In the National Vietnam Veterans Readjustment Study, 52% of combat Veterans with PTSD reported significant nightmares (2). There are fewer data on the prevalence of chronic nightmares with PTSD. Despite the efficacy of evidence-based treatments for PTSD such as Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT), the arousal and reactivity (hyperarousal) cluster symptoms that include sleep difficulties appear to be particularly difficult to resolve even after substantial PTSD improvement (10-13). In support of this viewpoint, insomnia occurring in the acute aftermath of a traumatic event is a significant risk factor for the later development of PTSD in civilian (7,8) and active duty (9) populations. It has been argued that sleep problems, rather than being just symptoms of PTSD, are a hallmark of the disorder (6). In the Millennium Cohort Study, 92% of active duty personnel with PTSD, compared to 28% of those without PTSD, reported clinically significant levels of insomnia (5). Insomnia was also the most commonly reported PTSD symptom in a survey of Veterans from Afghanistan and Iraq (OEF/OIF) (4). Insomnia is reported to occur in 90-100% of Vietnam era Veterans with PTSD (2,3). PTSD is unique among mental health disorders in that sleep problems are mentioned twice among its diagnostic criteria in DSM-5: the presence of insomnia qualifying as a symptom of an alteration in arousal and reactivity (hyperarousal) and the presence of frequent nightmares as an intrusion symptom. Prevalence of sleep problems in Veterans with PTSD VA Software Documentation Library (VDL).Clinical Trainees (Academic Affiliations).War Related Illness & Injury Study Center.
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