Publication year
2015
Citation Title
Sleep variability in military-related PTSD: A comparison to primary insomnia and health controls.
Journal Name
Journal of Traumatic Stress
Journal Volume
28
Issue Number
1
Page Numbers
8-16
DOI
10.1002/jts.21982
Summary
There were 45 Operation Enduring Freedom, Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans seeking treatment for posttraumatic stress disorder (PTSD) and sleep problems that were compared to 25 patients with primary insomnia and 27 healthy controls to examine differences in sleep patterns. Sleep symptoms in Veterans with PTSD were more variable across nights and less consistent across patients relative to sleep symptoms in insomnia patients without PTSD.
Key Findings
Veterans with PTSD had more sleep complaints, worse sleep quality, and greater night to night inconsistency than comparison individuals.
Veterans with PTSD had more insomnia symptoms and lower sleep efficiency than patients with primary insomnia.
Veterans with PTSD did not differ in mean sleep scores from the primary insomnia group.
Implications for Program Leaders
Incorporate information in their curricula about ways to improve the quality of sleep for Service members with PTSD
Educate couples who have a history of trauma before deployment on positive coping skills
Offer classes that teach relaxation techniques to Service members and their families
Implications for Policy Makers
Recommend screening all returning Service members for insomnia
Continue to support programs that address the unique challenges faced by deployed Service members and their spouses
Promote reintegration programs that include attention to assisting Service members’ family in adjusting to the Service member’s return
Methods
Active Duty Service members and Veterans seeking care for PTSD and sleep problems were recruited.
Patients with primary insomnia and healthy controls were taken from separate studies to match the PTSD sample according to age.
Participants had a structured clinical interview for psychiatric diagnoses, completed sleep diaries, had formal sleep testing, and completed questionnaires.
Daily sleep assessments were compared among the three groups (PTSD, insomnia, controls).
Participants
Ninety-seven people participated (76% male).
Average age of the sample was 34 years (SD = 8.50 years).
Thirty-eight percent of participants were Veterans, 5% were Active Duty, and 3% were Reserves.
Racial/ethnic composition of the sample is as follows: 70% were White, 15% were Black, and 6% were Asian American. Education level of the sample was 49% with college or higher, 33% with some college, and 17% were high school graduates.
Limitations
The two groups of patients were not matched on several key variables (e.g., education, race) which may have biased results.
The study was correlational and causal conclusions cannot be drawn.
The groups were not of equal size which may have impacted the results.
Avenues for Future Research
Assess both intra- and inter-individual variability in sleep across the course of a study
Examine the effectiveness of treatments for insomnia, comparing PTSD and insomnia groups among Service members
Explore the role of physical activity and exercise in sleep among Service members with PTSD
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Sleep disturbances are prevalent in posttraumatic stress disorder (PTSD) and are associated with a number of adverse health consequences. Few studies have used comprehensive assessment methods to characterize sleep in Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OEF/OIF/OND) veterans with PTSD. OEF/OIF/OND veterans with PTSD and sleep disturbance (n = 45) were compared to patients with primary insomnia (n = 25) and healthy control subjects (n = 27). Participants were assessed using questionnaire-based measures as well as daily subjective and objective measures of sleep. The 3 groups were compared with regard to (a) group means, (b) intraindividual (i.e., night-to-night) variability of sleep, and (c) interindividual (i.e., within-group) variability of sleep. In terms of group means, only objective sleep efficiency was significantly worse with PTSD than with primary insomnia (d = 0.54). Those with PTSD differed from those with primary insomnia on measures of intraindividual as well as interindividual variability (d = 0.48–0.73). These results suggested sleep symptoms in OEF/OIF/OND veterans with PTSD are more variable across nights and less consistent across patients relative to sleep symptoms in insomnia patients without PTSD. These findings have implications for research, as well as for personalizing treatment for individuals with PTSD.
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