Specialist Argues for Recognition of Sleep Disorder Linked to Combat

By Debbie Gregory.

Col. Vincent Mysliwiec, a sleep-medicine specialist for the U.S. Army, believes there is a new syndrome affecting young combat veterans.

Trauma-Associated Sleep Disorder, or TSD, is similar to Post-Traumatic Stress Disorder (PTSD) and REM Behavior Disorder (RBD.)

Those who have TSD commonly act out their dreams with screaming, thrashing kicks and punches, and also sleepwalk, sleep-talk, and snore loudly.

Around 2008, Mysliwiec, who is based at Brooke Army Medical Center in San Antonio, began observing sleep disturbances among veterans returning from Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in Afghanistan. He outlined the diagnostic criteria for TSD in a 2014 article in the Journal of Clinical Sleep Medicine.

Unlike in RBD, TSD nightmares are usually replays of a traumatic combat experience, rather than generalized scary dreams.

Mysliwiec said that giving this cluster of symptoms a formal diagnosis is important to patients. Servicemembers and veterans have been going to doctors with these symptoms and being told, “We don’t really know what it is,” he said. “The anxiety with not having a diagnosis after seeing a medical professional … is very concerning for patients.”

And it would be of obvious help to doctors treating such cases.

Clonazepam, a drug which treats PTSD, doesn’t seem to work on TSD symptoms. TSD sufferers have responded well to a hypertension drug called Prazosin. Cognitive behavioral therapy and sleep hygiene interventions, like regular sleep and wake times, also seem to be working.

Aside from any such treatments, however, those who suffer from TSD must institute “safe sleep practices,” according to Mysliwiec . That could mean couples temporarily sleeping in separate beds, a safeguard that can be a hard sell, he said.

Mysliwiec hopes that if the American Academy of Sleep Medicine accepts this diagnosis, more resources can be directed towards its study and treatment.

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