Posttraumatic stress and sleep: Differential relations across types of symptoms and sleep problems

doi:10.1016/j.janxdis.2011.03.007

Journal of Anxiety Disorders

Volume 25, Issue 5, June 2011, Pages 706-713

https://doi.org/10.1016/j.janxdis.2011.03.007 Get rights and content

Abstract

Posttraumatic stress symptoms and self-reported sleep problems reliably covary. The current study investigated how posttraumatic stress symptom clusters (i.e., hyperarousal, avoidance, and reexperiencing) relate to trouble initiating and maintaining sleep and nightmares. Participants included traumatic event-exposed respondents from the NCS-R. Results suggested that posttraumatic stress symptom severity is related to trouble initiating and maintaining sleep and nightmares. Investigation of symptom clusters indicated that reexperiencing symptoms were related to trouble initiating and maintaining sleep and nightmares, while hyperarousal symptoms were related to trouble maintaining sleep and nightmares. Findings partially support both reexperiencing and hyperarousal-based models of the relation between sleep and posttraumatic stress.

Highlights

► Results indicated total posttraumatic stress symptom severity related to difficulty initiating and maintaining sleep and nightmares. ► Reexperiencing symptoms were related to difficulty initiating and maintaining sleep, and nightmares. ► Hyperarousal symptoms were related to difficulty maintaining sleep and nightmares.

Section snippets

Method

The sample for the current study was drawn from the National Comorbidity Survey-Replication (NCS-R), a nationally representative epidemiological study designed to assess the prevalence and correlates of a number of psychiatric disorders. Detailed descriptions of methods, weighting, and sampling procedures have been described elsewhere (Kessler et al., 2004). Due to the focus on traumatic event exposure, we selected specific cases from the broader data set. This specialized sampling reduced the

Zero-order relations

Table 2 lists phi and point biserial zero-order relations that were examined among all of the primary variables.

Symptom severity

Three sets of hierarchical logistic regression analyses were used to test the main study hypotheses (see Table 3, Table 4, Table 5). The first analysis examined the unique relation of total posttraumatic stress symptom severity with the likelihood that respondents would report sleep onset difficulties, sleep maintenance difficulties, and nightmares, after statistically controlling for

Discussion

Research has demonstrated a link between posttraumatic stress symptoms and self-reported sleep problems (Ohayon & Shapiro, 2000). However, no study has investigated how specific sleep problems may be related to specific clusters of posttraumatic stress symptoms. The current study aimed to fill this gap by testing nine specific hypotheses and three exploratory hypotheses. Consistent with the first three hypotheses, results suggest a positive association between global posttraumatic stress

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claimed that patients with PTSD reporting higher level of hyperarousal would experience more sleep dysfunction compared to those reporting less hyperarousal. Specifically, hyperarousal symptoms were associated with difficulties in maintaining sleep and nightmares (Babson et al., 2011). Third, the prominent connection between sleep dysfunction and concentration difficulties was also in line with the dysphoric arousal cluster in the DSM-5 Seven-Factor Hybrid Model (Armour et al., 2015).
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Posttraumatic stress and sleep: Differential relations across types of symptoms and sleep problems

Abstract

Highlights

Section snippets

Method

Zero-order relations

Symptom severity

Discussion

Biological Psychiatry

Behaviour Research and Therapy

Behavior Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Clinical Psychology Review

Sleep Medicine Reviews

Comprehensive Psychiatry

Sleep Medicine Reviews

Biological Psychiatry

Sleep Medicine Reviews

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

Nicotine dependence mediates the relations between insomnia and both panic and posttraumatic stress disorder in the NCS-R sample

Depression and Anxiety

Hyperarousal and insomnia: state of the science

Sleep Medicine Reviews

Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress

Behavioral Sleep Medicine

Treatment of residual insomnia after CBT for PTSD: case studies

Journal of Traumatic Stress

Insomnia causes, consequences, and therapeutics: an overview

Depression and Anxiety

Epidemiologic field methods in psychiatry: the NIMH epidemiologic catchment area program