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Case Reports
. 2014 Oct 15;10(10):1143-8.
doi: 10.5664/jcsm.4120.

Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors

Vincent Mysliwiec  1 , Brian O'Reilly  2 , Jason Polchinski  2 , Herbert P Kwon  2 , Anne Germain  3 , Bernard J Roth  2
Affiliations
Case Reports

Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors

Vincent Mysliwiec et al. J Clin Sleep Med. .

Abstract

Study objectives: To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences.

Methods: A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors.

Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients.

Conclusions: We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma.

Keywords: REM sleep behavior disorder; military; nightmares; posttraumatic stress disorder; veterans.

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Figures

Figure 1
Figure 1. PSG epoch from case 1 depicting disruptive nocturnal behaviors in REM sleep and REM without atonia.
The figure depicts a 30-sec PSG epoch recorded during the first REM period which occurred 22 min after sleep onset. Definitive REMs are observed in the electro-oculography (EOG) channels [see LOC and ROC]. High frequency, low amplitude electroencephalographic (EEG) signal is present in the frontal, central, and occipital EEG channels [see F3-M1+M2, C3-M1+M2, O1-M1+M2]. The initial portion of the epoch demonstrates submental and limb electromyogram (EMG) atonia [see Chin 1 and R&L Leg], which is consistent with REM sleep, but the later portion of the epoch (following the *) shows elevated submental EMG tone and excessive phasic EMG tone in the limb leads [see Chin 1 and R&L Leg], consistent with REM without atonia. Tachycardia [see EKG] and tachypnea [see Chest and Abdomen] are present. Technician note annotated onset and video monitoring confirmed vocalizations including profanity and expressions of fear.
See this image and copyright information in PMC

References

    1. Germain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ. A brief sleep scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord. 2005;19:233–44. - PubMed
    1. Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry. 1995;152:110–5. - PubMed
    1. van der Kolk B, Blitz R, Burr W, Sherry S, Hartmann E. Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans. Am J Psychiatry. 1984;141:187–90. - PubMed
    1. Wallace DM, Shafazand S, Ramos AR, et al. Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: an exploratory study. Sleep Med. 2011;12:850–9. - PubMed
    1. Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146:697–707. - PubMed

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