Sleep disturbances in traumatic exposure and post-traumatic stress disorder

Sleep disturbances are a hallmark of traumatic experiences. Depending on the type of injury, fear, anxiety, and frequent recall of these events engender a sustained neurobiological response that disrupts the normal sleep-wake cycle culminating in an entrenched state of heightened arousal. A maladaptive cognitive and behavioral association ensues which can lead to longer sleep latencies and frequent awakenings with difficulty in regaining restorative sleep. The presence of post-traumatic stress disorder (PTSD) acts as a catalyst in reinforcing trauma-induced insomnia and/or nightmares. With traumatic brain injury (TBI), daytime hypersomnolence can be debilitating with adverse effects on quality of life. Fragmented sleep, whether it is secondary to insomnia or obstructive sleep apnea (OSA), contributes to neurocognitive deficit, depression, and chronic pain. Approach to treatment of trauma-related sleep disorders requires a personalized approach with psychotherapy, pharmacotherapy or a combination of both augmented with continuous positive airway pressure (CPAP) when indicated.