CPAP may improve PTSD in Veterans with sleep apnea

This article discusses research about post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). There have been research studies linking PTSD and OSA, possibly because of OSA-related sleep disruption. In particular, OSA can be more frequent in dream sleep, resulting in more dream sleep fragmentation. This could cause more nightmares, or at possibly more awareness of nightmares. In this study, the authors sought to determine if CPAP therapy for OSA also reduced PTSD severity in US Veterans.

The results showed a modest reduction in PTSD symptoms in patients with OSA treated with CPAP for 6 months. And the more nights someone used their CPAP, the less severe the PTSD symptoms. There were also improvements in sleep quality, daytime functioning, and quality of life.

9/11 and sleep apnea

Here is an article about how workers who were first responders to 9/11 have elevated risk of sleep apnea and post-traumatic stress disorder (PTSD). The article does not go into detail about the mechanism of action. I wonder if the rate of sleep apnea is higher due to localized inflammation in the upper airway due to the particulate matter inhaled at the scene. I could also envision higher rates of pulmonary disease from inhalation of particulates, but that was not mentioned in the article.

CPAP may reduce nightmares in post tramautic stress disorder

Post traumatic stress disorder (PTSD) is becoming more frequent among our soldiers. I have had the honor of working with military personnel and their families at several bases in my career - McConnell AFB, Camp Lejune, and most recently at Fox at the Redstone Arsenal. Sleeping problems are common and many report that sleep issues worsen after returning from deployment. In particular, I hear that snoring and breathing problems tend to worsen after returning home.

This article describes an interesting finding. Soldiers diagnosed with PTSD and obstructive sleep apnea (OSA) present to my office regularly. This study showed that CPAP therapy reduces nightmare frequency in those with PTSD. It makes sense as OSA can be more severe in dream sleep. If your dream sleep is disrupted by breathing events, you may experience more dreams, as you may wake up more often in the middle of, or right after a dream. CPAP will reduce the breathing events and may let you sleep right through, so that you don't remember your dreams (and nightmares) as much. There may be other reasons that CPAP reduces dreams too. When someone stops breathing in their sleep, adrenaline surges. This adrenaline surge may increase nightmares, especially in those with PTSD. So CPAP may reduce the adrenaline surges, thereby reducing the nightmares.

This article discusses research findings in rats. Researchers sleep deprived some rats after they were exposed to a traumatic event. The results showed that those sleep deprived rats exhibited less behavior problems from the post-traumatic event, compared to rats who were allowed to sleep normally after the event. These results are similar to what I wrote about in a similar blogpost.

It makes sense that not allowing the rats to sleep right after the event may interfere with the rats' ability to encode memories of the event. More studies are needed in humans to see if the same effect occurs.

Sleep Disturbances and PTSD

Review article in Medscape about the sleep disturbances in post-traumatic stress disorder (PTSD). Nightmares are a common feature of PTSD, with a reported prevalence of 50%-90% in long-term epidemiologic follow-up studies. Insomnia (both sleep-onset and maintenance insomnia) is a problem for most patients with PTSD. The reason for the sleep disturbance in PTSD has not been fully worked out. It's thought that underlying depression or anxiety could be a cause. Interestingly, obstructive sleep apnea is more common in PTSD patients. Periodic limb movements in sleep (PLMS) is more common in PTSD patients than in control patients. However, many of the medications used in PTSD could cause PLMS, meaning that it could have nothing to do with the PTSD directly. Treating the sleep disturbances in PTSD can potentially improve the lives of these patients.