ABSTRACT Background: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Objective: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Methods: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Results: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. Discussion: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

https://doi.org/10.1080/20008066.2023.2202058

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Abstract Background Evidence-based treatments of posttraumatic stress disorder (PTSD) aim to promote fear extinction learning. Post-learning sleep, particularly slow wave sleep (SWS), promotes memory consolidation and recall. Thus, boosting SWS might strengthen extinction recall. The current study investigated whether sleep-directed hypnosis designed to increase SWS and sleep quality improves extinction recall and reduces analog PTSD symptoms. Method In two subsamples (remote/laboratory), 211 healthy individuals underwent fear conditioning with a traumatic film clip. On the next evening, they underwent extinction training. Thereafter, the experimental group received sleep-directed hypnosis, whereas the control group listened to a control text. Extinction recall and generalization and film-related intrusions and rumination were assessed on the following morning. Results Subjective sleep quality declined following exposure to an aversive film. No group differences were found in SWS though exploratory analyses indicated less rapid eye movement sleep after hypnosis. After hypnosis, the experimental group reported improved sleep quality, whereas the control group showed a further deterioration. Hypnosis had no effects on extinction retention and generalization nor on analog intrusions and rumination. Conclusion The current results indicate that sleep-directed hypnosis may be beneficial for improving subjective sleep quality after trauma but not for enhancing extinction memory and reducing analog PTSD symptoms. 

/pdf/sleep-directed-hypnosis-improves-subjective-sleep-quality-3ooem8ei.pdf

Sleep-Directed Hypnosis Improves Subjective Sleep Quality but not Extinction Memory After Exposure to Analog Trauma

Angry and fearful compared to happy or neutral faces as conditional stimuli in human fear conditioning: A systematic review and meta-analysis

On making (and turning adaptive to) maladaptive aversive memories in laboratory rodents

The endocannabinoid system has been proposed as a promising candidate for treating posttraumatic stress disorder (PTSD). Despite a proliferation of preclinical and healthy human research, there is currently sparse endocannabinoid and cannabinoid research involving individuals with PTSD. Current evidence suggests discrepancies in the relationship between endocannabinoids and PTSD between basic (preclinical, healthy human) and clinical research. Specifically, more research is needed to understand how extreme stress and trauma exposure influence circulating concentrations of endocannabinoids acutely, as well what occurs to endocannabinoid tone and reactivity in the aftermath of trauma (e.g., 6 months following trauma). More information is also needed to understand how genotypes identified in basic research correlate with PTSD symptomology and fear-conditioning performance, as well as how treatment with cannabinoid compounds affects PTSD treatment outcomes. The current review discusses each of these issues in a comprehensive review of available evidence and suggests critical areas of future research. 

The endocannabinoid system and posttraumatic stress disorder (PTSD): A new narrative

/pdf/combining-the-trauma-film-and-fear-conditioning-paradigms-a-3a5kl4au.pdf

Combining the trauma film and fear conditioning paradigms: A theoretical review and meta-analysis with relevance to PTSD.

Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity.

Airline cabin crew operate in dynamic work environments that are continuously changing, from unpredictable shift work hours to travelling through multiple time zones. These likely impact cabin crews’ overall health and may affect their performance on safety-related tasks. Research on this population has been limited; therefore, the aim was to summarise the relevant literature regarding fatigue, sleepiness and mental health of cabin crew. This review followed the PRISMA-ScR guidelines and conducted a systematic search utilising five databases. The initial search identified 1223 studies, and through vigorous screening processes, 27 studies were selected for this review. Over half of the selected studies focused on international or long-haul flights, and a large proportion of the sample participants were women. Findings suggested a high prevalence of fatigue and sleepiness as well as unsatisfactory sleep quality with elevated susceptibility to sleep disorders. Factors identified with health outcomes were associated with flight operations (e.g., rosters) and individual differences (e.g., age and coping strategies). Regarding mental health, cabin crews are potentially at a greater risk for depression and anxiety compared to the general public. This review draws attention to the importance of using a standardised approach, such as validated measures for fair and consistent inferences.

/pdf/fatigue-and-sleep-in-airline-cabin-crew-a-scoping-review-1hcslmaz.pdf

Fatigue and Sleep in Airline Cabin Crew: A Scoping Review

Abstract Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, the paradigm modelling the development, maintenance and treatment of anxiety disorders including post-traumatic stress disorder (PTSD), which are disorders commonly associated with sleep disturbances. Previous studies examining associations between sleep and fear or extinction processes predominately focused on objectively measured sleep architecture using polysomnography, and the majority of the research has been done in healthy populations. To date, little research has focused on subjective sleep measures and particularly in clinical populations including PTSD, which often experience subjectively poor sleep. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity and healthy controls. Overall, we did not find that sleep was associated with fear conditioning extinction learning or extinction recall. However, emerging evidence highlighting the critical role of sex in PTSD risk, fear conditioning processes, as well as in the sleep-fear conditioning relationship. Exploratory analyses examining sex-specific effects found that shorter sleep onset latency and greater sleep efficiency during the previous night were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective against the commonly observed impaired extinction recall in PTSD in highly symptomatic women, but is not relevant in men.

/pdf/p105-women-with-greater-post-traumatic-stress-symptom-1nbgp9kw.pdf

Maya T. Schenker

Papers

Combining the trauma film and fear conditioning paradigms: A theoretical review and meta-analysis with relevance to PTSD.

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity.

Fatigue and Sleep in Airline Cabin Crew: A Scoping Review

P105 Women with greater post-traumatic stress symptom severity and less disrupted sleep have improved fear extinction recall compared to men