We have been among the leading research groups studying post-traumatic sleep disturbance, both in terms of evaluating the nature of these sleep problems and in treating them. This area actually represents the initial pathway of research for me and my research groups as we began treating nightmares in patients with or without a history of trauma.
The more we studied nightmare patients, the more we realized that insomnia almost always emerged as another and sometimes more serious sleep complaint. Whether they had difficulty falling asleep or staying asleep, early morning awakenings, or nonrestorative slumber, we were impressed with how nearly universal it was for treatment-seeking trauma patients to complain about their sleep. Regrettably, it was almost equally universal that these trauma survivors rarely found someone interested in exploring their sleep problems in depth.
Instead of discussing sleep problems or attempting to evaluate them as a sleep medicine physician might, most patients reported receiving prescription after prescription of various sleep aids or hypnotics, antidepressants, or mood stabilizers. Some received a smattering of sleep hygiene instructions, but few were provided advanced cognitive-behavioral instructions for insomnia, and almost no one was sent to a sleep center for sleep testing to check for breathing or movement disorders.
What we found over the course of the past decade is that post-traumatic sleep disturbance frequently comprises physical or physiological components as well as the psychological components. Many trauma survivors do appear to respond to cognitive-behavioral treatments, and many responded to our use of the imagery techniques for their nightmares, but once these treatments were completed, these patients often showed residual sleep symptoms, especially daytime fatigue or sleepiness. Some were still very aware of unrefreshing sleep upon awakening in the morning.
One thing led to another, and we discovered that most of these patients were also suffering from sleep-disordered breathing or from sleep movement problems such as restless legs syndrome or periodic limb movement disorder. Once we began to treat these conditions, the patients reported further improvements in their sleep. In 2003 we opened our community-based sleep medical center – Maimonides Sleep Arts & Sciences in Albuquerque, New Mexico – to specialize in helping patients with sleep and mental health problems. Since that time, we continue to see how mental health patients, especially those with anxiety, depression or PTSD, make important treatment gains when they also work to improve all aspects of their sleep disorders in addition to the treatments they use for their mental health disorders.
Sleep medicine truly has much to offer to mental health patients!