Severe Sleep Disruption in PTSD: Trauma-Associated Sleep Disorder

Following traumatic experiences, patients can develop trauma-associated nightmares, autonomic hyperactivity, and disruptive nocturnal behaviors that transcend the established definition of nightmares. Trauma-associated sleep disorder (TSD) is a proposed parasomnia that encompasses these symptoms. In this chapter we present a case of a 45-year-old active duty soldier who developed post-traumatic stress disorder and severe sleep disturbances following multiple deployments. On most nights he suffers from replicative nightmares about his deployment experiences with associated night sweats, tachypnea, and tachycardia as well as vocalizations, defensive posturing, and violent thrashing. Polysomnography was notable for the presence of rapid eye movement (REM) sleep without atonia as well as relative tachycardia and limb movements during REM sleep. He was treated with prazosin, which reduced the severity of his nightmares and disruptive nocturnal behaviors. The differential diagnosis for his sleep disturbances is presented with the conclusion that current nosology cannot account for his constellation of symptoms and TSD likely has unique neurobiological underpinnings. Recognizing TSD as a distinct parasomnia is paramount to address the severe nocturnal manifestations of this disease.