New research published in the Journal of Clinical Sleep Medicine suggests that the COVID-19 pandemic can trigger the re-emergence of traumatic dreams among patients previously in remission from PTSD.
As the novel coronavirus made its way around the globe, citizens in many cities and countries were asked to remain home and practice social distancing. In Ontario, Canada, a state of emergency was declared on March 17, involving a shut down of virtually all non-essential services in order to prioritize medical care.
Study author Madhulika A. Gupta, shares that outpatient “non-urgent” psychiatric care at her Ontario practice was limited to phone or video consultations during this time. She shares patient reports that describe sleep disturbances and suggest the provocation of PTSD symptoms during the COVID-19 pandemic.
Reports were collected from the first 20 “non-urgent” phone calls made between March 25 to April 8, from patients with a primary PTSD diagnosis. For 6 months to a year before the pandemic, the group had overall scores below 20 on the PTSD Checklist for DSM-5, classifying these patients as in remission. The sample included 3 men and 17 women between the ages of 25-64 with no known diagnosis of COVID-19. Four patients were working as health care providers in long-term care facilities and 4 were police or army veterans.
The patient reports revealed significant sleep disturbances in recent times. As Gupta describes, more than half of her patients (55%) expressed recent trouble falling asleep and 70% reported waking up several times a night, sometimes as a result of troubling dreams.
Another 80% described disturbing dreams or nightmares that did not appear to be overtly related to the pandemic. Additionally, more than half (56%) of patients who recalled their dreams expressed that the dreams “involved trauma that was ‘deeply buried’ and ‘very upsetting’ eg. Involved childhood sexual abuse.” Past trauma was not obviously linked to COVID-19. Gupta shares, “the only common theme that was identified by patients between their past traumas and COVID-19 experience was ‘a feeling of not being in control’.”
Finally, Gupta expresses that half of the patients who described perturbing dreams (8/16 patients) were taking prazosin before COVID-19 as part of their medical regimen to treat their nightmares. Of these patients, two were working in health care and had upped their prazosin dosage by 2 mgs, which reduced the vigor of their nightmares. “Both patients,” Gupta stresses, “noted that if they had not been able to manage their nightmares with prazosin since the state of emergency had been announced, they would have experienced a full relapse of their PTSD.”
Gupta asserts that although her patients’ dreams were not overtly related to the pandemic, the content was “consistent with the re-emergence of traumatic dreams related to earlier traumas in PTSD patients during times of change and transient stress” and “may be an early and more subtle sign of sympathetic activation and arousal modulation in PTSD.”
Given that these disturbing dreams were present in patients in PTSD remission, the author suggests that the findings may indicate the early provocation of PTSD symptoms and may offer guidance for “primary or secondary prevention of PTSD, eg, for the COVID-19 workers who may be at risk for developing PTSD.”
The study, “Spontaneous reporting of onset of disturbing dreams and nightmares related to early life traumatic experiences during the COVID-19 pandemic by patients with posttraumatic stress disorder in remission”, was authored by Madhulika A. Gupta.
