Sleep disturbances and inflammatory markers in post-traumatic stress disorder: implications for balneological rehabilitation

Abstract

Sleep disturbances are among the most prevalent and clinically relevant symptoms of post-traumatic stress disorder (PTSD) and have been associated with neurobiological and inflammatory dysregulation. Alterations in sleep architecture, circadian rhythm disruption, and insomnia may contribute to heightened stress reactivity, impaired emotional regulation, and the persistence of trauma-related symptoms. Growing evidence suggests that inflammatory mediators, including interleukin-6 and other cytokines, as well as markers of oxidative stress, may be involved in the complex relationship between sleep dysfunction and neuropsychiatric symptom severity. From a balneological perspective, evidence derived predominantly from populations other than patients with PTSD suggests that spa-based interventions may influence sleep-related and psychophysiological outcomes; however, their efficacy in PTSD has not been established. Balneotherapy, hydrotherapy, thermal interventions, and structured spa-based programmes may potentially influence sleep regulation through thermoregulatory, autonomic, neuroendocrine, and inflammatory mechanisms. These mechanisms and their clinical relevance have not been sufficiently evaluated in PTSD-specific trials. Integrating balneological interventions with contemporary understanding of PTSD neurobiology may provide a conceptual framework for future investigation of personalised rehabilitation strategies in patients presenting with sleep disturbances and neuroimmune dysregulation. This narrative review highlights the potential, but as yet insufficiently established, role of balneological rehabilitation in PTSD and underscores the need for well-designed controlled studies evaluating sleep parameters, inflammatory biomarkers, clinical outcomes, and safety.