Renowned sleep researcher, Dr. Anne Germain from the University of Pittsburg, reviewed her and others’ research at the 14th Annual Amygdala, Stress, and PTSD Conference on April 16th in Bethesda, MD. Dr. Germain’s talk, “Wake up to Sleep! A Translational Perspective of the Role of Sleep in Readiness and Resilience" was presented to over 300 clinicians, researchers and graduate students.
Dr. Germain began by summarizing the importance of sleep in brain plasticity, memory consolidation, emotion regulation, immune function, lymphatic clearing, and regulation of the cardiovascular system. She noted this importance is reflected in the doubling of peer-reviewed articles on sleep from 400 publications annually in 2011 to over 800 in 2017.
In the area of risk, many in the audience already knew that deployment was a risk factor for subsequent sleep disturbances (usually among the top five post-deployment complaints). However, Dr. Germain cited a Millennium Cohort study suggesting that sleep problems before deployment increase the risk of post-deployment mental health problems on par with that of combat exposure.
Dr. Germain also emphasized how important sleep is for resilience. Research participants randomly assigned to experimental sleep deprivation conditions are more easily prone to conditioned fear, which can lead to PTSD. REM sleep has been implicated in this connection. What was less obvious to many was that polysomnography (PSG) is not the best way to detect problems during REM. Dr. Germain likened assessing disruptions in REM with PSG to trying to figure out what’s wrong with your car’s engine by measuring the temperature of the hood. She advocates for PET and fMRI studies, the latter of which show decreased metabolism in the prefrontal cortex and increased metabolism in the limbic system during REM sleep.
Dr. Germain addressed recovery by advocating for increased dissemination of sleep treatments among military patients, especially those with PTSD. Many therapists treating PTSD patients with sleep problems erroneously believe sleep will improve simply by treating the PTSD with an evidence-based protocol such as Prolonged Exposure or Cognitive Processing Therapy. While this may be true for some, adding a sleep treatment boosts recovery. (See Dr. Germain’s 2013 review article for her assessment of whether sleep disturbances should be the hallmark symptom of PTSD.)
In her efforts to scale sleep treatments, Dr. Germain is a proponent of brief behavioral treatment of insomnia, or BBTI, which presents patients with stimulus control principles and sleep restriction across 4 weeks (face-to-face appointments in weeks one and three, and phone calls during weeks two and four).
Dr. Germain remains hopeful that some of our nation’s sleep problems can be addressed. But more providers need to be trained in BBTI. And more Servicemembers need to be educated on the importance of sleep, possibly by being issued a Warfighter Sleep Kit before they deploy.
For more about BBTI and other insomnia treatments, watch an expert panel hosted by CDP in 2018.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
David J. Reynolds, Ph.D., is the Military Internship Behavioral Health Psychologist and Deputy Training Director at Malcolm Grow Medical Clinics and Surgery Center (MGMCSC), Joint Base Andrews, Maryland.