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Nightmares in United States Military Personnel Are Multifactorial and Require Further Study

2018; American Academy of Sleep Medicine; Volume: 14; Issue: 07 Linguagem: Inglês

10.5664/jcsm.7252

1550-9397

Jennifer Creamer, Matthew S. Brock, Vincent Mysliwiec,

Circadian rhythm and melatonin

Free AccessNightmaresNightmares in United States Military Personnel Are Multifactorial and Require Further Study Jennifer L. Creamer, MD, Matthew S. Brock, MD, Vincent Mysliwiec, MD Jennifer L. Creamer, MD Address correspondence to: Jennifer Creamer, MD, Martin Army Community Hospital, Sleep Center, 6600 Van Aalst Blvd, Fort Benning, GA 31905(915) 504-4676 E-mail Address: [email protected] Martin Army Community Hospital, Sleep Medicine Center, Fort Benning, Georgia Search for more papers by this author , Matthew S. Brock, MD San Antonio Military Medical Center, Department of Sleep Medicine, JBSA-Lackland, Texas Search for more papers by this author , Vincent Mysliwiec, MD San Antonio Military Medical Center, Department of Sleep Medicine, JBSA-Lackland, Texas Search for more papers by this author Published Online:July 15, 2018https://doi.org/10.5664/jcsm.7252Cited by:2SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONWe appreciate the thoughtful commentary on our article evaluating nightmares in United States military personnel with sleep disturbances.1,2 At the San Antonio Military Health System Sleep Disorders Center, which is the largest sleep laboratory in the Department of Defense, we are aware of the high rate of patients affected by nightmares and the associated clinical and nocturnal distress that nightmares cause. This has led us to having a focus on this sleep disorder in our clinical practice and research on parasomnias to include nightmares and a novel parasomnia, trauma associated sleep disorder.3,4In our clinical experience, as well as the other sleep physicians who work in our sleep disorders center, none of us have diagnosed a patient with a persistent clinical sleep disorder, nightmares or otherwise, related to mefloquine toxicity. It is relevant to point out that the United States military recognized the neuropsychiatric side effects associated with mefloquine and use of this medication has decreased dramatically since 2008.5 Further, as noted by the lead author of the Cochrane Review,6 Dr. Tickell-Painter, “the review clarifies that these are symptoms reported by people taking mefloquine and not formal psychiatric diagnoses. Serious side effects with mefloquine seem to be rare, less than 1% of users.”7 Thus, while the symptoms of bad dreams or nightmares are a well-known side effect of this medication, their persistence is rare.We did not specifically evaluate the impact of medications which are commonly associated with nightmares (ie, bupropion, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, propranolol, etc.). In the article cited by Dr. Nevin regarding the persistence of nightmares after taking mefloquine, this study included a total of 73 patients from a Danish national registry who self-reported symptoms.8 After 3 years, 9 (12%) of the respondents noted nightmares; however, as the frequency, severity, and associated characteristics were not delineated, to include the criteria for nightmares, it is unknown if this finding represented a persistent side effect or was within the spectrum of bad dreams that occur in a general population.Ultimately, in order to better address nightmares, which are an under-reported, under-addressed disorder,9 and increased in individuals with war experiences,10 a systematic study in both military personnel and veterans is indicated. This is especially relevant noting the association with nightmares and suicidality.11 This study should account for trauma exposure and deployments, military duties, and comorbid disorders (ie, posttraumatic stress disorder, traumatic brain injury, anxiety, depression, etc.) as well as medications.DISCLOSURE STATEMENTAll work was performed at Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, Texas. All authors have seen and approved the manuscript. The auithors report no conflicts of interest. The opinions and assertions in this manuscript are those of the authors and do not represent those of the Department of the Air Force, Department of the Army, Department of Defense, or the United States government.CITATIONCreamer JL, Brock MS, Mysliwiec V. Nightmares in United States military personnel are multifactorial and require further study. J Clin Sleep Med. 2018;14(7):1275–1276.REFERENCES1 Nevin RLMeasurement of mefloquine exposure in studies of veterans' sleep disorders. J Clin Sleep Med; 2018;147:1273-1274, 29991432. LinkGoogle Scholar2 Creamer JL, Brock MS, Matsangas P, Motamedi V, Mysliwiec VNightmares in United States Military personnel with sleep disturbances. J Clin Sleep Med; 2018;143:419-426, 29510796. LinkGoogle Scholar3 Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJTrauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med; 2014;1010:1143-1148, 25317096. LinkGoogle Scholar4 Mysliwiec V, Brock MS, Creamer JL, O'Reilly BM, Germain A, Roth BJTrauma associated sleep disorder: a parasomnia induced by trauma. Sleep Med Rev; 2018;37:94-104, 28363448. CrossrefGoogle Scholar5 Kersgard CM, Hickey PWAdult malaria chemoprophylaxis prescribing patterns in the military health system from 2007-2011. Am J Trop Med Hyg; 2013;892:317-325, 23817331. CrossrefGoogle Scholar6 Tickell-Painter M, Maayan N, Saunders R, Pace C, Sinclair DMefloquine for preventing malaria during travel to endemic areas. Cochrane Database Syst Rev; 2017;10:CD006491, 29083100. Google Scholar7 Cochrane review looks at the effectiveness and side effects of mefloquine. Accessed May 3, 2018 https://medicalxpress.com/news/2017-10-cochrane-effectiveness-side-effects-mefloquine.html. Published October 30, 2017. Google Scholar8 Ringqvist Å, Bech P, Glenthø j B, Petersen EAcute and long-term psychiatric side effects of mefloquine: a follow-up on Danish adverse event reports. Travel Med Infect Dis; 2015;131:80-88, 25435322. CrossrefGoogle Scholar9 Nadorff MR, Nadorff DK, Germain ANightmares: under-reported, undetected, and therefore untreated. J Clin Sleep Med; 2015;117:747-750, 25845898. LinkGoogle Scholar10 Sandman N, Valli K, Kronholm E, Ollila HM, Revonsuo A, Laatikainen T, Paunio TNightmares: prevalence among the Finnish general adult population and war veterans during 1972-2007. Sleep; 2013;367:1041-1050, 23814341. CrossrefGoogle Scholar11 Sjöström N, Waern M, Hetta JNightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep; 2007;301:91-95, 17310869. CrossrefGoogle Scholar Previous article FiguresReferencesRelatedDetailsCited by Sleep disturbances and predictors of nondeployability among active-duty Army soldiers: an odds ratio analysis of medical healthcare data from fiscal year 2018Devine J, Collen J, Choynowski J and Capaldi V Military Medical Research, 10.1186/s40779-020-00239-7, Vol. 7, No. 1, Online publication date: 1-Dec-2020. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanismsRichards A, Kanady J and Neylan T Neuropsychopharmacology, 10.1038/s41386-019-0486-5, Vol. 45, No. 1, (55-73), Online publication date: 1-Jan-2020. Volume 14 • Issue 07 • July 15, 2018ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationMay 15, 2018Submitted in final revised formMay 15, 2018Accepted for publicationMay 15, 2018Published onlineJuly 15, 2018 Information© 2018 American Academy of Sleep MedicinePDF download