Bombs exploding, planes crashing, friends dying in your arms. For most of us, such horrific events are only the stuff of occasional nightmares. But for some people, scenes such as these are real memories—memories that can lead to post-traumatic stress disorder (PTSD) and trigger terrifying recurrent nightmares that make restful sleep an impossible dream.
The incidence of PTSD is disturbingly high, occurring in nearly 7% of the general population as well as an estimated 15% to 30% of military veterans (not just combat vets). To make matters worse, many people with PTSD also have obstructive sleep apnea, a disorder in which a person repeatedly stops breathing during sleep—and such episodes can further provoke nightmares. The good news: There’s an effective treatment that significantly reduces the frequency of nightmares for PTSD patients with sleep apnea, a new study shows.
Background: Obstructive sleep apnea occurs when the muscles of the back of the throat relax during sleep, allowing tissues to sag and block the airway—which halts breathing. The person typically snorts, grunts, gasps or coughs as the body rouses itself and breathing restarts, then falls back to sleep, never remembering that he/she woke up. This mini-suffocation occurs over and over, sometimes dozens of times each hour—and the resulting oxygen deprivation makes nightmares more likely to occur.
An effective treatment for sleep apnea is continuous positive airway pressure (CPAP). With CPAP, a mask worn over the nose and mouth during sleep is connected to a machine that produces mild but steady air pressure to keep the person’s airway open.
New study: Researchers at a Veterans Administration (VA) medical center combed the records at their sleep clinic to find patients who had been diagnosed with both obstructive sleep apnea and PTSD and who had been prescribed CPAP treatment. The patients had undergone sleep studies to determine the severity and timing of their apnea episodes…and had answered questionnaires about daytime sleepiness and nightmare frequency both before and after starting
After controlling for age, body mass index and various other factors, the researchers compared the results before and up to six months after the start of CPAP treatment. What they found: The number of nightmares dropped significantly when patients used CPAP, from a mean of 12.43 per week before treatment to 3.16 per week after three months on CPAP.
Beyond nightmares, big problems: In addition to contributing to nightmares, sleep apnea has some very serious health consequences. It can cause nighttime levels of blood oxygen to plummet from an optimal saturation of 100% to below 65%—and this increases the risk for high blood pressure, heart attack, stroke, congestive heart failure, type 2 diabetes, Alzheimer’s disease, erectile dysfunction, depression and anxiety.
Compliance concern: Like any treatment, CPAP can’t work if it isn’t used. Yet apnea patients often are reluctant to use the CPAP machine consistently during sleep, complaining that it is uncomfortable, inconvenient and/or cumbersome. For instance, in this study the patients typically complied with treatment about one-half to three-quarters of the time, with those who were most compliant experiencing the greatest benefit. Had the participants complied all the time, their nightmares might have been reduced even further—and so would the other health risks associated with sleep apnea.
Getting help: If you suffer from frequent nightmares and daytime sleepiness, ask your doctor for a referral to a sleep specialist. If you are diagnosed with apnea and prescribed CPAP, your slumber should improve and your nightmares abate—provided you follow the treatment protocol.
Veterans: PTSD symptoms usually start soon after a traumatic event, but they can appear months or even years later. In addition to nightmares, symptoms can include flashbacks, emotional numbness, hopelessness, anger, guilt, anxiety and/or hallucinations. If you suspect that you may have PTSD, talk to your doctor…call the Veterans Crisis Line at 800-273-8255…contact your local VA medical center…and visit ptsd.va.gov.
