Images of her mother's floating corpse invade one Katrina survivor's sleep.
Two weeks after hurricane Katrina ravaged the Gulf Coast, many people who
spent days awaiting rescue with no food or water in flooded attics or on
rooftops or overpasses, or huddling in stifling, fetid, crowded, rowdy
shelters, report struggling to sleep, distressing dreams, and frequent
While tattered sleep is only one of a long list of symptoms of acute stress
disorder, it's one that often responds quickly to hypnotic medications and
Normalization of sleep also can help people in crisis cope better with the
challenges of their waking lives, suggested Howard Roffwarg, M.D., a professor
of psychiatry and director of the Division of Sleep Medicine at the University
of Mississippi Medical Center in Jackson.
"Early treatment of acute stress disorder often prevents progression
to posttraumatic stress disorder," Roffwarg noted.
The city of Jackson, where 80-mph winds downed trees and disrupted power
but did not cause flooding, provided shelter in its coliseum for about 1,300
evacuees from the 90-mile stretch of Gulf Coast that took the brunt of the
storm. The University of Mississippi Medical Center set up ad hoc
multispecialty clinics in the trade mart adjacent to the coliseum.
Most of the people Roffwarg and colleagues saw in the first two weeks after
the hurricane had evacuated ahead of Katrina's landfall on August 29. They did
not face imminent danger from the flooding or witness injuries or deaths.
Still, Roffwarg said, most reported feeling stunned and anxious. Some didn't
know where relatives were or how friends had fared in the storm. Some knew
they had no home, possessions, or job to return to. As they narrated what had
happened to them, he said, they expressed great apprehension about having to
start their lives anew.
"I saw chins quivering and tears welling up," he reported. Most
of these people reported having much more trouble sleeping than usual.
Telling their story and receiving reassurance that their reactions were
normal brought some relief, Roffwarg said. He gave some people a prescription
for a two- to four-week course of a low-dose benzodiazepine with both sedative
and antianxiety effects, such as alprazolam, lorazepam, or clonazepam.
Most of these individuals had no history of psychiatric disorders or abuse
of alcohol or drugs. None reported feeling suicidal. Development of tolerance
to and dependence on the prescribed short-term medications is unlikely in this
population, Roffwarg said. Nevertheless, he advised those who received
prescriptions to return for follow-up to the medical center's regular
psychiatry clinic or see another physician if they relocated elsewhere, he
"Their life circumstances are not going to improve
immediately," Roffwarg said.
Many responders to the crisis—physicians and other medical personnel,
police and other community workers, telephone and power company employees,
relief organization staff and volunteers, and ordinary citizens—worked
nearly nonstop to provide help. They typically grabbed a little sleep at odd
hours, in buildings such as schools or churches, if they could, but often on
the open ground, in cars, or other dicey spots.
Physicians from New Orleans' Charity Hospital slept in red,
infectious-waste bags on the roof of the adjacent Tulane University Hospital
parking garage, using stacks of diapers for pillows, while security guards and
a Marine sniper watched out for marauders below, according to a report in the
New York Times.
Marcus Franklin, a staff writer for the St. Petersburg Times in
Florida, was shot and wounded in an attempted robbery while covering Katrina's
aftermath in Baton Rouge, La. Franklin blamed four days of sleep deprivation
for his lowered vigilance to his surroundings.
Assuring that rescue and relief workers get enough sleep to maintain their
alertness and decision-making skills is crucial to successful management of
catastrophic events, said Jerome Barrett, executive director of the American
Academy of Sleep Medicine (AASM), based in Westchester, Ill. The AASM issued
public service announcements urging responders to schedule periodic naps to
avoid extreme fatigue.FIG1
About 40 sleep disorder centers are located in the
Louisiana-Mississippi-Alabama southern-rim areas worst hit by Katrina. Spotty
phone and power service two weeks after the storm left assessment of damage to
these centers incomplete.
The AASM created a hurricane disaster relief fund to help repair damaged
sleep centers and sleep specialty practices, and plans to disperse all of the
contributions received as grants starting in October, Barrett reported. It
also is coordinating donations of therapeutic equipment from manufacturers and
other sleep centers, including continuous positive airway pressure devices
needed by patients with sleep apnea.
More information on the AASM's huricane disaster relief fund is
The National Sleep Foundation has posted tips to foster sleep in times of