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Vets with PTSD and sleep apnea less likely to use CPAP

Filed in
  • Sleep apnea
  • military
  • CPAP
  • PTSD

American Academy of Sleep Medicine  |  Dec 10, 2012
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Post–traumatic stress disorder (PTSD) in returning combat veterans with comorbid obstructive sleep apnea (OSA) is associated with significantly worse continuous positive airway pressure (CPAP) adherence compared to a similar population of patients without PTSD, according to a new study.  

“Current combat veterans are a particularly vulnerable population due to psychiatric diseases such as PTSD, depression and anxiety, substance use, traumatic brain injuries and multiple injuries often associated with disability and chronic pain, said lead author Jacob Collen, MD, Maj., MC, U.S. Army, Pulmonary, Critical Care and Sleep Medicine fellow at Walter Reed National Military Medical Center in Bethesda, Md. “Sleep disordered breathing is highly prevalent and has been demonstrated to worsen outcomes in patients with psychiatric disease, and prior, smaller studies have demonstrated that CPAP therapy may improve outcomes in patients with PTSD and obstructive sleep apnea.”

The study, which will appear in the December 15, 2012 edition of the Journal of Clinical Sleep Medicine, involved 90 patients with newly diagnosed OSA who initiated CPAP therapy (45 with combat-related PTSD and 45 controls). Results show that regular use of CPAP was significantly less common among patients with PTSD and was observed in 25.2 percent, compared with 58.3 percent among patients without PTSD. Greater adherence with CPAP was observed among patients with PTDS who were chronically using sedatives.

The authors were surprised to find that concurrent use of unspecified sedative agents was associated with improved CPAP compliance in patients with PTSD. Given the near universal use of multiple psychoactive medications in this population, it was not possible to discern which agents were responsible. However in previous studies, they have demonstrated that use of nonbenzodiazepine sedative hypnotics, a group of drugs used to treat insomnia, improves short-term CPAP compliance. 

“Given the multiple health concerns these soldiers face, and the rise in suicides in returning veterans, it is critical that we look for viable strategies to improve their overall health, said Collen.  “Patients with PTSD tend to have worse adherence with a number of medical therapies, which creates a barrier to improving clinical outcomes.  This study makes it clear that we need to do a better job at optimizing CPAP compliance in this population.”

The project mentor for this study was Christopher Lettieri, MD, Lt. Col., MC, U.S. Army, Chief of Sleep Medicine at Walter Reed National Military Medical Center in Bethesda, Md.


  1. 1 Terry McCullough 06 Jun
    Very Helpful...I'm having a tough time with my cpap, I can't use it. I'm a stroke waiting to happen.
  2. 2 Tod Merley 22 Dec
    Proper Treatment of Insomnia and PTSD:

    During a recent interview Dr. Barry Krakow related that his group has found that 90% of those presenting with insomnia had a sleep breathing disorder (half UARS half OSA) and in the rest the
    awakenings were over 90% attached to respiratory incidents[1].

    The pathology for PTSD also appears to be a sleep breathing physiological problem not a psychological one.

    This year I have found my symptoms of
    PTSD much helped by a simple solution which corrects the CO2 maintenance issues involved [2]. I believe it is so effective because the brain is so sensitive to changes in CO2 [3].

    Please treat insomnia and PTSD as the breathing disorders that they are.

    [1] :
    MP3 of - Expert Interview: Dr. Barry
    Krakow on PTSD, Insomnia, and Sleep Apnea

    [2] :
    J Clin Sleep Med. 2010 Dec 15;6(6):529-38.
    Treatment of positive airway pressure
    treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
    Gilmartin G, McGeehan B, Vigneault K,
    Daly RW, Manento M, Weiss JW, Thomas RJ.
    Source: Division of Pulmonary, Critical
    Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

    [3] :
    Philip N. Ainslie and James Duffin,
    Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation Published online before print February 11, 2009, doi: 10.​1152/​ajpregu.​91008.​2008 AJP - Regu Physiol May 2009 vol. 296 no. 5 R1473-R1495