TRANSCRIPT
PTSD sufferers often experience sleep issues like insomnia, flashbacks, anxiety, depression nightmares and sleep apnea.
Now, an increasing body of research suggests that treatment of these issues is an effective way to comprehensively treat the disorder.
As many as 75 per cent of Australian adults have experienced trauma in their lives, according to the Australian Institute of Health and Welfare.
But only an estimated 5-10 per cent will develop post-traumatic stress order.
The condition is typically experienced at higher rates by veterans with the ongoing Royal Commission into Veteran and Defence Suicide, hearing more about the impact of the disorder.
Jonathan Moscrop [[MOSS-crup]] is the Clinical Lead of the psychology service Mates4Mates - a charity which provides support to veterans for service-related injuries.
He describes the often profound impact PTSD can have on the quality of sleep for the veterans he counsels.
"Hyper-arousal, which is anxiety-like symptoms, fight or flight, increased heart rate, on edge. And the other cluster of symptoms being re-experiencing symptoms, and that's the intrusive memories, nightmares. So those two symptoms really impact one's ability to fall asleep, and obviously then stay asleep. And then a lot of people with PTSD will develop sleep-aversion, so they will come up with strategies in order to avoid going to sleep."
PTSD is on the rise in the general Australian population.
According to the latest data from the National Study of Health and Wellbeing, rates rose to 5.7 per cent in 2020-21, up from 4.4 per cent the previous year.
The relationship between sleep and PTSD is often described as bi-directional.
Sean Drummond is Professor of Clinical Neuroscience in the School of Psychological Sciences at Monash University.
He says that it is not simply a case of PTSD causing poor sleep.
"Sleep is also causally related to the development of PTSD. So we know for example, if somebody has difficulty sleeping, and particular if they have a sleep disorder like insomnia or obstructive sleep apnea prior to being exposed to a trauma, they are two-and-a-half to three times more likely to develop PTSD than someone who doesn't have a sleep problem before they're exposed to a trauma. And we know that people who develop sleep difficulties in the immediate aftermath of a trauma are more likely to go on and develop a full-blown PTSD, and not recover naturally, so the relationship really goes both ways."
Professor Drummond is presenting on the relationship between sleep and PTSD at the SleepDownUnder conference in Adelaide in November.
His work is part of an increasing body of research which suggests treating sleep issues may be an effective way to treat the disorder.
He co-authored a 2019 study, in which U-S veterans with the condition received either traditional trauma-based talk therapy, or talk therapy alongside sleep treatments.
It found that those who also received sleep therapy had greater relief from their daytime and night-time symptoms.
"Effectively what we've found is that the daytime intervention worked pretty well, just like we would it expect it to. It did not treat the sleep symptoms, just like prior literature shows. And then when we gave people sleep ((treatment)), the sleep symptoms, both the insomnia and the nightmares got significantly better in the group who received the sleep treatment, and interestingly the daytime symptoms of PTSD also got better after the sleep treatment, relative to after the control treatment."
Professor Amy Jordan the Director of the John Trinder Sleep Laboratory at the University of Melbourne, is one of the authors of an ongoing study on the connection between PTSD and obstructive sleep apnea.
Professor Jordan says it's unclear why the condition, which affects breathing during sleep, is so common among PTSD patients.
"PTSD is a mental health condition, and sleep apnea is occurring because the throat is closing during the night, and so how being exposed to a trauma and having this condition as a result of that is able to translate into your throat closing over more overnight is something we don't understand really at all well."
Professor Jordan says that US studies have found that as many as three-quarters of PTSD sufferers experience sleep apnea.
However, these studies have typically been on veteran populations, often male and middle aged who are generally more likely to suffer from sleep apnea.
The University of Melbourne is broadening its study to include younger participants including a higher proportion of women.
"What we did notice in doing that study is that people with post-traumatic stress disorder had high-levels of breathing discomfort just going about their daily lives, so there might be still something to this subjective awareness of breathing, and feeling uncomfortable with their breathing that is tipping over and contributing to the sleep apnea at nighttime."
There is also strong evidence to suggest that the treatment of sleep apnea can improve daytime PTSD symptoms as well.
Professor Andrea Phelps is the Deputy-Director of Phoenix Australia, a charity which focuses on the treatment of PTSD.
She says there's a growing move in treatment towards psychological therapies.
"There's a lot of support for that idea. We know that standard evidence-based treatments for P-T-S-D aren't terribly effective for sleep, and so we got a little of residual insomnia after PTSD treatment, which is why there has been a move towards saying well let's focus specifically on sleep treatment."
Professor Jordan says recent stressors like the COVID-19 pandemic, and climate emergencies like the 2019 bushfires may have contributed to the rise in PTSD rates.
She says that while the experience of veterans is important - many other Australians continue to be affected as well.
"They've advanced the field tremendously and that's great. We don't know for sure how much is applicable to someone who's had childhood trauma, or sexual assault or domestic violence, and so I think the underlying processes are assumed to be similar in terms of how PTSD is established and maintained, but I think there's lots of room for research."
Mr Moscrop says veterans suffering from PTSD and sleep issues should know that help is available.
"When it comes to PTSD, going to see your GP is always the first port-of-call, but going and getting help and just realising you're not alone. There's a big barrier to veterans seeking support but ex-service organisations are here to help and no-one really needs to go through that recovery alone."
If you or someone you know needs crisis support, contact Lifeline on 13 11 14, the Suicide Call Back Service on 1300 659 467 and Kids Helpline on 1800 55 1800 (for young people aged up to 25). More information and support with mental health is available at beyondblue.org.au and on 1300 22 4636.
