachel Manber, PhD

This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Aim – Describe primary sleep disturbances associated with posttraumatic stress disorder (PTSD), with focus on nightmares and insomnia. Relevance – Individuals experiencing PTSD report insomnia (trouble initiating and maintaining sleep) and recurrent distressing dreams among their most common and distressing symptoms.

This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Topics Reviewed VA/DOD Clinical Practice Guideline (CPG) recommends nonpharmacologic therapies as first-line treatments for PTSD-related sleep disturbances: – Imagery rehearsal. – Cognitive-behavioral therapy (CBT) for insomnia. Also potentially helpful: – Trauma-focused CBT (cognitive processing therapy, prolonged exposure). * – Eye movement desensitization and reprocessing. – Exposure, relaxation, and rescripting therapy. *Trauma-focused therapies may not fully resolve sleep disturbances in PTSD.

This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Topics Reviewed Pharmacological treatments also have important place in insomnia and nightmare management: – Selective serotonin reuptake inhibitors. – Serotonin antagonists/reuptake inhibitors. – Selective norepinephrine reuptake inhibitors. – Tricyclic antidepressants. – Monoamine oxidase inhibitors. – Anxiolytic and sedative hypnotic agents (benzodiazepines, benzodiazepine receptor agonists). – Antipsychotic agents (olanzapine, quetiapine, risperidone). – Adrenergic inhibiting agents (guanfacine, prazosin).

This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Topics Reviewed Pharmacological treatments for insomnia and nightmare management (cont): – Selective serotonin reuptake inhibitors and venlafaxine are considered by the VA/DOD CPG as the first-line treatment for global PTSD symptoms. – Prazosin is recommended as an adjunctive treatment for nightmares if cognitive behavior therapy and/or the first-line antidepressants are not fully effective. – Benzodiazepines are not recommended because of lack of efficacy and risk for developing dependence.

This article and any supplementary material should be cited as follows: Schoenfeld FB, DeViva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: a review. J Rehabil Res Dev. 2012;49(5):729–52. Slideshow Project DOI: //JRRD JSP Conclusions Nightmares and insomnia are common, persistent, and significant problems in PTSD. Comorbid conditions (e.g., depression, substance abuse, anxiety, TBI, other sleep disorders, chronic pain) can further contribute to sleep disturbance. CBT and some pharmacologic treatments offer relief. – However, we need to develop treatments that are even more specific to the unique features of PTSD sleep disturbances.