By Sandra Basu
WASHINGTON — Disturbed sleep is a common complaint for patients with PTSD and TBI, but military clinicians have some new tools to help treat the issue, according to experts.
“Sleep problems are common symptoms of both physical- and mental-health problems,” said Col. Christopher Robinson, deputy director for Psychological Health at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), Arlington, VA. “Although the nature and specificity of sleep problems in PTSD and TBI continues to be studied, promising behavioral and pharmacological treatments are recommended for healthcare providers.”
Robinson and other providers spoke about treating sleep problems during a recent webinar hosted by DCoE.
U.S. Army Spc. Steven McGovern of Quartz Hill, Calif., from the 16th Military Police Brigade, 503rd Military Police Battalion (Airborne), 21st Military Police Company (Airborne) Fort Bragg, N.C., beds down for the night at Forward Operating Base Whitehouse, in the Kajaki district, Afghanistan in April. Photo by Tech Sgt. Denoris Mickle.
Research has documented that sleep disturbances in TBI and PTSD patients are common. One 2007 study suggested a high prevalence of sleep disorders (46%) and excessive sleepiness (25%) in TBI patients. Another study, conducted by the National Intrepid Center of Excellence (NICoE), Bethesda, MD, looked at 94 patients, most of whom had either TBI, PTSD or both, and found that most of them suffered from insomnia, according to Anthony Panettiere, MD, a neurologist and sleep medicine physician at the center.
Panettiere explained that a good “sleeper” will stay quietly asleep for most of the night and awaken feeling refreshed, mentally and physically. They will not have a desire to nap during the day, they will dream regularly, they will beat the alarm clock or awake easily to the alarm and also will look forward to going to bed.
TBI and PTSD patients, however, may face challenges in getting a good night’s sleep.
“These patients, no matter how long they sleep, will typically feel unrefreshed. Some even feel worse when they wake up. Much of their night can be restless, or at least their spouse will perceive they are restless, if the patient doesn’t recall that.”
Their sleep may be further disrupted by pain, nightmares and hypervigilance.
During the day, these patients may feel fatigued and need caffeine and other stimulants to stay awake. “Unlike the good sleeper, who will look forward to going to sleep, they ruminate about falling asleep because of all of the bad things they have already foreseen happening in their sleep,” Panettiere said.
At the NICoE, patients with sleep issues undergo a sleep-disorder workup that includes a polysomnogram. In addition, clinicians interview the bed partner of the patient when possible and employ actigraphy, which is a specialized watch that monitors patient’s movement.
“This is an additional measurement of the amount of sleep they are getting and how restless their sleep is,” he explained.
For sleep-disordered breathing (SDB), Positive Airway Pressure Therapy (PAP), is the “gold-standard way” for treatment. For insomnia, sleep restriction, light therapy, stimulus control and regular exercise are among the sleep prescriptions used, Panettiere said.