CPAP therapy reduces nightmares in veterans with PTSD and sleep apnea
A new study suggests that CPAP therapy reduces nightmares in veterans with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA).
Results show that the mean number of nightmares per week fell significantly with CPAP use, and reduced nightmare frequency after starting CPAP was best predicted by CPAP compliance.
“Patients with PTSD get more motivated to use CPAP once they get restful sleep without frequent nightmares, and their compliance improves” said principal investigator Sadeka Tamanna, MD, MPH, medical director of the Sleep Disorders Laboratory at G.V. (Sonny) VA Medical Center in Jackson, Miss.
The research abstract was published recently in an online supplement of the journal SLEEP, and Tamanna presented the findings at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC.
The study involved a retrospective review of medical records to identify OSA patients who also carried a PTSD diagnosis and were treated in a VA medical center sleep clinic between May 2011 and May 2012. Mean number of nightmares per week before treatment and up to six months after CPAP prescription were extracted. Treatment compliance was determined from CPAP memory cards.
“One out of six veterans suffers from PTSD, which affects their personal, social and productive life,” said Tamanna. “Nightmares are one of the major symptoms that affect their daily life, and prevalence of OSA is also high among PTSD patients and can trigger their nightmares.”
The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep illness affecting up to seven percent of men and five percent of women. It involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe. The most effective treatment option for OSA is continuous positive airway pressure therapy, CPAP, which helps keep the airway open by providing a stream of air through a mask that is worn during sleep.
According to the National Center for PTSD of the U.S. Department of Veterans Affairs, PTSD symptoms such as nightmares or flashbacks usually start soon after a traumatic event, but they may not appear until months or years later. Symptoms that last longer than four weeks, cause great distress or interfere with daily life may be a sign of PTSD. To get help for PTSD, veterans can call the Veterans Crisis Line at 1-800-273-8255 and press 1, text 838255, contact a local VA Medical Center, or use the online PTSD program locator on the VA website.
How common are nightmares after trauma?
Among the general public, about 5% of people complain of nightmares. Those who have gone through a trauma, though, are more likely to have distressing nightmares after the event. This is true no matter what type of trauma it is.
Those trauma survivors who get PTSD are even more likely to complain of nightmares. Nightmares are one of the 17 symptoms of PTSD. For example, a study comparing Vietnam Veterans to civilians showed that 52% of combat Veterans with PTSD had nightmares fairly often. Only 3% of the civilians in the study reported that same level of nightmares.
Other research has found even higher rates of nightmares. Of those with PTSD, 71-96% may have nightmares. People who have other mental health problems, such as panic disorder, as well as PTSD are more likely to have nightmares than those with PTSD alone.
Not only are trauma survivors more likely to have nightmares, those who do may have them quite often. Some survivors may have nightmares several times a week.
What do nightmares that follow trauma look like?
Nightmares that follow trauma often involve the same scary elements that were in the trauma. For example, someone who went through Hurricane Katrina may have dreams about high winds or floods. They may dream about trying to escape the waters or being in a shelter that does not feel safe. A survivor of a hold-up might have nightmares about the robber or about being held at gunpoint.
Not all nightmares that occur after trauma are a direct replay of the event. About half of those who have nightmares after trauma have dreams that replay the trauma. People with PTSD are more likely to have dreams that are exact replays of the event than are survivors without PTSD.
Lab research has shown that nightmares after trauma are different in some ways from nightmares in general. Nightmares after trauma may occur earlier in the night and during different stages of sleep. They are more likely to have body movements along with them.
For a copy of the abstract, “Effect of continuous positive airway pressure (CPAP) therapy on nightmares in patients with post-traumatic stress disorder and obstructive sleep apnea,” or to arrange an interview with Dr. Tamanna or an AASM spokesperson, please contact AASM Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or .(JavaScript must be enabled to view this email address).
The American Academy of Sleep Medicine considers sleep disorders an illness that has reached epidemic proportions. Board-certified sleep medicine physicians in an AASM-accredited sleep center provide effective treatment. AASM encourages patients to talk to their doctors about sleep problems or visit http://www.sleepeducation.com for a searchable directory of sleep centers.
Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea
Continuous positive airway pressure therapy (CPAP) uses a machine to help a person who has obstructive sleep apnea (OSA) breathe more easily during sleep. A CPAP machine increases air pressure in your throat so that your airway does not collapse when you breathe in. When you use CPAP, your bed partner may sleep better, too.
You use CPAP at home every night while you sleep. The CPAP machine will have one of the following:
A mask that covers your nose and mouth.
A mask that covers your nose only-called nasal continuous positive airway pressure, or NCPAP (this type of mask is most common).
Prongs that fit into your nose.
You may want to try similar machines that have automatically adjustable air pressure or air pressures that are different when you breathe in than when you breathe out.
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Lynn Celmer, 630-737-9700, ext. 9364, .(JavaScript must be enabled to view this email address)
American Academy of Sleep Medicine