TASD, a sleep disorder in survivors of traumatic experiences

By Cristiano Antonino On Mar 7, 2023

TASD and sleep disorders: about 70% of people with PTSD (Post-Traumatic Stress Disorder) have sleep disorders

41% experience difficulty falling asleep, 47% sleep maintenance problems and 50-70% recurring nightmares (Lamarche & De Koninck, 2007).

Some scientific evidence suggests that the presence of disturbed sleep is a risk factor for the development of PTSD following the traumatic event

It has also been shown that survivors of traumatic events who manifested persistent sleep problems, despite having undergone targeted treatment for PTSD, did not show long-term improvement in the psychopathological picture (e.g., Roepke et al., 2013).

TASD (Trauma-Associated Sleep Disorder) is a parasomnia that has been identified and proposed in recent years

This parasonnia has been found to be associated with PTSD and shares some symptoms of REM Sleep Behaviour Disorder (Rapid-Eye-Movement Sleep Behaviour Disorder, RBD; Barone, 2020).

The proposed diagnostic criteria for TASD are (Mysliwiec et al., 2018):

The trigger is the traumatic experience;
The content of the dream activity is related to the traumatic experience experienced;
The sufferer enacts their dreams with excessive vocalisations and complex movements during sleep;
There are symptoms of hyperarousal and the presence of tachycardia, tachypnoea or diaphoresis (not due to a sleep disturbance);
REM sleep is characterised by the absence of muscular atonia (detected by polysomnography, PSG) or the enactment of dreams;There is no epileptiform activity in the electroencephalogram (EEG).

People with TASD enact their dreams, show elevated muscular activity in both REM and NREM sleep (with a lack of muscle atonia in REM sleep), present complex movements and excessive vocalisations, thus all phenomena similar to those presenting in REM Sleep Behavioural Disorder.

However, the symptoms of TASD first manifest themselves close to the traumatic experience (the disorder arises much earlier than the typical onset of RBD symptoms, which generally occurs around the age of 40) and the content of the nightmares is directly related to the traumatic event and the personal experience of that event, just as occurs in flashbacks in PTSD sufferers.

Conclusions

Further studies, especially longitudinal studies, are needed to clarify whether TASD is a disorder in its own right that develops from PTSD or whether it is the result of a particular interaction between PTSD and RBD (Feemster et al., 2019).

Bibliographic references

Barone D.A. (2020). Dream enactment behavior—a real nightmare: a review of post-traumatic stress disorder, REM sleep behavior disorder, and trauma-associated sleep disorder. Journal of Clinical Sleep Medicine, 16(11): 1943-1948.

Feemster J.C., Smith K.L., McCarter S.J. & St Louis E.K. (2019). Trauma-associated sleep disorder: a posttraumatic stress/REM sleep behavior disorder mash-up? J Clin Sleep Med, 15(2): 345-349.

Lamarche L.J. & De Koninck J. (2007). Sleep disturbance in adults with posttraumatic stress disorder: a review. J Clin Psychiatry, 68(8): 1257-1270.

Mysliwiec V., Brock M.S., Creamer J.L., O’Reilly B.M., Germain A. & Roth B.J. (2018). Trauma associated sleep disorder: a parasomnia induced by trauma. Sleep Med Rev, 37: 94-104.

Roepke S., Hansen M.L., Peter A., Merkl A., Palafox C. & Danker-Hopfe H. (2013). Nightmares that mislead to diagnosis of reactivation of PTSD. Eur J Psychotraumatol, 4(1): 18714.

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