Sleep disturbances in patients with post-traumatic stress disorder: Epidemiology, impact and approaches to management

CNS Drugs

Volumn 20, Issue 7, 2006, Pages 567-590

  Maher, Michael J ^a   Rego, Simon A ^a   Asnis, Gregory M ^a  

^a ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALPRAZOLAM; BENZODIAZEPINE; BUSPIRONE; CLONAZEPAM; CYPROHEPTADINE; FLUOXETINE; FLUVOXAMINE; GABAPENTIN; MIRTAZAPINE; NEFAZODONE; OLANZAPINE; PAROXETINE; PHENELZINE; PLACEBO; PRAZOSIN; QUETIAPINE; SEROTONIN UPTAKE INHIBITOR; SERTRALINE; TRAZODONE; ZOLPIDEM;

CLINICAL TRIAL; DOSE RESPONSE; DRUG EFFECT; DRUG HALF LIFE; DRUG TOLERABILITY; HUMAN; INSOMNIA; NIGHTMARE; POSTTRAUMATIC STRESS DISORDER; PREVALENCE; PRIORITY JOURNAL; PSYCHOTHERAPY; REVIEW; SIDE EFFECT; SLEEP DISORDER; SLEEP DISORDERED BREATHING;

ANTIDEPRESSIVE AGENTS; ANTIPSYCHOTIC AGENTS; COGNITIVE THERAPY; HUMANS; SLEEP DISORDERS; STRESS DISORDERS, POST-TRAUMATIC;

EID: 33745610463     PISSN: 11727047     EISSN: 11727047     Source Type: Journal    
DOI: 10.2165/00023210-200620070-00003     Document Type: Review

References (147)

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. text revision. Washington, DC: American Psychiatric Association, 2000
2. Leskin GA, Woodward SH, Young HE, et al. Effects of comorbid diagnoses on sleep disturbance in PTSD. J Psychiatr Res 2002; 36 (6): 449-52
3. Krakow B, Melendrez D, Warner TD, et al. To breathe, perchance to sleep: sleep-disordered breathing and chronic insomnia among trauma survivors. Sleep Breath 2002; 6 (4): 189-202
4. Mellman TA, David D, Kulick-Bell R, et al. Sleep disturbance and its relationship to psychiatric morbidity after hurricane Andrew. Am J Psychiatry 1995; 152 (11): 1659-63
5. Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev 2003; 23 (3): 377-407
6. Horne JA. Human sleep, sleep loss and behavior: implications for the prefrontal cortex and psychiatric disorder. Br J Psychiatry 1993; 162: 413-9
7. Gally JA, Edelman GM. Neural reapportionment: an hypothesis to account for the function of sleep. C R Biol 2004; 327: 721-7
8. Mellman TA, David D, Bustamante V, et al. Dreams in the acute aftermath of trauma and their relationship to PTSD. J Trauma Stress 2001; 14 (1): 241-7
9. Hartmann E. Nightmare after trauma as a paradigm for all dreams: a new approach to the nature and function of dreaming. Psychiatry 1998; 61: 223-38
10. Foa EB, Riggs DS, Gershuny BS. Arousal, numbing, and intrusion: symptom structure of PTSD following assault. Am J Psychiatry 1995; 152 (1): 116-20
11. Kilpatrick DG, Resick HS, Freedy JR, et al. Posttraumatic stress disorder field trail: evaluation of the PTSD construct: criteria A through E. In: Widiger TA, Friedman MJ, Pincus HA, et al., editors. DSM-IV sourcebook. Washington, DC: American Psychiatric Press, 1998: 803-46
12. Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry 2000; 41 (6): 469-78
13. Germain A, Buysse DJ, Shear MK, et al. Clinical correlates of poor sleep quality in posttraumatic stress disorder. J Trauma Stress 2004; 17 (6): 477-84
14. Krakow B, Germain A, Warner TD, et al. The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. J Trauma Stress 2001; 14 (4): 647-65
15. Roszell DK, McFall ME, Malas KL. Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD. Hosp Community Psychiatry 1991; 42 (3): 293-6
16. Neylan TC, Marmar CR, Metzler TJ, et al. Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatry 1998; 155 (7): 929-33
17. Koren D, Arnon I, Lavie P, et al. Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents. Am J Psychiatry 2002; 159 (5): 855-7
18. Harvey AG, Bryant RA. The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol 1998; 66 (3): 507-12
19. Lavie P, Katz N, Pillar G, et al. Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients. Biol Psychiatry 1998; 44 (10): 1060-5
20. Lavie P, Hefez A, Halperin G, et al. Long-term effects of traumatic war-related events on sleep. Am J Psychiatry 1979; 136: 175-8
21. Habukawa M, Uchimura N, Kotorii N, et al. Evaluation of sleep disturbance in post-traumatic stress disorder. Sleep Biol Rhythms 2003; 1 (3): 241-3
22. Mellman TA, Kulick-Bell R, Ashlock LE, et al. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry 1995; 152 (1): 100-5
23. Breslau N, Roth T, Burduvali E, et al. Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. Arch Gen Psychiatry 2004; 61 (5): 508-16
24. Dagan Y, Zinger Y, Lavie P. Actigraphic sleep monitoring in posttraumatic stress disorder (PTSD) patients. J Psychosom Res 1997; 42 (6): 577-81
25. Engdahl BE, Eberly RE, Hurwitz TD, et al. Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder. Biol Psychiatry 2000; 47 (6): 520-5
26. Fuller KH, Waters WF, Scott O. An investigation of slow-wave sleep processes in chronic PTSD patients. J Anxiety Disord 1994; 8 (3): 227-36
27. Hurwitz TD, Mahowald MW, Kuskowski M, et al. Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry 1998; 44 (10): 1060-5
28. Klein E, Koren D, Arnon I, et al. No evidence of sleep disturbance in post-traumatic stress disorder: a polysomnographic study in injured victims of traffic accidents. Isr J Psychiatry Relat Sci 2002; 39 (1): 3-10
29. Woodward SH, Bliwise DL, Friedman MJ, et al. Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD. J Trauma Stress 1996; 9 (1): 137-43
30. Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep: what a nightmare! Sleep Med Rev 2000; 4 (2): 183-200
31. Edinger JD, Erwin CW, Fins AI, et al. Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients. J Clin Neurophysiol 1995; 12 (3): 302-9
32. Edinger JD, Glenn DM, Bastian LA, et al. Sleep in the laboratory and sleep at home II: comparisons of middle-aged insomnia sufferers and normal sleepers. Sleep 2001; 24 (7): 761-70
33. Terzano MG, Parrino L. Origin and significance of the cyclic alternating pattern (CAP). Sleep Med Rev 2000; 4 (1): 101-23
34. Parrino L, Ferrillo F, Smerieri A, et al. Is insomnia a neurophysiological disorder? The role of sleep EEG microstructure. Brain Res Bull 2004; 63 (5): 377-85
35. Halasz P, Terzano M, Parrino L, et al. The nature of arousal in sleep. J Sleep Res 2004; 13 (1): 1-23
36. Drake CL, Roehrs T, Roth T. Insomnia causes, consequences, and therapeutics: an overview. Depress Anxiety 2003; 18 (4): 163-76
37. Drummond SP, Smith MT, Orff HJ, et al. Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia. Sleep Med Rev 2004; 8 (3): 243-7
38. Thorpy M. International classification of sleep disorders: diagnostic and coding manual. Rochester (MN): American Sleep Disorders Association, 1990
39. Brown TM, Boudewyns PA. Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder. J Trauma Stress 1996; 9 (1): 129-36
40. Ross RJ, Ball WA, Dinges DF, et al. Rapid eye movement sleep disturbance in posttraumatic stress disorder. Biol Psychiatry 1994; 35 (3): 195-202
41. Germain A, Nielsen TA. Sleep pathophysiology in posttraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry 2003; 54 (10): 1092-8
42. Krakow B, Germain A, Tandberg D, et al. Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors. Compr Psychiatry 2000; 41 (1): 49-56
43. Ross RJ, Ball WA, Dinges DF, et al. Motor dysfunction during sleep in posttraumatic stress disorder. Sleep 1994; 17 (8): 723-32
44. Duran J, Esnaola S, Rubio R, et al. Obstructive sleep apnea: hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years. Am J Respir Crit Care Med 2001; 163: 685-9
45. American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22 (5): 667-89
46. Moore P, Bardwell WA, Ancoli-Israel S, et al. Association between polysomnographic sleep measures and health-related quality of life in obstructive sleep apnea. J Sleep Res 2001; 10 (4): 303-8
47. Bennett LS, Barbour C, Langford B, et al. Health status in obstructive sleep apnea: relationship with sleep fragmentation and daytime sleepiness, and effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med 1999; 159 (6): 1884-90
48. Krakow B, Melendrez D, Pedersen B, et al. Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD. Biol Psychiatry 2001; 49 (11): 948-53
49. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163 (3): 608-13
50. Olson LG, King MT, Hensley MJ, et al. A community study of snoring and sleep-disordered breathing: prevalence. Am J Respir Crit Care Med 1995; 152 (2): 711-6
51. Dagan Y, Lavie P. Sleep apnea syndrome in war related PTSD victims [abstract]. Sleep Res 1991; 20: 178
52. Lavie P. Sleep disturbances in the wake of traumatic events. N Engl J Med 2001; 345 (25): 1825-8
53. Dagan Y, Lavie P, Bleich A. Elevated awakening thresholds in sleep stage 3-4 in war-related post-traumatic stress disorder. Biol Psychiatry 1991; 30 (6): 618-22
54. Schoen L, Kramer M, Kinney L. Auditory thresholds in the dream disturbed [abstract]. Sleep Res 1984; 13: 102
55. Blanchard EB, Hickling EJ, Buckley TC, et al. Psychophysiology of posttraumatic stress disorder related to motor vehicle accidents: replication and extension. J Consult Clin Psychol 1996; 64 (4): 742-51
56. Casada JH, Amdur R, Larsen R, et al. Psychophysiologic responsivity in posttraumatic stress disorder: generalized hyperresponsiveness versus trauma specificity. Biol Psychiatry 1998; 44 (10): 1037-44
57. Orr SP, Metzger LJ, Lasko NB, et al. Physiologic responses to sudden, loud tones in monozygotic twins discordant for combat exposure: association with posttraumatic stress disorder. Arch Gen Psychiatry 2003; 60 (3): 283-8
58. Shalev AY, Peri T, Brandes D, et al. Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study. Am J Psychiatry 2000; 157 (2): 255-61
59. Krakow B, Tandberg D, Scriggins L, et al. A controlled comparison of self-rated sleep complaints in acute and chronic nightmare sufferers. J Nerv Ment Dis 1995; 183 (10): 623-7
60. Idzikowski C. Impact of insomnia on health-related quality of life. Pharmacoeconomics 1996; 10 Suppl. 1: 15-24
61. Leger D, Guilleminault C, Bader G, et al. Medical and socio-professional impact of insomnia. Sleep 2002; 25 (6): 625-9
62. Dement WC, Pelayo R. Public health impact and treatment of insomnia. Eur Psychiatry 1997; 12 (1): 31-9S
63. Krakow B, Hollifield M, Johnston L, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 2001; 286 (5): 537-45
64. Jenkinson C, Davies RJ, Mullins R, et al. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 1999; 353: 2100-5
65. Krakow B, Haynes PL, Warner TD, et al. Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. J Trauma Stress 2004; 17 (3): 257-68
66. Kramer M, Kinney L. Vigilance and avoidance during sleep in US Vietnam war veterans with posttraumatic stress disorder. J Nerv Ment Dis 2003; 191 (10): 685-7
67. Clum GA, Nishith P, Resick PA. Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims. J Nerv Ment Dis 2001; 189 (9): 618-22
68. Nishith P, Resick PA, Mueser KT. Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder. J Trauma Stress 2001; 14 (3): 469-79
69. Woodward SH, Arsenault NJ, Murray C, et al. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol Psychiatry 2000; 48 (11): 1081-7
70. Zayfert C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress 2004; 17 (1): 69-73
71. DeViva JC, Zayfert C, Mellman TA. Factors associated with insomnia among civilians seeking treatment for PTSD: an exploratory study. Behav Sleep Med 2004; 2 (3): 162-76
72. Krakow B, Hollifield M, Schrader R, et al. A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: a preliminary report. J Trauma Stress 2000; 13 (4): 589-609
73. Krakow B, Artar A, Warner TD, et al. Sleep disorder, depression, and suicidality in female sexual assault survivors. Crisis 2000; 21 (4): 163-70
74. Krakow B, Melendrez D, Johnston L, et al. Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. J Nerv Ment Dis 2002; 190 (7): 442-52
75. Krakow B, Lowry C, Germain A, et al. A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. J Psychosom Res 2000; 49 (5): 291-8
76. Youakim JM, Doghramji K, Schutte SL. Posttraumatic stress disorder and obstructive sleep apnea syndrome. Psychosomatics 1998; 39 (2): 168-71
77. Foa EB, Davidson JRT, Frances A. The expert consensus guideline series: treatment of posttraumatic stress disorder. The Expert Consensus Panels for PTSD. J Clin Psychiatry 1999; 60 Suppl. 16: 3-76
78. Asnis GM, Kohn SR, Henderson M, et al. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs 2004; 64 (4): 383-404
79. Brady KT, Pearlstein T, Ansis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA 2000; 283: 1837-44
80. Davidson JR, Rothbaum BO, van der Kolk BA, et al. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 2001; 58 (5): 485-92
81. Davidson JR, Landerman LR, Farfel GM, et al. Characterizing the effects of sertraline in posttraumatic stress disorder. Psychol Med 2002; 32: 661-70
82. Singareddy RK, Balon R. Sleep in posttraumatic stress disorder. Ann Clin Psychiatry 2002; 14 (3): 183-90
83. Stein DJ, Davidson J, Seedat S, et al. Paroxetine in the treatment of post-traumatic stress disorder: pooled analysis of placebo-controlled studies. Expert Opin Pharmacother 2003; 4 (10): 1829-38
84. Meltzer-Brody S, Connor KM, Churchill E, et al. Symptom-specific effects of fluoxetine in post-traumatic stress disorder. Int Clin Psychopharmacol 2000; 15 (4): 227-31
85. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder: randomised, double-blind study. Br J Psychiatry 1999; 175: 17-22
86. Neylan TC, Metzler TJ, Schoenfeld FB, et al. Fluvoxamine and sleep disturbances in posttraumatic stress disorder. J Trauma Stress 2001; 14 (3): 461-7
87. Rosenthal R, Rosnow RL. Essentials of behavioral research: methods and data analysis. New York: McGraw Hill, 1991
88. De Boer M, Op den Velde W, Falger PJ, et al. Fluvoxamine treatment for chronic PTSD: a pilot study. Psychother Psychosom 1992; 57 (4): 158-63
89. Fujishiro J, Imanishi T, Onozawa K, et al. Comparison of the anticholinergic effects of the serotonergic antidepressants, paroxetine, fluvoxamine and clomipramine. Eur J Pharmacol 2002; 454 (2-3): 183-8
90. Zisook S, Chentsova-Dutton YE, Smith-Vaniz A, et al. Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry 2000; 61 (3): 203-8
91. Neylan TC, Lenoci M, Maglione ML, et al. The effect of nefazodone on subjective and objective sleep quality in post-traumatic stress disorder. J Clin Psychiatry 2003; 64 (4): 445-50
92. Gillin J, Smith-Vaniz A, Schnierow B, et al. An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic combat-related posttraumatic stress disorder. J Clin Psychiatry 2001; 62 (10): 789-96
93. McRae AL, Brady KT, Mellman TA, et al. Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Depress Anxiety 2004; 19 (3): 190-6
94. Rosack J. FDA orders liver warning on nefazodone labels. Psychiatr News 2002; 37 (3): 19
95. Nierenberg A, Adler L, Peselow E, et al. Trazodone for antidepressant-associated insomnia. Am J Psychiatry 1994; 151 (7): 1069-72
96. Warner MD, Dorn MR, Peabody CA. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry 2001; 34 (4): 128-31
97. Warner MD, Peabody CA, Whiteford H, et al. Trazodone and priapism. J Clin Psychiatry 1987; 48 (6): 244-5
98. Ashford J, Miller TW. Effects of trazodone on sleep in patients diagnosed with post-traumatic stress disorder (PTSD). J Contemp Psychother 1996; 26 (3): 221-33
99. Lerer B, Bleich A, Kotler M, et al. Posttraumatic stress disorder in Israeli combat veterans: effect of phenelzine treatment. Arch Gen Psychiatry 1987; 44 (11): 976-81
100. Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20 (8): 533-59
101. Wilson S, Argyropoulos S. Antidepressants and sleep: a qualitative review of the literature. Drugs 2005; 65 (7): 927-47
102. Kuenzel HE, Murck H, Held K, et al. Antidepressants and periodic leg movements of sleep. Pharmacopsychiatry 2005; 37 (5): 193-5
103. Yang C, White DP, Winkelman JW. Antidepressants and periodic leg movements of sleep. Biol Psychiatry 2005; 58 (6): 510-4
104. Picchietti D, Winkelman JW. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep 2004; 28 (7): 891-8
105. Castillo JL, Menendeza P, Segoviaa L, et al. Effectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome. Sleep Med 2004; 5: 507-8
106. Brophy MH. Cyproheptadine for combat nightmares in post-traumatic stress disorder and dream anxiety disorder. Mil Med 1991; 156 (2): 100-1
107. Harsch HH. Cyproheptadine for recurrent nightmares. Am J Psychiatry 1986; 143 (11): 1491-2
108. Gupta S, Austin R, Cali LA, et al. Nightmares treated with cyproheptadine. J Am Acad Child Adolesc Psychiatry 1998; 37 (6): 570-2
109. Jacobs-Rebhun S, Schnurr PP, Friedman MJ, et al. Posttraumatic stress disorder and sleep difficulty. Am J Psychiatry 2000; 157 (9): 1525-6
110. Taylor F, Raskind MA. The alpha1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol 2002; 22 (1): 82-5
111. Raskind MA, Dobie DJ, Kanter ED, et al. The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases. J Clin Psychiatry 2000; 61 (2): 129-33
112. Raskind MA, Peskind ER, Kanter ED, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry 2003; 160 (2): 371-3
113. Jakovljevic M, Sagud M, Mihaljevic-Peles A. Olanzapine in the treatment-resistant, combat-related PTSD: a series of case reports. Acta Psychiatr Scand 2003; 107 (5): 394-6
114. States J, St Dennis C. Chronic sleep disruption and the reexperiencing cluster of posttraumatic stress disorder symptoms are improved by olanzapine: brief review of the literature and a case-based series. Prim Care Companion J Clin Psychiatry 2003; 5 (2): 74-9
115. Ahearn EP, Krohn A, Connor KM, et al. Pharmacologic treatment of posttraumatic stress disorder: a focus on antipsychotic nightuse. Ann Clin Psychiatry 2003; 15 (3/4): 193-201
116. Stein MB, Kline NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry 2002; 159 (10): 1777-9
117. Butterfield MI, Becker ME, Connor KM, et al. Olanzapine in the treatment of post-traumatic stress disorder: a pilot study. Int Clin Psychopharmacol 2001; 16 (4): 197-203
118. Robert S, Hamner MB, Kose S, et al. Quetiapine improves sleep disturbances in combat veterans with PTSD: sleep data from a prospective, open-label study. J Clin Psychopharmacol 2005; 25 (4): 387-8
119. Mellman TA, Clark RE, Peacock WJ. Prescribing patterns for patients with posttraumatic stress disorder. Psychiatr Serv 2003; 54 (12): 1618-21
120. Cates ME, Bishop MH, Davis LL, et al. Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Ann Pharmacother 2004; 38 (9): 1395-9
121. Braun P, Greenberg D, Dasberg H, et al. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry 1990; 51 (6): 236-8
122. Barker MJ, Greenwood KM, Jackson M, et al. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004; 19: 437-54
123. Guilleminault C. Benzodiazepines, breathing, and sleep. Am J Med 1990; 88 (3A): 25-8S
124. Dieperink ME, Drogemuller L. Zolpidem for insomnia related to PTSD [letter]. Psychiatr Serv 1999; 50 (3): 421
125. Pagel JF, Parnes B. Medications for the treatment of sleep disorders: an overview. Prim Care Companion J Clin Psychiatry 2001; 3 (3): 118-25
126. Wells BG, Chu CC, Johnson R, et al. Buspirone in the treatment of posttraumatic stress disorder. Pharmacotherapy 1991; 11 (4): 340-3
127. Duffy JD, Malloy PF. Efficacy of buspirone in the treatment of posttraumatic stress disorder: an open trial. Ann Clin Psychiatry 1994; 6 (1): 33-7
128. Fichtner CG, Crayton JW. Buspirone in combat-related post-traumatic stress disorder. J Clin Psychopharmacol 1994; 14 (1): 79-81
129. Hamner MB, Brodrick PS, Labbate LA. Gabapentin in PTSD: a retrospective, clinical series of adjunctive therapy. Ann Clin Psychiatry 2001; 13 (3): 141-6
130. De Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry 1996; 57 Suppl. 4: 19-25
131. Lewis JD. Mirtazapine for PTSD nightmares. Am J Psychiatry 2002; 159 (11): 1948-9
132. Foa EB, Davidson JRT, Frances A. Effective treatments for PTSD. New York: Guilford Press, 2000
133. Nishith P, Duntley SP, Domitrovich PP, et al. Effect of cognitive behavioral therapy on heart rate variability during REM sleep in female rape victims with PTSD. J Trauma Stress 2003; 16 (3): 247-50
134. Krakow B, Johnston L, Melendrez D, et al. An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am J Psychiatry 2001; 158 (12): 2043-7
135. Krakow BJ, Melendrez DC, Johnston LG, et al. Sleep dynamic therapy for Cerro Grande fire evacuees with posttraumatic stress symptoms: a preliminary report. J Clin Psychiatry 2002; 63 (8): 673-84
136. Morin CM, Hauri PJ, Espie CA, et al. Nonpharmacologic treatment of chronic insomnia: an American Academy of Sleep Medicine review. Sleep 1999; 22 (8): 1134-56
137. Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999; 115 (4): 1127-39
138. Melendrez D, Krakow B, Johnston L, et al. A prospective study on the treatment of "complex insomnia": insomnia plus sleep-disordered breathing: in a small series of crime victims with PTSD. Sleep 2001; 24 Suppl. 2: A120
139. Krakow B, Melendrez D, Lee SA, et al. Refractory insomnia and sleep-disordered breathing: a pilot study. Sleep Breath 2004; 8 (1): 15-29
140. Bao G, Guilleminault C. Upper airway resistance syndrome: one decade later. Curr Opin Pulm Med 2004; 10 (6): 461-7
141. Brown TM, Skop BP, Mareth TR. Pathophysiology and management of the serotonin syndrome. Ann Pharmacother 1996; 30 (5): 527-33
142. Deviva JC, Zayfert C, Pigeon WR, et al. Treatment of residual insomnia after CBT for PTSD: case studies. J Trauma Stress 2005; 18 (2): 155-9
143. Stephen GA, Eichling PS, Quan SF. Treatment of sleep disordered breathing and obstructive sleep apnea. Minerva Med 2004; 95 (4): 323-36
144. Lesage S, Hening WA. The restless legs syndrome and periodic limb movement disorder: a review of management. Semin Neurol 2004; 24 (3): 249-59
145. Connor KM, Rothbaum B, Foa EB, et al. A controlled trial of combined sertraline and prolonged exposure therapy in post-traumatic stress disorder. Eur Neuropsychopharmacol 2002; 12 Suppl. 3: S335
146. Otto MW, Hinton D, Korbly NB, et al. Treatment of pharmacotherapy- refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther 2003; 41: 1271-6
147. Marshall RD, Cloitre M. Maximizing treatment outcome in post-traumatic stress disorder by combining psychotherapy with pharmacotherapy. Curr Psychiatry Rep 2000; 2: 335-40