Use of an Intraoral Neuroprosthesis for the Treatment of Posttraumatic Stress Disorder (PTSD)-Associated Nocturnal Behavior Disorder: Case Series of Four Patients.

Abstract

There is a noted bidirectional relationship between sleep and posttraumatic stress disorder (PTSD), often associated with nocturnal behavior disorders contributing to sleep disturbances and impaired daytime functioning. Furthermore, disruptive nocturnal behavior (DNB) significantly impairs quality sleep among servicemembers and their sleep partners. Psychotherapy, pharmacotherapy, and alternative, integrative health interventions, such as meditation, are not particularly useful in achieving significant and durable remission of DNB. The use of oral dental appliances has demonstrated clinical success in the role of adjunctive management of sleep disorders. However, the use of these devices in managing the symptoms of mental health issues most often seen in this patient cohort has not been elucidated. This case series describes the attenuation of DNB while using a highly modified intraoral mandibular splint for the treatment of nightmares, sleep disruptions, and other sleep parasomnias associated with PTSD and PTSD / traumatic brain injury. Four Special Forces Veterans and Operators previously diagnosed with PTSD and experiencing disruptive nocturnal behaviors, including night terrors, and having failed first-line, traditional intervention, were included in this case series. A custom-designed, intraoral neuroprosthesis was used as the intervention. All four patients demonstrated a notable and significant reduction in DNB. Subjective assessments and observations indicated enhanced sleep quality and reduced PTSD-related nocturnal disturbances. Patients reported overall improvement in daytime functioning and reduction in PTSD symptom severity. These first-of-their-kind findings support the intraoral neuroprosthesis as a novel, innovative therapeutic approach for managing two pathologies simultaneously: sleep disturbances and DNB with PTSD. This device shows promise as a non-pharmacological intervention to enhance mission readiness and improve treatment compliance.