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Review
. 2021 Oct 1;11(10):1310.
doi: 10.3390/brainsci11101310.

Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach

Emeric Saguin  1   2 , Danielle Gomez-Merino  2   3 , Fabien Sauvet  2   3 , Damien Leger  2   4 , Mounir Chennaoui  2   3
Affiliations
Review

Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach

Emeric Saguin et al. Brain Sci. .

Abstract

Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.

Keywords: PTSD; REM sleep; combat-related trauma; military; nightmares; sleep.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hypnograms for one French soldier (35 years old) before (a) and after (b) deployment and one soldier with PTSD (36 years old) (c). Night sleep EEG recordings were performed using the ambulatory wireless dry-EEG device, the Dreem Headband (DH), with automatic sleep staging classification (122). Fragmentation index is the total number of awakenings/shifts to Stage 1 (from deeper non-rapid eye movement [NREM] or REM sleep with 30 s per epoch) divided by the total sleep time in hour. Other parameters are considered to reflect sleep fragmentation, such as increased WASO or a high percentage of the N1/N2 sleep stage, which usually results from frequent arousal. The figure shows that the veteran without PTSD has good sleep efficiency and a low fragmentation index prior to deployment. During deployment, there is an increase in fragmentation index and WASO associated with a decrease in sleep efficiency and N3 sleep. The veteran with PTSD has low sleep efficiency with a high fragmentation index. The percentage of REM is high while that of N3 is rather low. Unpublished data from ongoing clinical trial SOMMEPT (https://clinicaltrials.gov/ct2/show/NCT04581850) (accessed on 10 June 2021).
Figure 2
Figure 2
Sleep disturbances, PTSD and specific interventions in military.
See this image and copyright information in PMC

References

    1. American Psychiatric Association . DSM-5, Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing; Arlington, VA, USA: 2013. pp. 271–280.
    1. Breslau N. The Epidemiology of Trauma, PTSD, and Other Posttrauma Disorders. Trauma Violence Abus. 2009;10:198–210. doi: 10.1177/1524838009334448. - DOI - PubMed
    1. Germain A. Sleep disturbances as the hallmark of PTSD: Where are we now? Am. J. Psychiatry. 2013;170:372–382. doi: 10.1176/appi.ajp.2012.12040432. - DOI - PMC - PubMed
    1. Pillar G., Malhotra A., Lavie P. Post-traumatic stress disorder and sleep-what a nightmare! Sleep Med. Rev. 2000;4:183–200. doi: 10.1053/smrv.1999.0095. - DOI - PubMed
    1. Rosen R.C., Cikesh B., Fang S., Trachtenberg F.L., Seal K.H., Magnavita A.M., Bovin M.J., Green J.D., Bliwise D.L., Marx B.P., et al. Posttraumatic Stress Disorder Severity and Insomnia-Related Sleep Disturbances: Longitudinal Associations in a Large, Gender-Balanced Cohort of Combat-Exposed Veterans. J. Trauma Stress. 2019;32:936–945. doi: 10.1002/jts.22462. - DOI - PubMed

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