Using an Ambulatory Technology Approach to Understand Nightmares, Nightmare Enactment, and Sleep-Related Violent Behavior: Toward Precision Diagnosis in PTSD
Abstract
The proposed research study directly addresses the Topic Area: Sleep Disorders, and also specifically addresses the Area of Encouragement: Research on the precision diagnosis and/or treatment of sleep disorders, especially related to post-traumatic stress disorder (PTSD). PTSD occurs in 8% to 10% of civilians, and 20% to 30% of combat Veterans. Sleep problems, including distressing nightmares, are present in nearly all individuals with PTSD. Recent research indicates that nightmares are linked to an increased risk of suicidal thinking, suicidal behavior and death by suicide, independent of other potential causes of suicide such as depression or insomnia. Research also indicates that suicide rates are rising in military Service personnel and Veterans. Because nightmares create severe distress in and of themselves and because their downstream effects may be so serious, it is essential to understand why nightmares occur and what factors lead to their occurrence. Nightmare enactment, or the acting out during sleep of events occurring in nightmares, as well as sleep-related violent behaviors, such as kicking, punching, shouting, and other disruptive behaviors during sleep, are also common in PTSD. While research indicates that violent behavior during sleep occurs in about 15% of civilians with PTSD, research in military personnel and Veterans and our clinical experience indicate that these events are even more common in military Service personnel and Veterans. Nightmare enactment and sleep-related violence dramatically affect bed partners and interpersonal relationships and result in personal injuries in individuals experiencing these behaviors. There is also a link between these behaviors and serious conditions, including Parkinson’s disease and neurodegenerative disease. It is critical to understand whether sleep behaviors in PTSD are related to Parkinson’s and/or neurodegenerative disease, so as to best prevent and treat them. It is also critical to determine whether a variety of other factors, such as the medications commonly used to treat PTSD, may contribute to these behaviors. Nightmares, nightmare enactment, and sleep-related violent behaviors are poorly understood. They are extremely hard to study in the sleep laboratory because they rarely occur in that setting, despite patient and bed partner reports of frequent, if not daily, occurrence of such events. It is thought that the feeling of safety created by sleeping in the sleep laboratory under monitored conditions reduces the likelihood of nightmares. This highlights the importance of studying sleep in patients’ homes, in their usual sleep environments. Until now, limitations in technology have prevented researchers from measuring sleep, using objective and subjective (self-report) measurements, in the home, where sleep events are most likely to occur. However, user-friendly tools are now available for measuring brain physiology (using the electroencephalogram, or EEG), as well as other aspects of physiology (breathing patterns, oxygen content in the blood, heart rate) during sleep in the home environment. Our research team has also developed a sleep diary mobile application for collecting study participants’ and their bed partners’ reports on sleep events and behavior on a daily basis, which provides data about sleep-related behavior and events as they occur, or close in time to their occurrence. Because it is hard to remember events that occur one or several days after their occurrence, especially when they occur in or around the sleep period, a sleep diary mobile app provides data that can be relied on more than traditional reporting methods. Our research team has significant experience utilizing these cutting-edge methods, as well as more traditional tools, such as audiovideo recorders and actigraphs with event markers (which measure wrist movement and capture event occurrence when the user taps an event marker button) for studying sleep.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010307
Entities
People
- Anne Richards
Organizations
- Northern California Institute for Research and Education
- United States Army