Thomas Neylan, MD, wants to help Veterans sleep better. “For all too many people who have served in combat, disturbed sleep is the dominant symptom,” says Dr. Neylan, who directs the PTSD clinical and research programs at SFVAMC. The cause, he says, is hyperarousal, “when you’re unable to switch off the brain at night and get restorative sleep.”
The consequences of chronically disturbed sleep are extremely serious, notes Dr. Neylan, who is also a UCSF Professor in Residence of Psychiatry. “People with chronic sleep problems have a harder time regulating their emotions during the day and can be more irritable. They often feel distractible and may have difficulty with tasks that are cognitively challenging,” he says. There are physical effects as well, including higher rates of obesity, diabetes, and cardiovascular disease. Plus, “We know from the work of Dr. Kristine Yaffe here at SFVAMC that Veterans with PTSD have a higher risk of dementia. There is evidence that chronic sleep problems could contribute to this risk."
Specific treatments for PTSD often improve sleep, says Dr. Neylan – but unfortunately, even after successful treatment, there is a high rate of residual insomnia. To address that problem, Dr. Neylan and his colleagues are finishing a study of behavior therapy for insomnia, “and our preliminary data is really quite promising – people sleep much better with this treatment.”
In the realm of potential new pharmacological treatments, Dr. Neylan is studying two peptides: hypocretin, which is involved in normal sleep/wake regulation, and corticotropin releasing factor (CRF), which plays a role in stress-associated hyperarousal. His team is conducting a study with a hypocretin antagonist, “and we are about to start a trial with a CRF antagonist, to see if this will help people sleep better and have general improvement in their PTSD symptoms.”
While existing evidence-based treatments for PTSD are good, says Dr. Neylan, “there is so much more to be done. Fortunately, here at SFVAMC, we have a great research environment and an incredible team of talented investigators. One of the things that we can contribute to the VA is to develop new treatments.”
Dr. Neylan’s hope is that within a decade, “we will not only have more tools in the treatment toolbox, but we will have a better way of matching the individual to the specific treatment that they may need – tailoring the clinical treatment to the person.”