PTSD game changer? Looking at brain molecules, sleep patterns for answers
Posttraumatic Stress Disorder is a significant or extreme emotional or psychological response to a shocking, dangerous, or traumatic event. Researchers discussed PTSD studies on sleep patterns and biomarkers at the Military Health System Research Symposium in Kissimmee, Florida. (U.S. Air Force photo by Senior Airman Christian Clausen/Released)
Whether service members experience a traumatic event in a warzone or at home, posttraumatic stress disorder can affect every aspect of their lives. Research on the disorder continues to advance as experts study its impact on behavior, psychology, and physiology.
During the Military Health System Research Symposium, researchers shared studies focusing on a specific aspect of posttraumatic stress disorder research: biomarkers. A biomarker is a molecule that can indicate unusual processes going on in a person’s body. These markers can flag a clinician’s attention for an underlying condition, including PTSD. They can objectively diagnose the disorder or show how severe the symptoms are in service members and veterans.
Using sleep as a pathway to understanding more about the disorder can open doors to innovative research, said Ashlee McKeon, a postdoctoral scholar with the military sleep tactics and resilience research team at the University of Pittsburgh. She studied the differences in self-reported symptoms, such as the amount of distress caused by memories and gaps in awareness, slow wave activity, and sleep spindle activity in service members and veterans with and without the disorder. Sleep spindles are a marker of light sleep while slow wave activity indicates deep sleep, which is restorative and helps with brain function.
“Despite being a PTSD diagnostic criterion, cognitive alterations receive less attention in the literature when compared to other symptoms,” said McKeon while speaking at the Military Health System Research Symposium in Kissimmee, Florida. The disorder can have clear physical and psychological indicators, such as problems with memory and thinking. People may suffer from nightmares, flashbacks, and sleep difficulties. “However, these symptoms can and do have a chronic negative impact on … overall functioning and quality of life.”
Previous studies on sleep show a connection between performance and sleep. These studies have also shown shortfalls in areas like working memory, attention, and function – all of which are known to be impaired in PTSD, said McKeon. Impaired cognitive performance has been linked to reduced slow wave activity and sleep spindle activity, both of which are needed for brain power.
Since the disorder can cause issues with sleep, whether it is the inability to sleep or nightmares, slow wave activity in people who experience ongoing sleep restrictions can mark just the opposite – increased pressure for sleep, said McKeon.
“It’s an intriguing finding that we’re excited to further explore in future work,” said McKeon. “I think we’re just starting to scratch the surface of how to understand slow wave activity and its influence on cognition in those with PTSD.”
Experts are also looking into the use of biomarkers as a way to tell if an individual has PTSD, mild traumatic brain injury, or both. Dr. Anne Van Cott, a neurologist with the Department of Veterans Affairs and University of Pittsburgh, said there can be a big overlap between the symptoms of PTSD and mild traumatic brain injury, which are often found together in patients. In these cases, there can be an advantage to using magnetic resonance spectroscopic imaging or MRSI, she added. In addition to the images provided through MRI testing, clinicians can use MRSI to go in closer and measure biochemical changes in the brain in a noninvasive way.
“It can identify biochemical changes that would not be detected in conventional anatomical imaging studies,” said Van Cott, adding that the advantage of this technique is that researchers can study a much smaller part of the brain tissue, and it can be done faster. Van Cott tried to find patients suffering from only PTSD, but found that many of the patients actually dealt with mild traumatic brain injury as well. During the study, she found veterans with only PTSD or with both PTSD and TBI had abnormalities to the left hippocampus, considered the center of emotion and memory, as compared to the control group.
“We believe … MRSI may serve as one reliable diagnostic biomarker for identifying military service personnel with PTSD, and military personnel with PTSD and mild traumatic brain injury,” said Van Cott. “There is some hope, based on the small sample size we have, that … MRSI may be able to distinguish between patients with PTSD alone and those with both, which is what I think we see clinically.”
The Military Health System Research Symposium brought medical providers, researchers, and senior leaders together to share research and health care advancements. The symposium highlights research for combat casualty care, operational medicine, clinical and rehabilitative medicine, and infectious diseases.
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