WASHINGTON — During the wars in Iraq and Afghanistan, scattered reports surfaced regarding an unusual sleep disorder among some combat veterans.
Col. Vincent Mysliwiec, MD, a sleep researcher, said that upon returning home from combat duty, some veterans were having nightmares with “dream-enactment behaviors.”
These behaviors were troubling, he said.
“They’d strike out, scream, yell at their spouse and even run around their bed and at times hurt themselves or others.”
In 2013, Mysliwiec was working at Madigan Army Medical Center at Joint Base Lewis, McChord, Washington. It was then, he said, when he came across such an instance at the center’s sleep laboratory.
“We found the first documented case in probably 30 years at Madigan,” he said.
What he saw, he said, was not only troubling, but puzzling, as there was no category for the sleep disorder in the International Classification of Sleep Disorders 3 and Diagnostic and Statistical Manual of Mental Disorders 5. ICSD-3 is the diagnostic manual for sleep disorders and DSM 5 is used by psychiatrists and psychologists.
So Mysliwiec and colleagues labeled what they saw as “trauma associated sleep disorder,” or TSD.
Regarding the 2013 finding, Mysliwiec said, “(A) friend and colleague at Madigan called it the ‘Rosetta Stone’ moment because we heard similar reports beginning in 2007 with Soldiers returning from combat. They’d be telling us these things, and we didn't know what this disorder was. We've also seen it described a handful of times in articles and journals.”
While it’s rare to see cases of TSD in sleep labs, Mysliwiec said a colleague of his witnessed just such a case in March in the sleep lab at Madigan. While it was an unfortunate experience for the Soldier, he said, it was an exciting moment for him and other sleep researchers because the diagnosis is consistent with their earlier findings.
Mysliwiec said TSD is definitely not a nightmare per se, because a person doesn’t move around in nightmares. He also said it’s not a REM behavior disorder. REM behavior disorders, he said, are typically found in patients in their 60s who also have a neurodegenerative disorder such as Parkinson’s.
Instead, TSD “is dream-enactment behaviors relating to trauma-related nightmares.”
Mysliwiec and his colleagues are working to get TSD categorized as a sleep disorder in both the ICSD-3 as well as the DSM 5.
Mysliwiec and his co-researchers will have three presentations regarding TSD at an annual sleep conference this year. He has also co-published his findings in the Journal of Clinical Sleep Medicine in 2014.
That paper was titled “Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors.” He also plans to release another study on the topic in a journal next year.
Treatment of TSD
Mysliwiec said some who suffer from TSD have benefited from being treated with prazosin, a sympatholytic drug also used to treat post-traumatic stress disorder.
“If you have PTSD, your body may release too much adrenaline,” he said. “Adrenaline is a hormone that can make you feel stressed and contribute to nightmares as well as abnormal behaviors in sleep. Prazosin blocks some of the effects of adrenaline released in your body.”