Hypnotic interventions for sleep in PTSD

Abstract

Sleep disturbance is quite common in patients with post-traumatic stress disorder (PTSD), as a symptom of the underlying disorder; as a part of comorbid anxiety, depression, or chronic pain disorder; or as an independent sleep disorder diagnosis. Chronic sleep disturbance from any cause is associated with poorer daytime functioning as well as medical comorbidities and thus critical to address. Insomnia, the most common sleep symptom, is a state of hyperarousal linked to central changes in metabolism and electroencephalographic activity and peripheral mechanisms such as autonomic activation. This physiological state when combined with inadvertent behavioral conditioning (e.g., checking the bedside clock) can become a chronic condition. In patients with PTSD, insomnia can be even more severely chronic given how the associated heightened hypervigilance and nightmares further disrupt sleep. Abnormalities in the brain’s default mode network (DMN) have been implicated in both PTSD, combat trauma (even without PTSD), childhood trauma, and insomnia. The DMN is a network of interconnected brain regions which is most active during low-demand tasks such as daydreaming and self-absorbed thinking and when not attending to outside stimuli. One of the under-recognized treatment modalities for insomnia in patients with PTSD is hypnosis. This chapter will review the empirical evidence on the effectiveness of hypnosis for insomnia and PTSD and summarize the neurobiological substrates underlying the hypnotic state, including changes in the DMN.