Trauma (PTSD) and Sleep Disorders

[HalfAsleep]

The question came up in another post about the inter-relationship between trauma (PTSD) and sleep disorders, including insomnia, nightmares, and sleep-disordered breathing. It does cover xPAP as one line of treatment.

I was particularly interested in the idea that trauma (PTSD) victims could hold their breaths during a forgotten sleep-time trauma re-enactment, and these breathing aberrations would be neither obstructive or central. Another possibility might be a silent scream which would limit flow, but not register as a snore.

Anyway, I got to researching and am referencing a peer-reviewed article. It seems to be easy to understand and evaluate.

Clinical Sleep Disorder Profiles in a Large Sample of Trauma Survivors: An Interdisciplinary View of Posttraumatic Sleep Disturbance 

http://www.sleepandhypnosis.org/ing/Pdf/...3b205a.pdf

One aspect especially worthy of mention: unbelievably, there are few studies covering this topic....

The article does, however, have a great set of footnotes referencing other trauma and sleep disordered breathing articles. I will see what else I can find along these lines.

-------------

If this citation is not okay with the moderators, please move it wherever is more appropriate.

[kiwii]

Thank you for the link.

When they speak of psychophysiological insomnia, does that include the need to be vigilant so that you have a chance to escape from danger? I wouldn't have thought of that as insomnia, although it sure isn't going to result in any sleep.

[HalfAsleep]

Now I'm on a jag on this topic (trauma and sleep disorders). I'll have to find out more.

Hyper-vigilance is one of the factors I was thinking about, although it might not be addressed precisely in that article. I'm quite sure hyper-vigilance would be reflected in flow rate; I would guess it might cause frequent arousals or mini-apneas that don't qualify as full-length apneas and therefore look insignificant.

I also volunteered on this forum the other day to try different ways of vocalizing to see how they would show up in SleepyHead. This angle started with my post on what constitutes snoring per SleepyHead. I started to think about trauma reactions and what they night do to SH graphs.

[kiwii]

That's very interesting. I'll have to take a peek at that thread. I've woken myself up screaming, or yelling "NO!" I would imagine that would show up pretty big on the graph.

As for hyper-vigilance though, you're either going to be wide awake, or nodding off and jerking awake. So wouldn't that look a lot like 'wake junk?' (nice to finally know that hyper-vigilance is hyphenated)

edit: Come to think of it, I bet the xPAP mask itself would wake a person up before they could yell. There is such a gush of air if I try to speak that it interferes with speech. Perhaps someone with night terrors would not be able to vocalize like they would otherwise.

[HalfAsleep]

Random response....

Under a FFM you don’t get the same rush of air in the mouth if you vocalize as you would with a nasal/pillow mask. So you can vocalize all you want. But I 100% agree with that rushing sound on a P10.

Maybe “sleep-wake junk” is exactly what trauma victims produce all night?

——

I’m especially interested in whether you could cause an obstructive event by vocalizing or holding your breath in panic mode. I’m thinking panic would look like an OA because it’s likely to have disruptive breathing beforehand.

Presumably, an event like that couldn’t be treated by an xPAP, but I might be wrong on this assumption, since this forum demonstrates it's possible to minimize events for almost everyone.

The counter to that may be that this forum sees a low proportion of trauma victims.

Perhaps trauma victims are often not identified as having sleep disordered breathing because they simply have so much disordered going on and no one thinks to give them a sleep study.

——

Regarding hyper-vigilance, I’m thinking it would create arousals. Maybe stage shifts, too?

General question...stage shifts don’t equate to arousals, as far as I can tell. How meaningful is the “stage shift” number on a sleep study? How many is “too many”? I had 120 or thereabouts stage shifts in 6 hours. That plus the AHI. I’m either shifting stages or not breathing. This doesn’t sound like a recipe for sleep.

[kiwii]

Regarding hyper-vigilance, I’m thinking it would create arousals. Maybe stage shifts, too?

Hyper-vigilance, as I've experienced it, would have to create shifts. There is very little sleep occurring, because the whole point of being vigilant is to be prepared to escape. Therefore you are attempting to stay awake - holding vigil, as it were. A post-trauma person may see this as a matter of life and death (and their life depends on them staying awake), depending on their situation and how they perceive it.

[edit: probably more common in the general population is a sense of needing to stay awake to keep yourself safe, as opposed to keeping yourself alive]

For the disordered breathing, that would also depend on whether the trauma victim is currently in a state of being triggered, or having nightmares.

[HalfAsleep]

This is a very interesting discussion, IMO. We are elaborating on each other’s ideas.

I’m anticipating when you do the Sleep Lab sleep study, Kiwii, that you’ll have a lot more data categories than you have right now. Something to look forward to!

Continued speculation in a PM....

[HalfAsleep]

Catathrenia...... https://en.m.wikipedia.org/wiki/Catathrenia

I’m on a jag of researching sleep disordered breathing as it may relate to trauma, i.e. not obstructive or central by current descriptors.


Get a load of this. Catathrenia is a sleep breathing condition where you hold your breath at inhale. The pattern is, you take a deep breath and hold it. The “hold it” is characterized by a glottal stop, i.e. presumably the throat closes off. This would look like flow limitation on SleepyHead? If long enough, the breath holding after a deep breath would register as obstructive on SH?

A breath like that can be followed by a whistling sound on exhalation, or no sound at all, but a very fast exhale. This would create sleep wave forms on exhale that are very pointy and short?

[Sleeprider]

Catathrenia...... https://en.m.wikipedia.org/wiki/Catathrenia

I’m on a jag of researching sleep disordered breathing as it may relate to trauma, i.e. not obstructive or central by current descriptors.


Get a load of this. Catathrenia is a sleep breathing condition where you hold your breath at inhale. The pattern is, you take a deep breath and hold it. The “hold it” is characterized by a glottal stop, i.e. presumably the throat closes off. This would look like flow limitation on SleepyHead? If long enough, the breath holding after a deep breath would register as obstructive on SH?

A breath like that can be followed by a whistling sound on exhalation, or no sound at all, but a very fast exhale. This would create sleep wave forms on exhale that are very pointy and short?

The wave form would rise to a peak and descend to the zero line and stay there until the breath is released.  An OA would be registered in most cases, but without an exhale ahead of the apnea it has a peculiar appearance.  I think we discussed seeing this in some of your charts.

[HalfAsleep]

SleepRider, I'm thinking the glottal stop would flatten out the top of the inhale wave form every breath, but maybe you're right. Yes, I do have apneas on inhale. I also get strings of shallow wave forms with flat tops. I have mini-breath stoppages all over the place on inhale (never exhale).

[Aside, so everyone knows what a glottal (tongue) stop is. Think the candy bar Kit Kat. Many Brits (especially upper and middle class) enunciate the middle t and k. There is a micro stop after the t. That's a glottal stop on the t. Americans might say something more like "Kick kat", the t smushed into the K.]

Catathrenia sufferers don't snore, but they do generally (but not always) vocalize. Interesting factoid: I don't snore. I likely vocalize sometimes.

There's very little oxygen desat associated with catathrenia. Interesting factoid: I don't have remarkable desats despite the number and length of my events.

I have to check the supporting sources in the Wikipedia article.

Input from other posters would be exciting, too.

Since I wandered away from the trauma topic, I've created a separate thread on catathrenia.