Clinical description of sleep and trauma-related nightmares in a population of French active-duty members and veterans with Post-Traumatic Stress Disorder

Introduction

Post-traumatic stress disorder (PTSD) is a major public health problem. The most frequent complaints in this pathology are sleep disorders and trauma-related nightmares in particular. Trauma-related nightmares are characteristic of PTSD and impact its severity insofar as they are associated with more severe, longer-lasting symptoms and resistance to first-line treatments. There are specific characteristics associated with military personnel, including overrepresentation of replicative trauma-related nightmares. The aim of this study was to provide an accurate description of sleep patterns and the characteristics of trauma-related nightmares in a population of active-duty members or veterans diagnosed with PTSD.

Methods

We recruited active-duty service members and veterans receiving treatment for PTSD in the psychiatric departments of five Military Teaching Hospitals (Hôpitaux d’Instruction des Armées, HIA) and described their sleep characteristics using a questionnaire, the Trauma-Related Nightmare Survey French version (TRNS-FR).

Results

Out of 77 patients, 72 (93.5%) who experienced traumatic nightmares were included. This population had very severe clinical manifestations of PTSD, with a mean PCL-S score of 62.6 and an estimated total sleep time of 5.3 h (317 min). Among these patients, 31% had replicative nightmares and 57.7% had partially replicative nightmares. Nightmares were frequent (4.7 nightmares on average over the previous week), highly realistic, and highly immersive with exacerbated symptoms during the nightmare and also upon awakening.

Discussion

Sleep quality was seriously altered among active-duty service members and veterans treated in Military Hospitals for PTSD with trauma-related nightmares. Certain criteria were identified to help characterize trauma-related nightmares: their level of replication, recurrence and the impact of these symptoms on patients’ lives.

Conclusion

Long-term traumatic nightmares are a prominent feature in the symptomatology of active service members and veterans suffering from PTSD. This symptom is of particular interest as it may be a sign of changes in the patient's condition and a potential therapeutic target.